Dr Olarn's Blog

Swine ‘flu June 26, 2009

For the past few weeks I have seen many cases of ‘flu. No doubt some were the much talked about swine flu, H1N1 flu, 2009 flu, what ever the latest nomenclature is. A ‘flu bug, by any other name, would give you fever and headache.

Some sufferers (and/or parents thereof) are nonchalant about it, while others are all in a tizzy. The fact is that swine flu is not all that different from the normal seasonal flu. Some sources even say that the symptoms of swine flu are often less severe than seasonal flu. Swine flu kills, but so does normal flu, and not in any lesser number. For people usually in good health, flu is not too big of a deal, with rare exceptions. For the elderly and those already weakened by chronic illness, catching ‘flu can indeed be serious, which is why they invented the ‘flu vaccine.

Some FAQ’s I’ve had to field on this topic:

I/my child has fever/flu like symptoms, should I get a ‘flu test?

It is nice to precisely identify the cause of an illness, so if the symptoms are adequately ‘flu like a ‘flu test may be useful. Also, it will help in estimating how widespread a ‘flu outbreak is. It may not however affect the treatment as most cases of ‘flu only require supportive measures (taking fever medicines, drinking lots of fluids etc). It mayaffect treatment decision if you contemplate taking Tamiflu in the event of a positive result.

Depending on your health care coverage, the cost of testing may be an issue.

Should I specifically test for swine/H1N1 ‘flu?

Again for statistical purposes this would be a good thing, but again a positive swine flu test may not affect treatment decision. Just because you have swine ‘flu does not mean you must take Tamiflu or otherwise be treated any differently from normal ‘flu

Should I/my child be admitted to hospital if I’ve caught ‘flu?

Not every case of ‘flu needs in-patient treatment by any means. Only cases with severe symptoms or complications need to be admitted to hospital. If you need to stay in hospital, the doctor would advise you.

What is Tamiflu, should I take Tamiflu?

Tamiflu is an antiviral drug which can mitigate the symptoms of ‘flu. It has been shown to work in normal ‘flu, bird ‘flu, and swine ‘flu. It is largely safe to use. It is not however always effective. Widespread use of Tamiflu has been shown to increase the incidence of resistance to the drug. This means that widespread use may result in the drug becoming ineffective, and since Tamiflu is the only available specific ‘flu treatment, indiscriminate usage may result in having no available effective treatment for future ‘flu episodes.

Also, even when it is effective the results are often not dramatic, perhaps shortening the illness period by a day, or reducing fever by a little. Although safe the drug can cause nausea and vomiting, and there has been reports of psychological disturbance linked to the drug, which has resulted in suicidal behaviour in some young people in Japan. The decision whether or not to take Tamiflu should be discussed with your doctor. Don’t pressure him/her for a drug you don’t need. I hate it when that happens to me.

I hear that supplies of Tamiflu are running short, should I stock up on Tamiflu, in case I need it?

Stocking up on Tamiflu is an option in countries which have poor regulation of dispensation of drugs, like here in Thailand. Although you cannot exactly buy it over the counter, you can ask/wheedle/demand that your doctor prescribe you some, and this is what happened frequently during the bird ‘flu panic a few years ago. The result of this is that shortage of Tamiflu became a self-fulfilling prophecy. A large number of people held on to their stocks of Tamiflu until the expiry date, at which point the expensive, hard to get drug became useless garbage.

Should I/my child be vaccinated against ‘flu?

The ‘flu vaccine is highly recommended for the elderly, and for those who have pre-existing conditions which makes catching ‘flu a high-risk prospect. For those in good/normal health it is debatable how necessary the ‘flu vaccine is. Flu vaccines are about 70% effective in preventing seasonal ‘flu (and 0% effective in preventing bird flu or swine flu), and its effectiveness wears off after about a year, which means you would need annual ‘flu shots to maintain immunity. Yes ‘flu vaccine can prevent the rather unpleasant symptoms of ‘flu, reduce the risk of days off school or days off work, and the risk of being stopped at an airport for running a fever whilst travelling. On the other hand the idea of having vaccine shots every year is unappealing, and there has been reports of nasty neurological complications resulting from too many ‘flu vaccine shots.

This is as much as I’ve got time for, for now. Please keep in mind this here ain’t no CDC, my opinions are my own and if you want authoritative information about ‘flu, go to official government sites.