Health Chats
Swine Flu Chat
Tuesday Oct 20, 2009, 12:00PM - 01:00PM (EST)
Enoch Choi, MDBlank
Palo Alto Medical Foundation
Urgent Care, Palo Alto, CA
Fall is here, school is back in session, and once again it’s time to gear up for flu season. This year will have special challenges, as we are preparing for both seasonal flu and H1N1 (swine) flu. Dr. Enoch Choi, MD, an Urgent Care provider in the San Francisco Peninsula, will help answer questions on how to tell swine flu from a cold, and from seasonal influenza.<br><br> The pandemic H1N1 flu (aka “swine flu”) began in April, and circulated in daycares, schools and camps over the summer but dropped off until very recently increasing to widespread levels again in many states. Virtually all the flu around now is the pandemic H1N1 virus. The H1N1 virus also predominated in the recent winter months of the Southern Hemisphere, which typically spreads north as we have our winter. There is concern that we are now experiencing a second wave of H1N1 this fall with the return of children to school. <br><br> <img src="http://www.medhelp.org/images/email/arrow.jpg">&nbsp;&nbsp; Learn more about Swine Flu from Dr. Choi's blog posts:<br> <a href="http://www.medhelp.org/user_journals/show/124636">2nd Wave of H1N1 Widespread Across America, Get Immunized!</a><br> <a href="http://www.medhelp.org/user_journals/show/83652">Do I have Swine Flu?</a> <br><br> <img src="http://www.medhelp.org/images/email/arrow.jpg">&nbsp;&nbsp; Read the chat transcript from Dr. Choi's most recent <a href="http://www.medhelp.org/health_chats/archive/19">Swine Flu Health Chat on May 8, 2009</a>.
monica148:
Physiologically, what is it that happens to a person who has H1N1 flu which may lead to their death?
Dr. Enoch Choi:
young people seem to have a overactive strong immune response that damages the lungs making them leaky, there are early reports that CT scan of the lungs of severely ill patients with pneumonia following H1N1 can help diagnose these patients.
Dr. Enoch Choi:
if your lungs can't exchange oxgyen for carbon dioxide then the low oxygen levels are very harmful
mattymommy:
My son with asthma also is allergic to eggs but tolerates the season flu vaccine. Would he be able to tolerate the H1N1 vaccine in the same way?
Dr. Enoch Choi:
since the H1N1 vaccine is manufactured in the same process as seasonal influenza, ask your doctor if he can tolerate H1N1 vaccine.  it is not indicated for those with severe egg allergy.  consider asking for an egg challenge with an allergist to see how severe the allergy is.
MenloParkMom:
My family has already received the seasonal flu vaccine.  I would like for all of us to receive the H1N1 vaccine as well.  If there continues to be a shortage over the next few months, is there some point that it will be too late to get vaccinated?
Dr. Enoch Choi:
in the county just south of you where i am, santa clara, the public health department has received shots and is tentatively planning a clinic from 8a - 6p.  keep your eyes peeled for an announcement in the san jose mercury news.  you may call CHOP and see if san mateo county is having shot clinics too
Dr. Enoch Choi:
clarification: santa clara, the public health department has received shots and is tentatively planning a clinic from 8a - 6p on saturday, and every saturday
Cinains:
How long do you have to wait after getting the seasonal flu shot to get the H1N1 vaccine?
Dr. Enoch Choi:
you can get both at the same time.  you have to wait a month between nasal sprays
Netta50:
Hello! I am a 50 year old woman that has been sick in bed for 6 days. I have chills, fever of 101.8 and my body aches all over, with a massive headache. I was going to go to the doc today, but I just don't feel up to going anywhere, also I have body aches for years, but this has been unbearable. Any advice would be appreciated.
MedHelp:
This will be the final question for today.
Dr. Enoch Choi:
call your doc.  symptoms of fever of 100 deg and either sore throat or cough are possibly H1N1.  other symptoms increase the likelyhood such as muscle aches, headache, runny nose.  It's important to call and ask how serious your symptoms are.
MedHelp:
This chat was very popular and there are still many questions left unanswered. Dr. Choi has graciously agreed to continue answering them after the chat, so check the archives in a few days to view the rest of the answers.
Dr. Enoch Choi:
i'll be happy to answer the more than 40 questions as soon as i see a couple patients.  come follow me at http://www.twitter.com/enochchoi
Dr. Enoch Choi:
see ya!
MedHelp:
Thanks for joining us today. And a big thank you to Dr. Choi for answering so many questions in one hour...and for agreeing to continue to answer the rest of the questions.
bob009:
Is vaccination against H1N1 completely safe ?
Dr. Enoch Choi:
http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm
Dr. Enoch Choi:
assumed to be as safe as seasonal vaccine sine same manufacturing used
ready2talk2000:
How can we see for ourselves what is in the H1N1 shot?  Where is there proof of the mercury content, etc???
Dr. Enoch Choi:
medications come with a FDA package insert, you could ask for that
DMK1981:
My friend told me that her 3 kids have H1N1 & that the doctor stressed for them to stay at home & for sure not to be around pregnant women. That the H1N1 Swine flu kills 1 out of every 3 women that gets it. I am 15 weeks pregnant & now I am scared to death!! Why is this virus harder on pregnant women?
Dr. Enoch Choi:
http://www.cdc.gov/h1n1flu/guidance/pregnant.htm
Dr. Enoch Choi:
from the CDC:When should I get emergency medical care?

Photo of hospital signIf you have any of these signs, call 911 right away:

    * Difficulty breathing or shortness of breath
    * Pain or pressure in the chest or abdomen
    * Sudden dizziness
    * Confusion
    * Severe or persistent vomiting
    * A high fever that is not responding to Tylenol®
    * Decreased or no movement of your baby
Azmy:
What are the types of vaccines available for H1N1 and what is the best?
Dr. Enoch Choi:
4 types are available, talk to your doctor which is the best for you
Dr. Enoch Choi:
"there's so much of news and rumors going around that i dont know what to believe any more. I was kindof surprised to hear that if I have had any type of flu this year, that means I am considered to have H1n1? http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml I currently have a cough for about a week but no fever - does that mean its H1n1?"  At my clinic we require a fever of 100+ with cough or sore throat to diagnose H1N1 although if you read http://www.flu.gov and http://www.cdc.gov/h1n1flu/ you will read that H1N1 can occur without fever.
Dr. Enoch Choi:
"for children who have to get two h1n1 vaccinations (under age 10), if they have to get the same type (shot v. flu mist) each time? for example, if a child gets flu mist, can he get a shot for the booster? (or vice versa?)"  I don't know but this chart gives guidelines for the appropriate ages for different immunizations http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5839a3.htm#tab
Dr. Enoch Choi:
"If I am able to only get one dose of the H1N1 vaccine for my daughter, does that offer any protection? We are taking a month long trip in dec. to Asia And are unsure whether we will be able to get a second dose before we leave. This means her second dose may happen 8 weeks later rather than 4. Is it better to wait on dose 1 so that we can space the second by 4 weeks?"  I think the studies suggest better antibody response after 2 doses, and the studies haven't gone on long enough to see what happens after 1 dose.  here are the studies: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5839a3.htm#tab  
CSL Biotherapies, Inc. Influenza A (H1N1) 2009 monovalent vaccine [Package insert]. King of Prussia, PA: CSL Biotherapies Inc.; 2009. Available at http://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm182401.pdf. Accessed October 7, 2009.
Novartis Vaccines and Diagnostics, Ltd. Influenza A (H1N1) 2009 monovalent vaccine [Package insert]. Cambridge, MA: Novartis Vaccin
Dr. Enoch Choi:
"I'm the mom of boys with Cystic Fibrosis (mild, luckily). In any case, do you know if our whole family would be able to get the shot from the County. I think we quality"  I believe you would according to : http://bit.ly/3M3hVO Santa Clara County Fairground free H1N1 vaccines for those with high risk Nov7+15+21 9:30-3:30p (pregnant, age<24, <64 chronic ill)
Dr. Enoch Choi:
"I am pregnant (20 weeks) and have asthma, and have a 2 y.o. and have been trying to track down the vaccine for us (we've both had regular flu shots).

In terms of the Santa Clara fair on 11/7, I will go there and try to get us shots. My question is that I thought kids under 6 had to have 2 shots of H1N1 so will they administer both at once or only 1 and we'd need to follow up for a second shot somewhere? I am a patient at Menlo Medical Center and my OB Jagdip Powar at Welch Rd. does not have the H1N1 shots yet.

How widely advertised are the Santa Clara public shots? i.e. should I expect major lines?

Thanks for all your advice. I saw on FB that you posted on Astrid Thompson's site. Is she a friend of yours? She is my former colleague from Stanford GSB and friend!"