ANNOUNCEMENTS
for information related to
FLU CLINICS
DRUG RECALLS OR PUBLIC HEALTH WARNINGS
INFLUENZA
There is wide spread flu activity through out Massachusetts.
The most recent isolates have identified it as Influenza A H3N2. Although early reports indicated that this year's flu vaccine was a good match for the circulating strains, we are clearly seeing many cases in vaccinated individuals.
To date Tamiflu resistance has not been a problem, but it only "works" if taken within the first 24 - 48 hours of symptoms.
Symptoms of ANY flu include:
Signs to seek emergency care include:
Who's at higher risk from any kind of flu?
Management:
There is wide spread flu activity through out Massachusetts.
The most recent isolates have identified it as Influenza A H3N2. Although early reports indicated that this year's flu vaccine was a good match for the circulating strains, we are clearly seeing many cases in vaccinated individuals.
To date Tamiflu resistance has not been a problem, but it only "works" if taken within the first 24 - 48 hours of symptoms.
Symptoms of ANY flu include:
- fever of 100 degrees or more,
- cough,
- body chills and aches,
- congestion.
- Diarrhea and vomiting sometimes occur, particularly with the swine or H1N1 flu.
Signs to seek emergency care include:
- shortness of breath,
- chest pain or pressure,
- confusion or seizures,
- persistent vomiting or inability to hold down liquids,
- bluish lips.
Who's at higher risk from any kind of flu?
- Pregnant women
- people of any age with heart disease, asthma, diabetes and other chronic illnesses
- children under 2
- people over 65.
Management:
- Stay at home and rest
- Drink lots of fluids, but try to avoid a lot of milk as it tends to promote congestion.
- Take two Tylenol/acetaminophen and alternate it every 4 hours with two Advil/ibuprofen, so that every 8 hours you take the same.
- Mucinex DM twice a day is helpful to breakup phlegm and supress the cough.
- Lozenges are fine for the sore throat.
- Avoid contact with others (kissing, shaking hands) and try not to cough in anyone's face.
- Use tissues and dispose of them in a garbage container.
- There is no need to come to the office or go to the ER unless you have any of the signs or symptoms listed above that would require urgent medical attention.
- You need to be patient as it can drag on.
- You can go back to work 24 hours AFTER you have stopped running a fever (off Tylenol/ibuprofen)
Flu Widespread, Leading a Range of Winter’s Ills
By Donald G. McNeil Jr and Katharine Q. Seelye : NY Times : January 9, 2013
It is not your imagination — more people you know are sick this winter, even people who have had flu shots.
The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus, a surge in a new type of norovirus, and the worst whooping cough outbreak in 60 years. And these are all developing amid the normal winter highs for the many viruses that cause symptoms on the “colds and flu” spectrum.
Influenza is widespread, and causing local crises. On Wednesday, Boston’s mayor declared a public health emergency as cases flooded hospital emergency rooms.
Google’s national flu trend maps, which track flu-related searches, are almost solid red (for “intense activity”) and the Centers for Disease Control and Prevention’s weekly FluView maps, which track confirmed cases, are nearly solid brown (for “widespread activity”).
“Yesterday, I saw a construction worker, a big strong guy in his Carhartts who looked like he could fall off a roof without noticing it,” said Dr. Beth Zeeman, an emergency room doctor for MetroWest Medical Center in Framingham, Mass., just outside Boston. “He was in a fetal position with fever and chills, like a wet rag. When I see one of those cases, I just tighten up my mask a little.”
Massachusetts General Hospital in Boston started asking visitors with even mild cold symptoms to wear masks and to avoid maternity wards. The hospital has treated 532 confirmed influenza patients this season and admitted 167, even more than it did by this date during the 2009-10 swine flu pandemic.
At Brigham and Women’s Hospital, 100 patients were crowded into spaces licensed for 53. Beds lined halls and pressed against vending machines. Overflow patients sat on benches in the lobby wearing surgical masks.
“Today was the first time I think I was experiencing my first pandemic,” said Heidi Crim, the nursing director, who saw both the swine flu and SARS outbreaks here. Adding to the problem, she said, many staff members were at home sick and supplies like flu test swabs were running out.
Nationally, deaths and hospitalizations are still below epidemic thresholds. But experts do not expect that to remain true. Pneumonia usually shows up in national statistics only a week or two after emergency rooms report surges in cases, and deaths start rising a week or two after that, said Dr. Gregory A. Poland, a vaccine specialist at the Mayo Clinic in Minnesota. The predominant flu strain circulating is an H3N2, which typically kills more people than the H1N1 strains that usually predominate; the relatively lethal 2003-4 “Fujian flu” season was overwhelmingly H3N2.
No cases have been resistant to Tamiflu, which can ease symptoms if taken within 48 hours, and this year’s flu shot is well-matched to the H3N2 strain, the C.D.C. said. Flu shots are imperfect, especially in the elderly, whose immune systems may not be strong enough to produce enough antibodies.
Simultaneously, the country is seeing a large and early outbreak of norovirus, the “cruise ship flu” or “stomach flu,” said Dr. Aron J. Hall of the C.D.C.’s viral gastroenterology branch. It includes a new strain, which first appeared in Australia and is known as the Sydney 2012 variant.
This week, Maine’s health department said that state was seeing a large spike in cases. Cities across Canada reported norovirus outbreaks so serious that hospitals were shutting down whole wards for disinfection because patients were getting infected after moving into the rooms of those who had just recovered. The classic symptoms of norovirus are “explosive” diarrhea and “projectile” vomiting, which can send infectious particles flying yards away.
“I also saw a woman I’m sure had norovirus,” Dr. Zeeman said. “She said she’d gone to the bathroom 14 times at home and 4 times since she came into the E.R. You can get dehydrated really quickly that way.”
This month, the C.D.C. said the United States was having its biggest outbreak of pertussis in 60 years; there were about 42,000 confirmed cases, the highest total since 1955. The disease is unrelated to flu but causes a hacking, constant cough and breathlessness. While it is unpleasant, adults almost always survive; the greatest danger is to infants, especially premature ones with undeveloped lungs. Of the 18 recorded deaths in 2012, all but three were of infants under age 1.
That outbreak is worst in cold-weather states, including Colorado, Washington, Wisconsin, Minnesota and Vermont.
Although most children are vaccinated several times against pertussis, those shots wear off with age. It is possible, the authorities said, that a new, safer vaccine introduced in the 1990s gives protection that does not last as long, so more teenagers and adults are vulnerable.
And, Dr. Poland said, if many New Yorkers are catching laryngitis, as has been reported, it is probably a rhinovirus. “It’s typically a sore, really scratchy throat, and you sometimes lose your voice,” he said.
Though flu cases in New York City are rising rapidly, the city health department has no plans to declare an emergency, largely because of concern that doing so would drive mildly sick people to emergency rooms, said Dr. Jay K. Varma, deputy director for disease control. The city would prefer people went to private doctors or, if still healthy, to pharmacies for flu shots. Nursing homes have had worrisome outbreaks, he said, and nine elderly patients have died. Homes need to be more alert, vaccinate patients, separate those who fall ill and treat them faster with antivirals, he said.
Dr. Susan I. Gerber of the C.D.C.’s respiratory diseases branch, said her agency has not seen any unusual spike of rhinovirus, parainfluenza, adenovirus, coronavirus or the dozens of other causes of the “common cold,” but the country is having its typical winter surge of some, like respiratory syncytial virus “that can mimic flulike symptoms, especially in young children.”
The C.D.C. and the local health authorities continue to advocate getting flu shots. Although it takes up to two weeks to build immunity, “we don’t know if the season has peaked yet,” said Dr. Joseph Bresee, chief of prevention in the agency’s flu division.
Flu shots and nasal mists contain vaccines against three strains, the H3N2, the H1N1 and a B. Thus far this season, Dr. Bresee said, H1N1 cases have been rare, and the H3N2 component has been a good match against almost all the confirmed H3N2 samples the agency has tested.
About a fifth of all flus this year thus far are from B strains. That part of the vaccine is a good match only 70 percent of the time, because two B’s are circulating.
For that reason, he said, flu shots are being reformulated. Within two years, they said, most will contain vaccines against both B strains.
Joanna Constantine, 28, a stylist at the Guy Thomas Hair Salon on West 56th Street in Manhattan, said she recently was so sick that she was off work and in bed for five days — and silenced by laryngitis for four of them.
She did not have the classic flu symptoms — a high fever, aches and chills — so she knew it was probably something else.
Still, she said, it scared her enough that she will get a flu shot next year. She had not bothered to get one since her last pregnancy, she said. But she has a 7-year-old son and a 5-year-old daughter, “and my little guys get theirs every year.”
By Donald G. McNeil Jr and Katharine Q. Seelye : NY Times : January 9, 2013
It is not your imagination — more people you know are sick this winter, even people who have had flu shots.
The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus, a surge in a new type of norovirus, and the worst whooping cough outbreak in 60 years. And these are all developing amid the normal winter highs for the many viruses that cause symptoms on the “colds and flu” spectrum.
Influenza is widespread, and causing local crises. On Wednesday, Boston’s mayor declared a public health emergency as cases flooded hospital emergency rooms.
Google’s national flu trend maps, which track flu-related searches, are almost solid red (for “intense activity”) and the Centers for Disease Control and Prevention’s weekly FluView maps, which track confirmed cases, are nearly solid brown (for “widespread activity”).
“Yesterday, I saw a construction worker, a big strong guy in his Carhartts who looked like he could fall off a roof without noticing it,” said Dr. Beth Zeeman, an emergency room doctor for MetroWest Medical Center in Framingham, Mass., just outside Boston. “He was in a fetal position with fever and chills, like a wet rag. When I see one of those cases, I just tighten up my mask a little.”
Massachusetts General Hospital in Boston started asking visitors with even mild cold symptoms to wear masks and to avoid maternity wards. The hospital has treated 532 confirmed influenza patients this season and admitted 167, even more than it did by this date during the 2009-10 swine flu pandemic.
At Brigham and Women’s Hospital, 100 patients were crowded into spaces licensed for 53. Beds lined halls and pressed against vending machines. Overflow patients sat on benches in the lobby wearing surgical masks.
“Today was the first time I think I was experiencing my first pandemic,” said Heidi Crim, the nursing director, who saw both the swine flu and SARS outbreaks here. Adding to the problem, she said, many staff members were at home sick and supplies like flu test swabs were running out.
Nationally, deaths and hospitalizations are still below epidemic thresholds. But experts do not expect that to remain true. Pneumonia usually shows up in national statistics only a week or two after emergency rooms report surges in cases, and deaths start rising a week or two after that, said Dr. Gregory A. Poland, a vaccine specialist at the Mayo Clinic in Minnesota. The predominant flu strain circulating is an H3N2, which typically kills more people than the H1N1 strains that usually predominate; the relatively lethal 2003-4 “Fujian flu” season was overwhelmingly H3N2.
No cases have been resistant to Tamiflu, which can ease symptoms if taken within 48 hours, and this year’s flu shot is well-matched to the H3N2 strain, the C.D.C. said. Flu shots are imperfect, especially in the elderly, whose immune systems may not be strong enough to produce enough antibodies.
Simultaneously, the country is seeing a large and early outbreak of norovirus, the “cruise ship flu” or “stomach flu,” said Dr. Aron J. Hall of the C.D.C.’s viral gastroenterology branch. It includes a new strain, which first appeared in Australia and is known as the Sydney 2012 variant.
This week, Maine’s health department said that state was seeing a large spike in cases. Cities across Canada reported norovirus outbreaks so serious that hospitals were shutting down whole wards for disinfection because patients were getting infected after moving into the rooms of those who had just recovered. The classic symptoms of norovirus are “explosive” diarrhea and “projectile” vomiting, which can send infectious particles flying yards away.
“I also saw a woman I’m sure had norovirus,” Dr. Zeeman said. “She said she’d gone to the bathroom 14 times at home and 4 times since she came into the E.R. You can get dehydrated really quickly that way.”
This month, the C.D.C. said the United States was having its biggest outbreak of pertussis in 60 years; there were about 42,000 confirmed cases, the highest total since 1955. The disease is unrelated to flu but causes a hacking, constant cough and breathlessness. While it is unpleasant, adults almost always survive; the greatest danger is to infants, especially premature ones with undeveloped lungs. Of the 18 recorded deaths in 2012, all but three were of infants under age 1.
That outbreak is worst in cold-weather states, including Colorado, Washington, Wisconsin, Minnesota and Vermont.
Although most children are vaccinated several times against pertussis, those shots wear off with age. It is possible, the authorities said, that a new, safer vaccine introduced in the 1990s gives protection that does not last as long, so more teenagers and adults are vulnerable.
And, Dr. Poland said, if many New Yorkers are catching laryngitis, as has been reported, it is probably a rhinovirus. “It’s typically a sore, really scratchy throat, and you sometimes lose your voice,” he said.
Though flu cases in New York City are rising rapidly, the city health department has no plans to declare an emergency, largely because of concern that doing so would drive mildly sick people to emergency rooms, said Dr. Jay K. Varma, deputy director for disease control. The city would prefer people went to private doctors or, if still healthy, to pharmacies for flu shots. Nursing homes have had worrisome outbreaks, he said, and nine elderly patients have died. Homes need to be more alert, vaccinate patients, separate those who fall ill and treat them faster with antivirals, he said.
Dr. Susan I. Gerber of the C.D.C.’s respiratory diseases branch, said her agency has not seen any unusual spike of rhinovirus, parainfluenza, adenovirus, coronavirus or the dozens of other causes of the “common cold,” but the country is having its typical winter surge of some, like respiratory syncytial virus “that can mimic flulike symptoms, especially in young children.”
The C.D.C. and the local health authorities continue to advocate getting flu shots. Although it takes up to two weeks to build immunity, “we don’t know if the season has peaked yet,” said Dr. Joseph Bresee, chief of prevention in the agency’s flu division.
Flu shots and nasal mists contain vaccines against three strains, the H3N2, the H1N1 and a B. Thus far this season, Dr. Bresee said, H1N1 cases have been rare, and the H3N2 component has been a good match against almost all the confirmed H3N2 samples the agency has tested.
About a fifth of all flus this year thus far are from B strains. That part of the vaccine is a good match only 70 percent of the time, because two B’s are circulating.
For that reason, he said, flu shots are being reformulated. Within two years, they said, most will contain vaccines against both B strains.
Joanna Constantine, 28, a stylist at the Guy Thomas Hair Salon on West 56th Street in Manhattan, said she recently was so sick that she was off work and in bed for five days — and silenced by laryngitis for four of them.
She did not have the classic flu symptoms — a high fever, aches and chills — so she knew it was probably something else.
Still, she said, it scared her enough that she will get a flu shot next year. She had not bothered to get one since her last pregnancy, she said. But she has a 7-year-old son and a 5-year-old daughter, “and my little guys get theirs every year.”
Do I still need a flu shot if I’ve already had the flu?
First, how do you know you had the flu? There are more than 100 viruses that can cause “colds and flu” symptoms — though a bad flu is worse than most of them. Doctors often describe it as “high fever, aches and the feeling that you’ve been hit by a truck.” The country is having an early flu season, plus a big wave of norovirus (sometimes called “stomach flu” or “winter vomiting flu”), plus its worst whooping cough outbreak in 50 years, plus the usual spate of winter colds. Unless a doctor took a nasal swab, you can’t be sure that what you had was flu — and unless it was sent on to a top state laboratory or to the Centers for Disease Control and Prevention lab for sequencing (which is not routine), even your doctor wouldn’t be able to say for sure exactly which flu virus it was.
Second, even if you had the flu, you presumably had only one strain, which you now have antibodies against. There are at least four strains circulating this year: H3N2, H1N1, and two different B strains. The flu shot contains vaccines against three of them (it only has one of the B’s). By next year, some flu shots will have four vaccines. So a shot would still offer protection against flus you have not had. I suppose your chances of getting flu twice in one season aren’t huge — but some people just get unlucky. And if you have any reason to particularly fear flu, like a depressed immune system, serious obesity or diabetes, or if you are pregnant, you should definitely talk to a medical professional about this.
First, how do you know you had the flu? There are more than 100 viruses that can cause “colds and flu” symptoms — though a bad flu is worse than most of them. Doctors often describe it as “high fever, aches and the feeling that you’ve been hit by a truck.” The country is having an early flu season, plus a big wave of norovirus (sometimes called “stomach flu” or “winter vomiting flu”), plus its worst whooping cough outbreak in 50 years, plus the usual spate of winter colds. Unless a doctor took a nasal swab, you can’t be sure that what you had was flu — and unless it was sent on to a top state laboratory or to the Centers for Disease Control and Prevention lab for sequencing (which is not routine), even your doctor wouldn’t be able to say for sure exactly which flu virus it was.
Second, even if you had the flu, you presumably had only one strain, which you now have antibodies against. There are at least four strains circulating this year: H3N2, H1N1, and two different B strains. The flu shot contains vaccines against three of them (it only has one of the B’s). By next year, some flu shots will have four vaccines. So a shot would still offer protection against flus you have not had. I suppose your chances of getting flu twice in one season aren’t huge — but some people just get unlucky. And if you have any reason to particularly fear flu, like a depressed immune system, serious obesity or diabetes, or if you are pregnant, you should definitely talk to a medical professional about this.
MORE GOOD NEWS ABOUT TAKING A DAILY DOSE OF ASPIRIN...........
IF YOU CAN TOLERATE IT.
Researchers at the University of Oxford found that after three years of daily aspirin use, the risk of developing cancer was reduced by almost 25 percent when compared with a control group not taking aspirin. After five years, the risk of dying of cancer was reduced by 37 percent among those taking aspirin.
A second paper that analyzed five large randomized controlled studies in Britain found that over six and a half years on average, daily aspirin use reduced the risk of metastatic cancer by 36 percent and the risk of adenocarcinomas — common solid cancers including colon, lung and prostate cancer — by 46 percent.
Daily aspirin use also reduced the risk of progressing to metastatic disease, particularly in patients with colorectal cancer, the studies reported.
Norovirus is acquired by ingesting material contaminated with small amounts of infected feces or fluids. Food and water may be contaminated during processing as well.
The symptoms of norovirus illness usually include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people also have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness.
The illness often begins suddenly and the infected person may feel very sick. In general, diarrhea is more common in children and vomiting is more common in adults. Noroviruses very readily spread from person to person through contaminated food or water, and by touching contaminated surfaces.
The illness lasts for about one or two days. People with norovirus illness are contagious from the moment they begin feeling sick until at least three days after they recover.
It is recommended that anyone who develops diarrhea and/or repeated vomiting should remain out of work until at least 48 hours after symptoms resolve.
There is no specific medication to treat norovirus, but infected people should drink plenty of liquids to replace fluid lost through vomiting and diarrhea. Dehydration can occur rapidly and may require medical treatment or hospitalization.
The best course of action is prevention. The use of soap-and-water hand washing during and after such illness followed by the use of an alcohol hand gel is highly encouraged.
The symptoms of norovirus illness usually include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people also have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness.
The illness often begins suddenly and the infected person may feel very sick. In general, diarrhea is more common in children and vomiting is more common in adults. Noroviruses very readily spread from person to person through contaminated food or water, and by touching contaminated surfaces.
The illness lasts for about one or two days. People with norovirus illness are contagious from the moment they begin feeling sick until at least three days after they recover.
It is recommended that anyone who develops diarrhea and/or repeated vomiting should remain out of work until at least 48 hours after symptoms resolve.
There is no specific medication to treat norovirus, but infected people should drink plenty of liquids to replace fluid lost through vomiting and diarrhea. Dehydration can occur rapidly and may require medical treatment or hospitalization.
The best course of action is prevention. The use of soap-and-water hand washing during and after such illness followed by the use of an alcohol hand gel is highly encouraged.
Really? The Claim:
Hand Sanitizer Stops Norovirus Spread
By Anahad )'Connor : NY Times : January 14, 2013
THE FACTS
As public health officials struggle to contain a series of viral outbreaks this winter, many people are reaching for bottles of hand sanitizer.
Studies show that alcohol-based sanitizers, particularly those with 60 percent ethanol or more, can reduce microbial counts on contaminated hands and reduce the spread of some strains of the flu. But against norovirus, the severe gastrointestinal illness gripping many parts of the country, they may be useless.
Some viruses, like influenza, are coated in lipids, "envelopes" that alcohol can rupture. But non-enveloped viruses, like norovirus, are generally not affected.
Bleach is effective against norovirus, and can be used to decontaminate countertops and surfaces. And for people, the best strategy may be washing hands with plain old soap and water.
In 2011, the Centers for Disease Control and Prevention studied 91 long-term care facilities. During the winter of 2006-07, they identified 73 outbreaks, 29 of which were confirmed to be norovirus.
The facilities where staff members used alcohol-based sanitizers, were six times more likely to have an outbreak of norovirus than the facilities where the staff preferred using soap and water.
The C.D.C. says that as a means of preventing norovirus infection, alcohol-based sanitizers can be used "in addition" to hand washing, never as a substitute.
THE BOTTOM LINE
Hand sanitizers can reduce the spread of some viruses, like the flu. But against norovirus they are largely ineffective; better to use soap and water.
Hand Sanitizer Stops Norovirus Spread
By Anahad )'Connor : NY Times : January 14, 2013
THE FACTS
As public health officials struggle to contain a series of viral outbreaks this winter, many people are reaching for bottles of hand sanitizer.
Studies show that alcohol-based sanitizers, particularly those with 60 percent ethanol or more, can reduce microbial counts on contaminated hands and reduce the spread of some strains of the flu. But against norovirus, the severe gastrointestinal illness gripping many parts of the country, they may be useless.
Some viruses, like influenza, are coated in lipids, "envelopes" that alcohol can rupture. But non-enveloped viruses, like norovirus, are generally not affected.
Bleach is effective against norovirus, and can be used to decontaminate countertops and surfaces. And for people, the best strategy may be washing hands with plain old soap and water.
In 2011, the Centers for Disease Control and Prevention studied 91 long-term care facilities. During the winter of 2006-07, they identified 73 outbreaks, 29 of which were confirmed to be norovirus.
The facilities where staff members used alcohol-based sanitizers, were six times more likely to have an outbreak of norovirus than the facilities where the staff preferred using soap and water.
The C.D.C. says that as a means of preventing norovirus infection, alcohol-based sanitizers can be used "in addition" to hand washing, never as a substitute.
THE BOTTOM LINE
Hand sanitizers can reduce the spread of some viruses, like the flu. But against norovirus they are largely ineffective; better to use soap and water.
