H1N1 rebound question for Perry/hornblower or if anyone else knows

[HappyGrace]

I am hearing from friends IRL and read a couple posts here about how people will get h1n1 for a couple days, feel better and go back to regular activity, then rebound with the illness a couple days later and sometimes it's worse.

 

A df said this happened to them and she saw on the Mayo Clinic site that this is common (I can't find it on there.) Like I said, several other friends have had this happen, and I read it on here too. People (and I think that Mayo Clinic site) are saying to take it easy for about a week to make sure.

 

Anyone hear of this? What is the recommendation?

 

I'm wondering because although we still have fevers here, the kids are feeling much better and if the fevers go away by tomorrow, I expect they would not be contagious and would be well enough by Wed to attend sports activities, but now I'm not so sure if that's a good idea!

[WishboneDawn]

That sounds like secondary infections. The flu depresses your immune system and leaves you vunerable to bacterial infections. It's not actually the H1Ni in the rebound and it's something that's a problem with even the seasonal flus.

 

It's how I got bronchitis last spring.

[Mommyof4ks]

That is happening around here too. It happened to me with the seasonal flu last year too. I don't know why, but it is not uncommon and I did not have a secondary infection.

[HappyGrace]

See, that would be the typical thing that they would look for-secondary infection-but people are going back to the dr., thinking that's what it is, and it is not. It's very strange!

[swellmomma]

See, that would be the typical thing that they would look for-secondary infection-but people are going back to the dr., thinking that's what it is, and it is not. It's very strange!

 

Yup, it ihas happened with 2 of my kids already. It was not secondary infections. They seemed to be getting better, they still did not resume normal activity but certainly more than they had been doing. (As in they got up and played with toys rather than laying in bed/on the couch all day). The next day they were sick again, high fever etc. Both were worse for about 24 hours than they had been for the whole course of their illness at that point. The one was presumably fine again for about 24 hours, then played a bit and is now feeling sick again though to a lesser degree than before. We have been playing this yo-yo for 4 days or so now. The other is feeling better today(after a rebound yesterday), so we will see.

 

I have still been making them take it easy, gave up our regular activities, they are all having a mid-day nap. Quiet play, reading and videos during the day. Not their normal high energy activities. BUT as soon as they pick up the pace of their play, even to add crawling around the room driving cars rather than just sitting and the next day they are sick again. It is like the movement/activity is stirring everything up inside and kicking the virus into action again.

[Tree House Academy]

I have heard quite a bit of this...more with kids than with adults, it seems.

 

I do worry about secondary infections - maybe they aren't life threatening ones, but what about bronchitis? My dh always gets sick, then gets bronchitis on top of it. He has to use an inhaler for the duration of the illness or he gets down with it. Perhaps these kids are developing bronchitis? Or something else that is more "mild" than pneumonia?

 

At any rate, hope you all feel better soon.

[Jennifer in MI]

This fits our pattern here too. I had 4 days or so of nausea, body aches, chills, exhaustion, etc. Then I was better for a couple days and then came down with the terrible cough that lasted two weeks. I was quite sick the first 2 days with the cough and then it was just annoying.

 

A couple of my kids had the cough from the beginning, but also felt better after a few days and then got worse.

 

Now, dd - the only one who wasn't sick when the entire rest of the family had presumed H1N1 - has a fever (102.5!) and sore throat. But, she's eating normally and acting fine.

 

I'm starting to feel like this will never end.

[hmschooling]

My husband isn't an RN yet, but is in RN school surrounded by RN's and works clinicals in the hospital-- his instructors are telling him (since they know I am pregnant) and several students have contracted it, that even 5 days after the fever is gone (that's WITHOUT medication to keep it down) the person is still contagious. And about two days before the fever starts. If you have/had H1N1, you should wear a mask and try to avoid being around others.

 

Deaths of children with it here have increased and doctors are warning children and pregnant women to stay away from all public places. It's serious business...fever and cough will be the most prominent first signs. Most people that get it won't feel fine a couple days later then sick again unless they've gotten the H1N1 vaccine and are able to fight it off easily.

[HappyGrace]

I definitely don't want to pass it on to ANYONE, particularly compromised people, and we are willing and able to stay home as long as we need to do so. However, the CDC website itself says that 24 hours after last sign of fever, and they are no longer recommending 7 days, etc.:

http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

 

Reading further down that page, it says that individual communities can make other decisions based on need. I wonder if that's what's going on in your community?

 

Although it would make sense that it's the same virus everywhere at this point-either it is or is not communicable for the same amount of time wherever it shows up. I wonder why there are discrepancies? There has been so much faulty info all along with this thing-it's hard to know what to do!

 

It does say that you may be "shedding" virus but at a lower level after 24 hours-I guess that is probably what your RNs are talking about. I wonder why the CDC changed the recommendation then? I guess probably economic considerations.

Edited November 2, 2009 by HappyGrace

[Tree House Academy]

Deaths of children with it here have increased and doctors are warning children and pregnant women to stay away from all public places. It's serious business...

 

Where do you live? I have yet to have a doctor tell children to stay out of all public places. Are they suggesting kids stop going to public school too? That is not very sound advice if they are. They are no more exposed at, say, Walmart than they are at school. Actually much less so!

 

Yes, there are deaths and they expect more before it is over, but 99.95% of people who get H1N1 do not die.

[Perry]

I definitely don't want to pass it on to ANYONE, particularly compromised people, and we are willing and able to stay home as long as we need to do so. However, the CDC website itself says that 24 hours after last sign of fever, and they are no longer recommending 7 days, etc.:

http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

 

I wonder why there are discrepancies? There has been so much faulty info all along with this thing-it's hard to know what to do!

It is confusing, isn't it? The difficulty is that each virus, and even each strain of virus, behaves a little differently, so it takes awhile to sort things out. In addition, recommendations change depending on how the epidemic plays out. If we were seeing a really virulent influenza, with high case fatality rates, they would be much more extreme with recommendations to prevent transmission.

 

Absence of fever doesn't mean you aren't contagious. People shed virus for 7-10 days after infection with influenza. The amount of virus is highest at the beginning of the illness and you are most contagious then. You can be contagious for ~24 hours before symptoms, although you probably shed virus in lower amounts than after symptoms begin.

 

By one week, most people aren't contagious. Young children and immunocompromised people tend to shed virus longer than others.

 

As long as you have symptoms (cough, sore throat) you are probably contagious. Although if you develop a secondary infection, like pneumonia or bronchitis, and are coughing because of that, you aren't necessarily contagious anymore.

 

 

It is true that they are not recommending people stay home until all risk of contagion is over.

 

If we wanted to accept zero risk for transmission, everyone would have to stay home for 10-14 days after an ILI, and until their symptoms are completely gone. That clearly isn't possible and would be extremely disruptive. Schools and businesses would close, there would be a severe shortage of doctors and nurses and other HCW, there would be all kinds of travel restrictions, people would lose their jobs, and it would have a major economic impact globally. Obviously that would be a ridiculous overreaction to what's turning out to be a fairly mild illness for the great majority of people. So the question is where you draw the line. I believe CDC is trying to strike a reasonable balance between reducing social/economic disruption and minimizing transmission of influenza.

 

 

CDC

 

This revision for the community setting is based on epidemiologic data about the overall risk of severe illness and death and attempts to balance the risks of severe illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption.

Edited November 2, 2009 by Perry

[hornblower]

Argh - I wrote a long reply & then I got a server busy & it was all lost.....

 

I wouldn't plan sports for Wed.

 

The official recommendation is 24 afebrile without use of tylenol/motrin etc. I personally think that's too short.

 

I think the recommendations are trying to strike a balance between public health & the economy. School closures are controversial and expensive & parents wants to send their kids back as soon as possible due to loss of wages etc.

 

And even if it's safe for the community (because the recovering person is no longer shedding) it may not be safe for the person - are they ready to be exposed to all the other germs that are out there?

 

I wouldn't do sports on Wed. I'd plan a few more quiet days, walks in the fresh air, nature walks etc and slowly resume normal activities 3-4 days after no fever & feeling well again.

 

 

Also a btw, Ukraine is shutting schools & public places etc for 3 weeks to stop the spread. Nationwide shut down. I can't figure out if they're over -reacting or rationally assessing the state of their health system, or what....

 

 

And stas are funny things - 90% of polio infections cause NO SYMPTOMS AT ALL. I was thinking about this when pondering the pov that some people hold about vaccinating for the 'real dangerous things'....

[Perry]

I have heard this anecdotally but so far haven't seen any good explanation. I'll let you know if I hear anything.

 

My dh and ds both had what I first thought was a mild case of flu for about a week. They had a little sore throat, conjunctivitis, and mild cough. Dh got better, but as ds was almost recovered, he suddenly developed high fevers, terrible cough, and felt generally awful. He gradually got better, but the cough continued and we treated him for bronchitis.

 

Now I don't know if that first week was some other virus and then he developed flu, or if he had mild flu which suddenly got worse after a week. Guess I'll never know.

[HappyGrace]

I hate server busy-bummer, Hornblower!

 

Like I said, with our homeschooling lifestyle, we are fine to stay home as long as needed.

 

Ds is a day ahead of dd, and he is down to about 101.5 and playing a little. Dd is still at about 102.5 and comfortable, but wanting to just rest. It won't hurt them to be restful for 3-4 more days, and then we'll evaluate. I don't want them to overdo and rebound, or to pick up any other illness. And I'll feel we're doing our part to not spread germs to others!

 

I can see the pressure the CDC would have on them-with economic issues, etc. I thought 24 hours with no fever seemed really short, and it couldn't have hurt to go 48 hours!

 

Interesting about Ukraine!

 

I'm finding it really interesting too about this rebound of the illness, and would love to hear more!

 

A HUGE thank you to Perry and Hornblower-our resident flu experts! Let's sign you up to take over public relations at Mayo-lol!

[mom2jjka]

This happened to my kids.

They had the high fevers and felt lousy for a couple of days, got better, and then the fevers returned. The second round DD's cough turned into croup. :-(

[Rebecca VA]

I read that the Ukraine is being hit with the pneumonic plague. It's almost untreatable, and they're terrified, and that's why public gatherings and travel between regions are being discouraged.

 

Here's a link: http://mignews.com.ua/en/articles/376396.html

[hornblower]

re Ukraine - WHO's latest says it looks like H1N1. They've found H1N1 by rt-pcr.

 

http://www.who.int/csr/don/2009_11_01/en/index.html

 

They're running confirmatory tests & I'm sure there's a rush to do the genetic sequences there to see what's going on. There's a WHO team on the ground investigating.

[Tree House Academy]

I read that the Ukraine is being hit with the pneumonic plague. It's almost untreatable, and they're terrified, and that's why public gatherings and travel between regions are being discouraged.

 

Here's a link: http://mignews.com.ua/en/articles/376396.html

 

 

Looks like 10K cases documented and 27 people died - 20 of flu and 7 of unknown illnesses. What in the world are they doing???:001_huh:

[Tree House Academy]

re Ukraine - WHO's latest says it looks like H1N1. They've found H1N1 by rt-pcr.

 

http://www.who.int/csr/don/2009_11_01/en/index.html

 

They're running confirmatory tests & I'm sure there's a rush to do the genetic sequences there to see what's going on. There's a WHO team on the ground investigating.

 

 

Is this a mutated H1N1 then? Or is that what they are thinking? Otherwise, it sounds like they are over-reacting (or maybe just reacting strongly?) to what the rest of the world is dealing with...?

[hornblower]

Looks like 10K cases documented and 27 people died - 20 of flu and 7 of unknown illnesses. What in the world are they doing???:001_huh:

 

 

"As of 30 October 2009, over 2,300 individuals have been admitted to hospital, including over 1,100 children. One hundred and thirty one (131) cases have required intensive care, including 32 children. As of 31 October 2009, a total of 38 fatalities associated with severe manifestations of ARI have been registered. Preliminary epidemiological data analysis indicates that severe cases and deaths primarily occur among previously healthy young adults aged 20 – 50 years. Fatal and severe cases are reported to have sought medical attention 5 to 7 days after onset of symptoms.

International experience of the (H1N1) 2009 pandemic to date, especially from the Southern Hemisphere, has shown that poor clinical outcomes are associated with delays in seeking health care and limited access to supportive care. In addition, this virus has also shown its ability to cause rapidly progressive overwhelming lung disease which is very difficult to treat."

 

I think they're looking at over 65 deaths now.

 

Bulgaria is apparently also shutting things down.

 

I do suspect this has to do a lot with an assessment of the status of the medical system. For all that our hospitals and ICU's are groaning under the strain, we're ticking along. These countries just do not have the hospitals or ICU's or vents to cope. Their only hope - given the late rollout of vax - is to limit transmission.

[Tree House Academy]

"As of 30 October 2009, over 2,300 individuals have been admitted to hospital, including over 1,100 children. One hundred and thirty one (131) cases have required intensive care, including 32 children. As of 31 October 2009, a total of 38 fatalities associated with severe manifestations of ARI have been registered. Preliminary epidemiological data analysis indicates that severe cases and deaths primarily occur among previously healthy young adults aged 20 – 50 years. Fatal and severe cases are reported to have sought medical attention 5 to 7 days after onset of symptoms.

International experience of the (H1N1) 2009 pandemic to date, especially from the Southern Hemisphere, has shown that poor clinical outcomes are associated with delays in seeking health care and limited access to supportive care. In addition, this virus has also shown its ability to cause rapidly progressive overwhelming lung disease which is very difficult to treat."

 

I think they're looking at over 65 deaths now.

 

Bulgaria is apparently also shutting things down.

 

I do suspect this has to do a lot with an assessment of the status of the medical system. For all that our hospitals and ICU's are groaning under the strain, we're ticking along. These countries just do not have the hospitals or ICU's or vents to cope. Their only hope - given the late rollout of vax - is to limit transmission.

 

I see. My numbers were from the article Rebecca in VA posted, but I see now that I took numbers from Oct 28.

 

In the WHO article you linked, it said that they are seeing most severe illness in younger people, just like here. Do you think they are just being overwhelmed in general? I am not sure what you meant by "they are looking at the over 65 deaths now."

 

The article Rebecca in VA posted also said that they had decided NOT to vaccinate at this point::confused:

 

05:39 p.m. Doctors are calling on citizens not to vaccinate against influenza, because such vaccination in the midst of the epidemic may injure the health, coordinator of epidemic influenza in Lviv Miron Borysevich claimed at a press conference, proUA.com reports.

 

"When an outbreak of influenza begins, nobody is being vaccinated. From the point of view of epidemiology this can not be done because it is harmful. It may harm the patient," - he said.

[Perry]

 

05:39 p.m. Doctors are calling on citizens not to vaccinate against influenza, because such vaccination in the midst of the epidemic may injure the health, coordinator of epidemic influenza in Lviv Miron Borysevich claimed at a press conference, proUA.com reports.

 

"When an outbreak of influenza begins, nobody is being vaccinated. From the point of view of epidemiology this can not be done because it is harmful. It may harm the patient," - he said.

That's strange.

I don't think you'll hear this from WHO.

[grace'smom]

Is this a mutated H1N1 then? Or is that what they are thinking? Otherwise, it sounds like they are over-reacting (or maybe just reacting strongly?) to what the rest of the world is dealing with...?

 

The Washington Post is questioning whether this is a hype because of upcoming political elections. I'll find a link...

 

Sorry, I made a mistake. It wasn't Washington Post, it was Comcast News... Here is the link http://www.comcast.net/articles/news-world/20091102/EU.Ukraine.Swine.Flu/

Edited November 2, 2009 by grace'smom
insert link, edit source citation

[Tree House Academy]

That's strange.

I don't think you'll hear this from WHO.

 

LOL - I thought it was pretty bizarre too...unless they are just worried that vaccinating will weaken ones immune system until they build immunities making them more vulnerable to the flu going around???

[RanchGirl]

I am hearing from friends IRL and read a couple posts here about how people will get h1n1 for a couple days, feel better and go back to regular activity, then rebound with the illness a couple days later and sometimes it's worse.

 

A df said this happened to them and she saw on the Mayo Clinic site that this is common (I can't find it on there.) Like I said, several other friends have had this happen, and I read it on here too. People (and I think that Mayo Clinic site) are saying to take it easy for about a week to make sure.

 

Anyone hear of this? What is the recommendation?

 

I'm wondering because although we still have fevers here, the kids are feeling much better and if the fevers go away by tomorrow, I expect they would not be contagious and would be well enough by Wed to attend sports activities, but now I'm not so sure if that's a good idea!

 

We had whatever is going around (I'm not sure it's h1n1 since so few cases are actually testing positive for h1n1 according to CBS news and now they've stopped testing anyway) and dh and the kids did not have the relapse, but I did. It was worse than the initial illness! I have a tendency toward bronchitis and I did not rest well after the illness; I was immediately back to my typical pattern of staying up late and not getting enough sleep. I think sleep is critical with this one.

 

I noticed that both my son and his friend got really unusually winded playing basketball a few days after they were symptom-free. Red in the face, gasping for breath after 1 quarter, which is not typical for either of them. Although neither relapsed into illness, they definitely were not 100% ready to be back to their normal athletic selves. I would say give it a few days after the fever and other symptoms are gone, and after that still allow for extra rest and recovery time after sports.