Influenza Update

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Flu Update from our CF Center Director

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This influenza season is creating increased concerns for our patients and families with cystic fibrosis. The CF team members have noted that each family has unique questions regarding the vaccines, preventative treatments and measures needed to reduce our patient's risk of infection in their schools and communities. This year is unusual in that we have our usual seasonal influenza as well as the novel influenza A H1N1 virus (swine) which is expected to reach pandemic levels of infection this year.

This important issue will be with us for the next several months and we have decided to add a brief column regarding this timely topic. I will plan on updating our CF website every few weeks or whenever new information is available about important issue regarding influenza that may impact members of our CF Center. During this year we will follow national or Center of Disease Control (CDC) recommendations as well as local or state recommendations established by the Indiana State Department of Health and Clarian and Riley Hospital experts.

This first column will review the basics and the current status of treatment and prevention for our influenza infections. As stated above, this year is unique in having two separate circulating flu illnesses and subsequently two separate influenza immunization sessions. The first influenza prevention program for the seasonal influenza is available now in our clinics and is the vaccine for the usual winter seasonal flu virus. It is a mixture of several flu strains. We recommend vaccination for the seasonal flu for all CF patients and their family members who are greater than 6 months of age. Some of the younger patients will require two vaccines or a booster shot. The nurses will review any reasons not to receive the flu vaccine. The most common is reason is an allergy to eggs. Parents and siblings of CF patients can receive their immunizations from their primary care physicians or the local health department.

As of today, the vaccines for the novel influenza A H1N1 are still in development and details regarding the vaccination program are still being formulated. More than likely the vaccines will be available for use in mid to late October. It's safe to say that CF patients will be considered as an at-risk population and vaccinating will be recommended. However, we still do not know what the specific age or dosage recommendations from the CDC will be for our patients. We will update this column as soon as this important information is available.

Early identification of persons with influenza is important for prevention medications, if warranted, and importantly for decreasing spread of these very communicable diseases. For the most part, both influenza illnesses this year are similar in symptoms and these include fever, cough, muscle aches and pains, and often listlessness in the younger patients. Shortness of breath or dyspnea is often a symptom that accompanies serious influenza disease. Gastrointestinal symptoms such as nausea, vomiting and diarrhea are occasionally seen. Sometimes fever is not observed. Supportive care which includes close observation of adequate fluid intake and medications for fever and rest are important. Children should not receive aspirin or aspirin containing products due to the rare concern of Reyes's syndrome.

Prevention medications such as oseltamivir (Tamiflu) or zanamivir are often recommended for persons with suspected or confirmed influenza that require hospitalization or with underlying medical conditions that may cause severe disease. Cystic Fibrosis would be considered in this latter category. It is important that the medication be initiated early or within the first 48 hours of illness.

It is also important to know that all persons do not require preventative medications. Your physician will help make this important decision. All persons should however practice measures to prevent the spread of disease if they have influenza symptoms. The disease is spread mostly by secretion contact therefore all sick patients should practice good hygiene measures. These include good hand washing and respiratory hygiene practices to prevent the transmission of the virus.

Treatment may often be started without laboratory confirmation of disease. This is important for several reasons including the often false negative nature of the rapid tests as well as the importance of not delaying treatment in the above special circumstances. Other respiratory viruses can mimic signs and symptoms of the influenza virus and need to be considered. As stated above, we will continue to monitor the recommendations for our CF patients and families in this unique respiratory viral season. Please contact the CF nurses or your physician regarding specific questions if needed.

Michelle S. Howenstine, MD
Center Director
CF Center