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Q. for Perry

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Hi Perry,


First of all, can I say that I think you're wonderful to answer our questions the way you do so thoroughly.


Here's my latest (I hope it makes sense) ~


Our local hospital system here in CA has said that they're not testing for H1N1 when people call in sick, even show up with mild symptoms.


It seems to me that they're only testing after a lung has collapsed etc. meaning the patient becomes very, very sick.


Is it possible that the "mild" cases we're seeing are "just" the seasonal flu and the really awful cases are actually the H1N1?


A friend's son has a boy in her class that's been in the hospital for over a week in ICU in our town. He's confirmed H1N1. One of his lungs collapsed, the other lung had to have fluid removed. And he got pneumonia. (The parents were on Nightline discussing it.)


My long-winded question: how the heck do "they" really know anything if very, very few people are being tested??


I have friends saying, "oh, yeah, we have the swine flu going through our school and our son had it last week, but he only had a temp for 24 hours and he could have gone back to school the next day but I kept him home."


I'm sorry: I had the flu back in the '90's and it was AWFUL. It wasn't a 24 hr. thing. Ever since, I've gotten my flu shot. I don't want to go through that ever again.


So, how do the experts know that swine flu isn't mixed in with the seasonal flu? Or even just regular viruses? If they're not testing??


Sorry for the novel!



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Is it possible that the "mild" cases we're seeing are "just" the seasonal flu and the really awful cases are actually the H1N1?



CDC has an extensive surveillance system, with samples collected and tested from designated locations all over the US. WHO has a similar program worldwide. I can't copy the table correctly, so go to CDC and scroll down to US Virologic Surveillance.


During week 40, almost 14,000 specimens were tested. Specimens are only taken from patients with ILI (influenza like illness), usually defined by fever and cough or sore throat. Of those 14,000, about 30% were positive for influenza. Of those 30% over 99% were influenza A and less than 1% were influenza B. Of the A viruses, NONE were seasonal influenza A. Not all were subtyped, but of those that were, virtually all were 2009 H1N1. About 1/3 weren't subtyped, but it doesn't matter- the numbers are large enough and representative of the entire US, so if there were seasonal flu going around, they should be able to detect it.



One caveat: if they only collect samples from people with fever, they are missing mild cases of flu. However, it doesn't seem likely that seasonal flu is any more likely to cause illness without fever, so they shouldn't be underestimating the number of seasonal strains.


It's interesting that 70% of the samples were not positive for influenza. I don't know what test they use for surveillance. The rapid tests are notorious for high rates of false negatives. I can't say more about it without knowing what test they use. Hornblower, do you know?


There is more information here about the surveillance system.

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Thank you, Perry. I think I get it now.


My hunch is right then -- there are plenty of people -- that 70 % -- getting sick and automatically saying it's H1N1.


It doesn't really matter I guess, I was just wondering.


New subject: our hopsital system is saying different thing constantly. One nurse says you have to wait 21 days between seasonal flu shot and H1N1 shot. Another says they have flu mist for H1N1. Another says they don't.


Ahhh! Do you happen to know anything about the 21 day thing?


Thanks again!



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The way the CDC words it in the weekly surveillance makes me think it's not the rapid tests.

They say "4,093 (29.4%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza. "


To me that sounds like lab confirmed, presumably by PCR.


In Cda we also run a separate respiratory virus detections program where they publish weekly reports on RSV, parainfluenza, hMPV and adenovirus in addition to influenza. I think last week we had a bit of parainfluenza showing nationwide; other than that, only influenza is showing.


Of course regular coronavirus might be prevalent & I've also heard a # of people complaining of allergy symptoms which might be leading to testing for flu & coming neg.




About the 21day spread between seasonal & H1N1 - BC has done a flip flop and will now make them available for simulteneous vax, 1 in each arm.


The CDC says this:

Can the seasonal vaccine and the 2009 H1N1 vaccine be given at the same time?


Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.



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I just called and our hospital is saying that there must be 28 days if you're getting the seasonal flu mist spray and the H1N1 flu mist spray.


But no waiting period between the vaccines.


And for our hospital it's only available to kids 6 to 24.

Adults 25 to 60-something w/ chronic probs.

Health care workers.


That leaves me out, but takes care of my boys and dh.



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