|H1N1 is back – What do we know and what can we do?
The Influenza A H1N1 flu virus is back in full force, and while the panic doesn’t seem as widespread as it was in 2009, there is still cause for concern. The currently circulating pH1N1 virus is a slight variation of the H1N1 virus that was circulating in 2009. To date during this 2013-2014 flu season in California, there have been 45 deaths, 2 of which have been pediatric. And while most of the deaths have been in patients who have had other health conditions that put them at higher risk for severe complications from influenza, some have been in otherwise apparently healthy people. However, we must still remember that less than half of those infected are predicted to have symptoms, and fortunately, most people will have a relatively mild illness. While there are certainly people who are getting very sick, the vast majority will not have an illness anywhere severe enough to even consider hospitalization.
Symptoms can range anywhere from mild cold-like symptoms, to high fevers, chills, sore throat, runny nose and cough, headache, body aches, and vomiting/diarrhea. The CDC notes that about 12% of those who have H1N1 do not have fever, and many have vomiting and/or diarrhea as the predominant symptoms. Patients who are more likely to be hospitalized are children and adults who have associated risks, especially asthma, chronic lung or heart disease, diabetes, pregnancy, and immunosuppression for whatever reason. The following populations are considered at highest risk for influenza complications:
- Children younger than 5 years and especially those younger than 2 years
- Adults older than 65 years
- Pregnant women
- Persons younger than 19 years who are receiving long-term aspirin therapy
- Persons with chronic lung, cardiovascular, neurologic, renal, hepatic, or metabolic disease, including diabetes
- Those with immunosuppression
At the moment, virtually all of the Influenza Type A we are seeing is the H1N1 strain. While many clinics and hospitals are not testing for H1N1 infection, one advantage to getting tested is that if you or your child test positive, you will know that you are subsequently protected against future H1N1 infections this season. The rapid flu test that can be performed in our office does not test specifically for H1N1, but if you test positive for Influenza Type A, we presume it is with H1N1 since that is currently the most prevalent circulating flu strain. The symptoms we are seeing in our patients have ranged from a mild cold to more severe flu-like symptoms complicated by pneumonia. While this is purely anecdotal, the patients who seem to be doing better with the illness are those that are already on good immune supports – see below for our suggested immune supports for the flu season.
What about the flu vaccine?
As you may be aware, the flu vaccine is made by trying to predict the 3 or 4 most prevalent flu strains that will be circulating the following year. Some years, none of the flu strains in the vaccine match the circulating flu strains. Other years, they have a better match. This year’s vaccine for the 2013-2014 flu season seems to be a good match with the circulating influenza A H1N1 virus and less prevalent influenza A H3N2 virus. We should have enough preservative-free vaccine for any child whose parent chooses to vaccinate. We also have a limited amount of preservative-free vaccine for adults.
Should you or your child get the flu vaccine? This is a tough question to answer, and a decision that only you can decide for yourself or your child. We do recommend that patients with lung/heart disease or other chronic illnesses receive the vaccination. Apart from that, the decision really needs to be made on an individual basis. The flu vaccine is contraindicated for patients with severe egg allergy or life-threatening reactions after previous flu vaccines. Precautions should be taken for those who have experienced Guillain-Barre syndrome after previous influenza vaccination, and I would also say in patients with a strong family history of other autoimmune or neurodegenerative illnesses.
Given that we know which influenza A H1N1 strain is prevalent, and this strain is in this year’s flu vaccine, we anticipate that the current flu vaccine should be effective in preventing H1N1 infection. However, it will only be effective if those people receiving the vaccine mount an appropriate immune response. While 97% of adults ages 18-64 years given the vaccine may show protective levels of antibody titers at 21 days after vaccination, the same isn’t necessarily true for children. At 10 days, the antibody response to the flu vaccine in kids is found to be much lower. The low response in children under 9 years of age accounts for the recommendation that children 6mos – 9 years who are receiving their first flu vaccine receive 2 doses of the flu vaccine approximately 1 month apart. After 2 doses, the antibody response has been found to be approximately 77%.
The decision to get the vaccine depends on what risks you as patients and parents are willing to take. While H1N1 infection tends to produce mild illness in most, it certainly can cause more serious and even life-threatening complications, especially for those populations considered at risk. On the other hand, no vaccine is 100% risk-free. It’s not an easy choice. Many patients have asked what I have done, and I feel that I should share with you my decision and my thought process. I did get the H1N1 vaccine myself, and did give it to my 2 children and husband. My decision to do so was based on many different factors. The first was that as a pediatrician, I have been and will be exposed to many kids with H1N1 infections – my priority is to be available for all of my patients and not miss any days due to illness, and also to not transmit H1N1 infection to my family, or to my patients and their families unintentionally. The second was that we do not have a major family history of neurologic illness including autism, autoimmune illness, or other chronic illness. The final factor is that we have been rigorous about eating a diet rich in antioxidants and taking supplements that support our family’s detoxification processes and immune system so that I have fewer concerns about having side effects from the vaccine.
What can I do to keep myself and my kids healthy?
Whether or not you decide to vaccinate yourself or your child, we believe it is of utmost importance to do as much as you can to keep you and your kids as healthy as possible. Even if you choose to vaccinate, it is important to remember that no vaccine is 100% effective, and taking action to optimize your and your family’s health is just as important. Many of my patients want to know what I do to stay healthy. And as I mentioned before, the patients who seem to be doing the best with H1N1 infection are those who are already taking good immune supports.
Commonsense measures to prevent cold/flu
Of course, there are several commonsense measures which most of you are likely already doing to prevent cold/flu. But just as a reminder:
Nutritional supplements to boost the immune system
- Wash those hands frequently, especially before eating or touching your face.
- Stay well-hydrated
- Eat lots of colorful fruits and vegetables. These are full of antioxidants which will destroy the free radicals that weaken our immune system.
- Drink your bone broth! Consult with our nutritionist, Kandice Stellmon, for fantastic bone broth recipes and usage ideas.
- Eat fermented foods. The probiotics contained in the foods have tremendous immune boosting power. In fact, the fermented Korean cabbage, kimchi, was found to have significant effects in preventing and fighting the H1N1 influenza virus!
- Avoid simple sugars and processed/junk food. Did you know that your blood shows lab evidence of a lowered immune system within 30 minutes of eating simple sugars (like glucose, refined sugar, and fructose), and causes a 50% reduction in your white blood cells' abilities to kill germs? This effect was most noticeable 2 hours after ingestion, but was still present 5 hours later! Maybe that’s why your child always seems to get sick after those birthday parties replete with birthday cake and juice or soda. Conversely, keeping blood sugar levels healthy has been shown to enhance immune system activity.
- Get fresh air and moderate daily exercise. Moderate exercise can boost the production of macrophages, the kind of white blood cells that “eat” bacteria and viruses. However, intense exercise can actually temporarily decrease immune function – so don’t overdo it!
- Get adequate sleep. An increase in sleep actually increases the number of your white blood cells. On the other hand, loss of sleep even for a few hours at night, increases inflammation in our body which makes us more susceptible to developing a cold or flu.
- Minimize stress. Emotional stress creates a physiological stress on our bodies that lowers our immune defenses and makes us more vulnerable to illness. Stress has been shown to lower our white blood cells' abilities to kill germs, and actually create more inflammation that may make us feel even sicker. No, it’s not just in your head!
Apart from these measures, there are a variety of nutritional supplements that can further boost the immune system and give your child’s body that extra defense to more effectively ward off and fight colds and flus. The dosages that I mention are only intended as general guides, and may vary according to each patient’s unique needs. We encourage you to make an appointment with one of our physicians to discuss an individualized immune support plan with specific dosage recommendations for you or your child:
What can you do if you or your child has a cold/flu?
- Fish oil - of course! While not specifically shown to prevent cold and flu, omega-3 essential fatty acids have a host of immune benefits too long to list!
- Probiotics – A study showed a drastic reduction in fever and upper respiratory symptoms in children who took a probiotic with a specific combination of Lactobacillus and Bifidobacterium daily throughout the cold and flu season. This combination is found in Metagenics Ultra Flora Plus. The recommended dosage for children and adults is ¼ tsp or 1 capsule 2x/day.
- Vitamin C - The studies looking at vitamin C for cold/flu prevention have mixed results, but the bottom line is that vitamin C is a powerful antioxidant which assists our ability to ward off and deal with infection. I have been using Metagenics Ultra-Potent C because it has added ingredients such as lysine and glutathione which assist in fighting viruses. In general, I recommend Vitamin C 500mg 2x/day.
- Vitamin D3 - There is speculation that rates of illness increase over the winter because of the widespread deficiency of Vitamin D. Studies have shown that people supplemented with adequate levels of Vitamin D3 during the cold and flu season had significantly lower rates of infection. Vitamin D3 actually increases our body’s production of cathelicidin, an antimicrobial compound. The Vitamin D Council recommends a maintenance dosage of 1000IU of Vitamin D3 per 25 pounds of body weight (the dosage may be higher in people with Vitamin D deficiency, which is epidemic and can be measured through an easy bloodtest).
- Zinc - Zinc is required for the normal functioning of white blood cells. Supplementing with just 15mg of zinc per day can improve the ability of our immune cells to ward off infection.
- Arabinogalactan - This is a natural sugar derived from the bark of the larch tree that enhances “natural killer cell” and macrophage activity – these cells are part of our first line of defense against any invading organism. We carry the Vital Nutrients arabinogalactan powder, and generally recommend ½-1 tsp 2x/day.
- Imu-Max - A recent study found that a preparation of echinacea, propolis, and vitamin C remarkably reduced the episodes of illness and fever when given daily during a 12-week winter period. This preparation is found in Ortho Molecular Products “Imu-Max”, with the dosage studied at 1 tsp 2x/day for children ages 1-3 years and 1.5 tsp 2x/day for children ages 4-5 years. (A word of caution: echinacea should not be used daily for very prolonged periods, and should not be used in individuals with autoimmune disease).
- SyImmune and/or Oscillococcinum - These are homeopathic medicines that may help to prevent influenza infection. I take one of these each per week for cold/flu prevention and give the same to my children and husband. I also give my children 1 SyImmune before or right after any known “germfest” – i.e., birthday parties or plane travel.
- Xlear nasal spray - One of the MOST preventive things you can do is to irrigate your and your children’s nasal passages with Xlear nasal spray at the end of every day, and after any potential exposure (work, school, playgroups, plane travel, etc.). This is a saline nasal spray with xylitol and grapefruit seed extract, both of which have antimicrobial properties. You cannot overdo it, and will not get “addicted” to it. Other options for nasal irrigation are a regular saline spray or neti pot. Apart from regular hand washing, I believe that daily and frequent nasal irrigation is one of the MOST important things that we can do to prevent influenza and other viral infections. This is because after exposure to a virus, the virus tries to invade and multiply in your nasal passages for at least 1-2 days before you develop any symptoms. Nasal irrigation can wash away viral particles before they have the opportunity to take hold, and thereby prevent many infections from happening in the first place!
I have found that starting various homeopathic and herbal medicines at the very beginning of my cold/flu symptoms can significantly shorten the duration and severity of illness and even knock it out of my system within a day or two. This is what I take and recommend for my whole family at the start of a cold/flu:
Specific homeopathic medicines, such as homeopathic Aconitum Napellus, Belladonna, Ferrum Phosphoricum, Gelsemium, Bryonia, and Pulsatilla, to name a few, can also be very helpful for cold and flu. The particular homeopathic medicine(s) used will depend on the specific symptoms that are being experienced by you or your child. An individualized treatment plan can be best determined by a thorough exam and sick visit with one of our physicians.
- Windbreaker - This is a Chinese herbal formula by Kan Herbs. It works GREAT for cold/flu, fever, even allergies! Add Chest Relief if there is a cough, or other formulas depending on the specific symptoms.
- Elderberry syrup - Elderberry has been found to prevent invasion by viruses and bacteria, and also improve cough. A study found that elderberry has the ability to inhibit H1N1 infection in vitro. The authors of the study note that “the H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu).”
- Esberitox - This is a combination of echinacea, wild indigo, and thuja. Esberitox has been found to reduce the duration of colds/flus and increase natural killer cell and macrophage activity. The recommended dosage is 1 tab 3x/day for children ages 2-5 years, 2 tabs 3x/day for children ages 6-12 years, and 3 tabs 3x/day for children over 12 years and adults.
- Pelargonium sidoides - Pelar-what? Also known as Umckaloabo, this traditional African herb can significantly shorten the duration and severity of colds, bronchitis, sinusitis, and throat infections. It has been found to improve macrophage activity, kill bacteria and viruses, and improve the ability to clear mucous from the lungs. We carry an alcohol-free syrup of Pelargonium sidoides called ViraClear. It can also be found over-the-counter as Umcka Syrup by Nature’s Way. The recommended dosage is ½ tsp 3x/day for children ages 2-6 years, 1 tsp 3x/day for children ages 6-12 years, and 1.5 tsp 3x/day for children over 12 years and adults.
- Oscillococcinum - This is a homeopathic flu remedy. The recommended dosage is 1 vial 3x/day for 1 day, preferably at the onset of flu symptoms.
- SyImmune or SyInfect - These are also homeopathic remedies used for any acute infection or fever. The general dosage is 1 tablet every 2-3 hours during the first 1-2 days of illness.
- Increased Vitamin C.
- Increased nasal irrigation with Xlear nasal spray.
When should you or your child see the doctor?
In general, if you or your child has come down with the flu, it is best to stay at home and rest, and avoid contact with others. You should, however, seek medical attention if you or your child has:
We wish everyone a healthy winter season. Eat your fruits and veggies, get plenty of rest and exercise, and most of all – stay well!
- Fever for more than 4-5 days
- Confusion, excessive drowsiness
- Inconsolability, excessive irritability
- Difficulty breathing
- Severe or persistent vomiting
- Dehydration (no urine for more than 6-8 hours)
- Or if you or your child falls in a high-risk category and may benefit from Tamiflu administration
Dr. Song and all of us at Whole Family Wellness