I am writing this on a flight home to LA from New York. I went to the very cold east coast for a Save the Children board meeting and Gala. I participated in three days of nonstop discussions (and celebration) of the humanitarian efforts of this amazing NGO (non governmental organization) for which I have had the honor of serving as a trustee. I did not read any medical journals…so I thought I would share some of the tough challenges that we discussed that threaten children in our current crisis filled world. To do so, I am quoting some of the facts presented to our board at dinner Tuesday night…

2013 was the first time since World War II when more than 50 million people were displaced from their homes as a result of war and violence. Over 15 million refugees fled to developing countries which themselves have significant needs. The drivers of this humanitarian crises are likely to continue and include climate change, population growth with a “youth budge”, urbanization, migration, political instability, religious fundamentalism, intolerance and hate. (The last are my words.) 200 million people have been affected by natural disasters and there are 100 violent conflicts a year. The most vulnerable are children. Child protection, their health, nutrition and education needs are among the most underfunded components of responses by the international community.

Here is where I can proudly report on what Save the Children is doing: During 2014 Save the Children has responded to 90 humanitarian emergencies in 53 countries reaching 8 million people. These include building Ebola treatment centers in West Africa, community education and outreach programs to educate on risk avoidance, diagnosis facilities and programs to care for children orphaned by Ebola. Save the Children’s global outreach concentrates on child protection, health, nutrition and education in countries that few of us will ever visit and may have trouble finding on a map…South Sudan, CAR, Somalia, Sudan, Mali, Ethiopia, Mozambique (I have reported on schools The LA Associates of Save the Children have built in the last two countries), Iraq, Yemen, Syria, Philippines, Pakistan, and India as well as Laos, Myanmar, DRC and Nicaragua (to name a few).

Yes, these are statistics and names of far off countries, and as we read them they may not register on an emotional level. But the story of one child with a name who may die before the age of 5, or may never have a home or family because of conflict and disease, or if that child is a girl and has a greater chance of dying in childbirth than learning to read…when we know that child’s name we begin to care. I have had the opportunity to meet some of these children and their families … I am proud to be a small part of an organization that strives to value their future.

I hope you will decide to learn more by going to savethechildren.org.

Next week, I will resume my usual women’s health update articles.

Last week, I had a somewhat animated discussion with an erudite friend who felt that science is so advanced that we don’t have to worry about resistant bacteria. I argued that we did. And although when it comes to bacterial attacks I really don’t want to be the one to say “I told you so”, an article in last week’s JAMA confirmed that I (and all of us) are right to be worried.

The article was titled “Report Reveals Scope of US Antibiotic Resistance Threat”. The author points out that although antibiotic resistance is well known to US clinicians, until now the true scope of the problem has been unclear and underestimated. A new report by the Centers for Disease Control and Prevention (CDC) provides clarity. They stated that more than 2 million people in the United States become infected every year with organisms that are resistant to antibiotics, and at least 23,000 die. They added that nearly 250,000 people acquire Clostridium difficile infections each year, a serious diarrheal illness that is not so much antibiotic resistant but rather is precipitated by antibiotic use.

The report listed at least eight different types of bacteria in the gut that have been found to be resistant to some or all of the most powerful antibiotics, as well as bacteria on the skin (Staphylococcus) and bacteria that inhabit the upper respiratory tract. The director of the CDC said in a recent press briefing that their report shows just the bare minimum and that they up to now that have only counted the infections that are resistant to antibiotics that occur in hospitals. They know however, that there are many more infections in nursing homes, dialysis units, long-term hospitals, assisted-living facilities and communities. The estimate is that hospital infections alone result in significant need for increased and prolonged care as well as loss of productivity and cost more than $50 billion a year! According to the FDA, more than 70% of the bacteria that cause hospital associated infections are now resistant to at least one type of antibiotic most commonly used to treat these infections.

One of the pathways that bacteria learn to become resistant is that genes jump from one organism to another. So, if one type of bacteria is resistant, it can teach others to have the same ability to shrug off antibiotic impact. Now that I’ve rung the bacteria alarm, I want to at least let you know that experts feel that we can try to do something about this. They have set a goal of at least preventing a worsening situation and perhaps improving the one that we currently have. They recommend developing and administering more immunizations, instituting infection prevention actions in healthcare settings, preparing and handling food more safely and being vigilant about hand washing. And to keep up with the natural process of antibiotic resistance that occurs as bacteria become resistant, researchers have to continue to develop new antibiotics. Despite this clear and present danger, the number of new FDA approved antibacterial drugs have been decreasing steadily since the 1980s. The federal government (which plays a very important role in our health) has passed “Generating Antibiotics Incentives Now Act” (GAIN) in 2012. It is (as usual) long and complicated but it essentially is trying to increase the commercial value of antibiotics by extending the length of time an approved drug is free from competition and simplifying the regulatory pathway for FDA approval of new antibiotics.

Perhaps one of the most important things we as physicians and you as patients need to realize is that antibiotics should be used appropriately and safely. Currently, up to half of antibiotic use in humans and much of antibiotic use in animals is absolutely unnecessary. So please remember this the next time you have a slight cough or sore throat and call your doctor to get an antibiotic prescription. There is a good chance that the antibiotic won’t help and moreover it can increase the chance of developing resistance to this and other “bugs” in your body and in the bodies of others.

We’ve all been hearing more and more about HPV infections; that they cause cervical cancer, vaginal cancer, anal cancer, throat cancer, mouth cancer and venereal warts. I’ve written several articles about the need to immunize girls and boys with the HPV vaccine. The most common vaccine, Gardasil is given in 3 doses, it is a quadravalent vaccine, which means it gives immunity to 4 types of HPV (6,11,16 and 18). These are the ones that cause 70% of cervical cancers, many of the other above mentioned cancers as well as venereal warts. But alas, despite the multiple direct to consumer ads in the media, recommendations by most doctors and the studies in peer-reviewed journals, only one third of adolescents are currently being immunized.

We would certainly expect the prevalence of these infections to be significantly diminished in those whose parents had the clinical acumen to have their children immunized. But they represent just 30% of their peers. So it was pleasantly surprising to find that a study published online in the Journal of Infectious Diseases reported that the prevalence of infections with the human papilloma virus types included in the Gardasil vaccine dropped by almost 60% among females aged 14 to 19 years during the four-year period after the vaccine became available and was recommended. Dr. Thomas Frieden, the CDC director, said during a press conference held to announce the results of the study, that increasing the vaccination rate to 80% would prevent about 50,000 cases of cervical cancer among girls alive today. “We owe it to the next generation- our sisters, our daughters, our nieces and to protect them against cervical cancer.”

Just to remind you, a three dose series of the quarivalent HPV vaccine was recommended in 2006 by the CDC as a routine vaccination for females age 11 to 12 years and for females aged 13 to 26 years who had not been previously vaccinated. In 2011, the recommendation for the vaccine was expanded to include boys aged 11 and 12 years and for non vaccinated males up to 26 years. No data is yet available on the proportion of males who have been vaccinated and/or the impact of vaccination on their infection rates.

The nearly 60% drop in HPV infection is greater than expected but can be due to “herd immunity” from vaccination (nothing to do with animals, it means that those who got the vaccination were unable to infect those who did not).

Remember, HPV is the most common STD in United States. The estimate is that 14 million people becoming infected with HPV every year. According to the CDC, 79 million of the those who have become infected with HPV are in their late teens and early 20s. Every year, about 19,000 cancers in women are caused by HPV; most are cervical cancer. And of 8,000 cancers caused by HPV that occur in men in the United States, most of them are oropharyngeal (mouth and throat).

Wow, this vaccine can make a huge difference. It may be too late for many of us who are over the age of 26 but we certainly can make sure that the younger (and youngest) generation are vaccinated… Not to do so is malparenting!

As a fellow of ACOG (The American College of Obstetricians and Gynecologist, the term “fellow” has no gender significance)….I recently received a survey to complete with questions about my age, number of hours I teach, see patients, percent of patients who are on Medicare, languages I speak, etc….the usual questions that one would expect them to ask in order to keep their census up to date. But this time they included a second page of questions that asked about my knowledge of a specific infection. When I realized my knowledge was minimal (actually I didn’t know anything about it), I quickly looked it up so that I could mark their queries in other than the column “I don’t know”. (The survey was multiple choice).

I’d like to share the information I learned with you….not because you too will be “tested” but because general knowledge about this water borne infection in not well known (even by doctors) and there are warnings that should be issued to help protect many of us.

The infection is due to a parasite called Cryptosporidium. It causes (you guessed it) cryptosporidiosis (nick name Crypto) …which usually manifests itself as diarrhea. It’s a fascinating organism. It thrives in cattle, sheep and pigs as well as wild animals such as deer, elk and moose, especially their young offspring (calves and lamb) and, unfortunately, in humans. Once a parasite gets to the small intestine (the gut) though ingestion, it can multiply and recycle indefinitely. In a fascinating process, once in the gut, this microscopic parasite actually undergoes a sort of fertilization to form a zygote, and this ends up having 4 offspring called sporozoites. (Sorry if I am getting too detailed, but it’s the biologist in me.) Some sporozoites remain in the gut and infect new cells. Others that get surrounded by a cyst wall become oocysts, and these are passed in the feces and into the environment. All this happens astoundingly quickly…each generation can develop and mature in 12 to 14 hours. During the last 2 decades, “Crypto” has become one of the most common causes of waterborne disease in humans in the US and through out the world!

The usual source of infection is water that has been contaminated by the feces of animals or infected humans. If a person drinks the water or involuntarily swallows it while swimming, they then “catch” cryptosporidiosis. Crypto has been found in swimming pools, hot tubs, Jacuzzis, fountains, lakes, springs, rivers, and ponds which can be contaminated with sewage or feces from humans or animals. It can be spread by eating uncooked food that is contaminated, by touching your mouth with contaminated hands…which could have “picked up” the parasite from touching surfaces (and this includes diapers) that have been contaminated by stool from an infected person or handling an infected cow or calf. (We do the latter infrequently in LA.)

Symptoms of the infection usually appear within 2 to 10 days of exposure and include diarrhea, abdominal cramping, nausea, vomiting, low grade fever and weight loss. In persons who are immunocompromised (due to diseases such as AIDS or cancer), the infection may become life threatening. The good news is that the immune system in healthy individuals is able to stop the infection, although symptoms may last for one to two weeks. But even after symptoms subside, sporozoites can be excreted in the feces and if that person swims, he or she can pass them into the water from spores that are present in the outer part of the anus or even on the thighs (ugh!). Here is where physician advice should include sanitary precautions to wash hands, use separate towels and not go swimming for 2 weeks after all the symptoms have resolved. The other rather concerning information that I discovered was that chlorine disinfection of the organism is ineffective; even one oocyst can withstand pure bleach for 24 hours and still cause infection .Most water filters today do remove small particles including cryptosporidium from our drinking water…but this may not occur in home wells (or swimming pools).

According to the CDC, the best way to protect yourself and others from this cause of diarrhea is to:

  • Wash your hands after using the toilet and before handling food (especially for persons with diarrhea).
  • Wash hands after every diaper change, especially if you work with diaper-aged children.
  • Do not swim if you are experiencing diarrhea (essential for children in diapers) and stop for 2 weeks after diarrhea subsides
  • Avoid water that might be contaminated.
  • Do not swallow recreational water.
  • Do not drink untreated water from shallow wells (or boil it first).
  • Do not consume untreated ice or drinking water when traveling in countries where the water supply may not be safe.
  • Use safe uncontaminated water to wash all food that is to be eaten raw (and if there is a chance that the food might be contaminated, peel it).
  • Avoid eating uncooked foods while traveling in countries with poor water treatment and food sanitation
  • You’ll love this one….avoid fecal exposure during sexual activity.

The diagnosis can only be made if stool samples are tested for the parasite, and frankly the test is not always positive the first time so several samples may be necessary.

The only FDA approved treatment is through a prescription of a medication called nitazoxanide (brand name Alinia). Most people with healthy immune systems will recover without treatment. Diarrhea should be managed with fluids to prevent dehydration.

So now you know and could “pass” the survey put out by ACOG. If I include a bottom line, as I usually do in my newsletter, it would probably include the phrase “Don’t swallow” (at least while swimming), know your drinking water source and wash your hands!

I have just returned from Israel. Ten time zones and a 15 hour (if it’s non-stop) flight will guarantee jet lag. So please forgive me if this piece is somewhat disjointed. The El Al flights I took were uneventful and indeed I slept most of the way. But as I landed in LA my ear painfully popped, I started coughing and sneezing, had a sore throat and generally felt awful.  I was reminded of a segment that I had done for the Today Show titled “Microbes on a Plane”. (It was supposed to be a take-off on that awful movie “Snakes on a Plane”.) Thankfully, after judicious but liberal use of antihistamines, anti cough medicines, lozenges and anti rhinitis nasal sprays I feel better (but am still jet lagged). Did I get sick from my plane ride? Probably not.  More likely I acquired a viral infection while visiting my family and friends (and spending time in several hospitals, a university and a nursery school).

Having just gone through this I felt it would be appropriate (and easy) to share what I wrote for the Today Show in this week’s newsletter. I assume that you will be reading this at home or in your office and not on a plane….

Which diseases are most likely transmitted through cabin air?

  • The common cold. Believe it or not, there are very few published reports of cold outbreaks as a result of air travel. That may be due to the fact that colds are so common that it’s difficult to compute whether they were “caught” on a plane. Also the decrease in the humidity of airplane air with subsequent drying of nasal passages, fatigue and proximity to someone who is sneezing and coughing are variables that affect a person’s susceptibility and the likelihood of infection with cold viruses. But “infected” plane air is probably not to blame; a study of the percentage of fresh air, which was re-circulated in the cabin (50 percent versus 100 percent), showed that it made no difference in the development of upper respiratory tract infections. (This would not be the case, however, if the plane is on the ground, the doors are closed and the air system is shut off.)
  • Influenza (seasonal and H1N1). We know that air travel allows individuals from one area of the world to spread a specific type of flu to another and indeed, air travel is probably the chief cause of global spread. But there is less concern about actual in-flight transmission, unless the aircraft is grounded with an inadequate ventilation system. In that case, there have been documented outbreaks. The current recommendations require “that passengers be removed from an aircraft within thirty minutes of shutting off the ventilation system”. The best way to decrease your chances of infection is to get your flu shot, and remember, immunity occurs two weeks after the vaccine, so plan ahead. (By the way I had mine.

Other airborne “large droplet” diseases include:

  • Tuberculosis. This disease is global; one-third of the world’s population is currently infected. Studies since the mid-1990’s have documented in-flight TB transmission. The largest USA incident occurred when a passenger traveling on a trip from Baltimore to Honolulu infected four of fifteen passengers seated within the closest two rows (they didn’t all develop TB, but they did have positive TB skin tests). A risk analysis published in 2004 estimated that the overall probability of TB infection during a long air flight is around one in a thousand, when a person with TB symptoms is on the plane. This is similar or perhaps even less than the chance of becoming infected by a person with TB in other confined spaces.
  • SARS. This is transmitted by large airborne droplets or by direct contact. There has been substantial evidence that in 2003 during the SARS outbreak, transmission of the virus occurred through airplane air to passengers seated within five rows of the initially infected person and that the infection occurred on fairly short flights. (In one three-hour flight from Hong Kong to Beijing 22 of 120 passengers contracted SARS). Since then, the “epidemic” has dissipated and there have been no major outbreaks of concern.

What about food and water contamination?

Microorganisms that cause food poisoning and gastroenteritis diseases usually are spread by contamination of food or water. These include salmonella, staphylococcus, cholera and a virus called Norwalk-like agent. No food borne or water borne outbreaks have been reported over the past few years, probably because the food is so often pre-packaged and frozen.

The water in on-flight tanks, especially if filled from water sources which are less than “pure” may be contaminated. Long or repeated storage within the tank can, despite best efforts, result in bacterial growth.  If you don’t want to drink the water in the country from whence the flight originated, don’t drink the water from the plane tank. Bottled water is always the safest way to maintain hydration.

What about the dry air?

The humidity within the cabin is usually below 25 percent and can definitely cause sinus and mucous membrane discomfort. We would probably feel better if the humidity was 35% (that’s what it is in a comfortable home environment), but increasing humidity can also encourage growth of bacteria and fungi, especially in the aircraft water tanks; hence the airline industry has hesitated to do so.

So what can we do to stay healthy when we fly?

  • Respect others. Don’t fly if you are sick. Aside from concern for the other passengers’ health, flying with an ear, nose or sinus infection and/or severe congestion, may cause obstruction of airflow in your middle ear and sinuses during takeoff and landing. This in turn can cause severe ear and sinus pain and injury to the eardrum.
  • Prevent dehydration. Drink plenty of water (and make sure your children do this, they are especially susceptible to dehydration.) If you want to ensure that the water you drink is not contaminated, ask for bottled water. Don’t add ice cubes if they are made from water that could be unsafe. Drink tea and coffee only if the water used to make it is boiled or is bottled.
  • Limit caffeine and alcohol, these add to dehydration and jet lag.
  • Prevent dryness of your skin, eyes and airways. Use moisturizer, saline eye drops (or rewetting drops) for contact lenses and saline nasal sprays. (As I write this I’m aware of the restrictions on bringing these items on board the plane; I hope they will be reversed. You can always get a note form your doctor for the eye and nose drops.)
  • Practice good hand hygiene. Wash your hands before you eat. Don’t put your unwashed hands in your mouth or rub your eyes.
  • Move. If someone nearby seems sick, ask if you can move to another seat. And don’t forget, even if you are surrounded by healthy individuals, it’s important to get up, move and stretch to prevent blood clots and deep veined thrombosis (DVT).
  • Mask? The use of masks to prevent infection within the aircraft carrier is unproven.

Bottom Line: Work, recreation and families have become global. Most of us have to fly. With rare exceptions, we don’t risk serious illness. Simple hygiene, hydration and judgment can help prevent air related health problems.

New Bottom Line: Follow these rules, but know that lack of sleep, the stress of long distance travel and exposure to viruses and bacteria in distant places can result in illness. In my case it was blessedly brief. I plan to repeat this and many other trips. I know that immunity is not bestowed with a medical degree. I wish it were.

I normally use my web site to update my patients and readers about recently published studies and/or health recommendations. Several weeks ago I wrote about the need to get the seasonal flu vaccine, and indeed my nurse gave it to many of you (and me). I also promised to let you know when the H1N1 vaccine is available in our office.  As I write this, we have not received our order. I will keep you posted.

Departing from my usual weekly missive, I thought I would share a personal viral story. I flew to London with my husband two weeks ago (he had meetings there and hey, why not go with him?) I didn’t feel well before we left, but the airline (it was British Air) wanted a huge sum to change the ticket. So I boarded and slept the entire journey hoping that I once I arrived I would feel better. I was worse. Aside from an elevated temperature, I had all the symptoms of the flu. So I followed the advice that I have given those of you at high risk (although I don’t really fall into the CDC high risk category….I am neither a young child, adolescent, nor pregnant and have no chronic lung or immune issues….but I am a health care provider), and I started tamiflu. Four days later despite bed rest and the medication, I was still sick. To make matters worse, there was no chicken soup to be had from room service. Before continuing our trip, I thought I had better make sure I did not have pneumonia. My husband had a friend who gave him the name of a private consultant in London. After dropping his name (that of the friend), I got an appointment at the end of the day. The office was a short taxi ride from the hotel. I actually “dressed up” for the visit, after all I didn’t want a doctor in London to think that an American physician walked around in jeans. We were ushered into the most beautiful waiting room I had ever seen. It had high ceilings with ornate molding above, original art on the walls and simple but exquisite couches below. The mahogany tables were covered by art books, and a tactful display of travel and fashion magazines. I was asked to fill out an information sheet that requested my name, address and phone numbers. On that same sheet was a note that stated that American Express was not accepted, but that cash, check or other credit cards would be….moreover the bill would not be forwarded to national health. The charge for a consultation only versus a consultation with exam was also posted. There were no HIPPA forms

Despite feeling truly lousy I was awed by my surroundings. And when the doctor himself came out to the waiting room to usher us into his consulting room, I felt I must be special; until I noticed that he didn’t have a nurse. Doctor XXX was an elegant, handsome man in his 50’s with an impeccable English accent. I liked him instantly. He took a very comprehensive history and I strove to give answers in our universal medical lingo. After all I didn’t want to be considered as “just” a sick patient. But and as we spoke and I listened to my answers I realized that had I (in my white coat habitat) asked the same questions I would indeed have come up with the diagnosis of “typical flu”, or for billing code purposes, upper respiratory virus. When he heard I had self medicated with tamiflu, he smiled deprecatingly. “I had H1N1, it was just a mild flu and I was better in 3 days.” He went on to tell me that many of his patients have had it and although tamiflu was available in Great Britain, it was not as frequently prescribed as in the USA.  That’s when I noticed that his cough, although in a lower octave, was worse than mine! I was not about to argue….he had the stethoscope. So I meekly asked him to check my lungs. We went into his exam room and I duly inhaled and exhaled. “I hear no rales or ronchi” (the sounds that indicate partial obstruction to the bronchi) he pronounced. “I suppose you would like me to check your blood for infection?”  And then without washing his hands or putting on gloves he expertly drew blood from my cubital vein and applied a band aid. “The results will be ready tomorrow. If you want an x-ray I can send you to hospital this evening”. It turns out that there was no x-ray machine in the office. Although I was assured that the hospital was only a ten minute taxi ride away, I felt too ill to attempt the journey and the possible wait. So we paid the bill (it was discounted, I assume for professional status) and went back to the hotel. The next day he called and told me that my blood count was “stupendously normal”….and asked if I still wanted the x-ray. I didn’t….the chance of my having pneumonia with a stupendous blood test was slim, and in truth I was feeling better.

I am not telling this story to disparage the doctor, but to point out the difference in medical practice between the USA and Great Britain, even with private care. In many ways he was right. I did not need an x-ray and if I had waited, my flu would have probably run its course without medication. Our expectation for instant diagnosis and subsequent immediate cure makes us the patients, demand a lot of probably unnecessary tests and yes, as the physicians, over prescribe. Did I have H1N1? I’ll never know….once the symptoms have passed. Will I get the H1N1 vaccine once it’s available?….Yes.

I’m home now and feel better. Don’t worry, by now I am not infectious!

The HINI virus has had various names. I am in Israel as I write this;  in the beginning of its spread it was termed the Mexican flu, it then became the virus hazirim, or swine flu. In the U.S. the term swine flu was officially expunged perhaps due to concerns by the “other white meat” industry. So its numerical, virologic appellation has been adapted by everyone and is here to stay. This virus has previous unknown and constantly evolving genetic features. It is highly transmissible (but not through your bacon or pork chops) and has traveled the world, mostly via traveling people. It is truly an epidemic! In Israel they currently estimate that over the next year, 25% of the population will become infected. The number touted in the U.S.A is even greater….perhaps as high as 40%! To date, those who get really sick and/or even die are young, pregnant or have underlying medical problems. The incidence of H1N1, like seasonal flu, is expected to increase in the fall and winter when we are confined to closed interior spaces and more likely to transmit the virus from person to person.

H1N1 has received tremendous publicity. Prescription sales of Tamiflu (the antiviral medication that helps diminish length and severity of certain viral infections which to date includes H1N1) have rocketed. The U.S. government promises that if needed, stocks will be replenished. I receive daily bulletins from the CDC and WHO that if not hysterical, show great concern. For once I don’t feel that the media is making more of the H1N1 viral spread than it should. A vaccine is coming, but it looks like it won’t be in our pharmacies, hospitals or medical offices until the late fall. Meanwhile the FDA has approved the next general flu vaccine. It is directed against other flu strains that are expected to be in circulation as the weather cools. But this seasonal flu shot will not provide protection against the 2009 H1N1 virus.

In the midst of the impending H1N1 crisis please don’t forget… seasonal influenza viruses can be horrific….and indeed cause more than 200,000 hospitalizations and at least 36,000 deaths in the U.S. yearly. The latter statistic is especially significant for older people, young children and people with chronic medical conditions. Each year the WHO, FDA and CDC work together to identify the up and coming viral strains that will cause the most illness in the upcoming season. They then work with the vaccine manufacturers to develop the appropriate vaccine. I know that at the end of the flu year we have, in the past, been informed that there were other flu strains out there, and  that “they” got it wrong. But there is a far better chance that these organizations got it right.

There are 3 new strains of virus that will be included in the general flu shot this year. And according to the FDA “even if the vaccine and the circulating strains are not an exact match, the vaccine may reduce the severity of the illness and help prevent influenza-related complications”.

So start your fall and the getting-colder-season (at least in some parts of the country, I don’t know what the weather will be like here in sunny California) by getting your seasonal flu vaccine as soon as it’s available. A novel H1N1 vaccine will eventually be ready for consumer use….but not right away. So if you want this vaccine (and with all the warnings that inundate our media, most of you will), a second shot will be necessary. Once an H1N1 vaccine is available, initial supplies will go to vaccinate the most vulnerable groups…young children, young adults, pregnant women, healthcare personnel and those with chronic conditions. Eventually the hope is that it will be available for everyone.

This will be the winter of our viral discontent… But there is much we can do to help prevent viral spread. Stay home when you are sick (and make sure your children, significant others and friends do), wash your hands as frequently as possible, practice cough and sneeze protection, don’t greet others with the usual I-have-to be-polite handshakes and kisses.(I certainly hope Obama uses hand sanitizers!) If you come down with flu symptoms call your health practitioner (and if you are my patient, call me or my staff) at the onset of your symptoms. We no longer have to run tests to confirm the diagnosis. (The CDC has stopped counting specific cases). We will probably prescribe antiviral medication such as Tamiflu to help you get better quickly.

AND get your seasonal flu shot. Don’t wait for the H1N1 vaccine; when it’s available the media (and companies that produce it) will make sure you are informed. This year two shots will be better than one or none.