Who should be treated for H1N1 flu?

October 18, 10:35 PMBaltimore Health ExaminerDr. Delia Chiaramonte

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H1N1 influenza

courtesy of novavax.com

Many people will get H1N1 flu this season yet most of them won't get any treatment beyond acetaminophen, soup and a week on the couch.  How is it decided which patients will get treatment?

The Centers for Disease Control (CDC) has determined that flu sufferers who are at highest risk of severe complications should be prioritized for antiviral treatment.  High risk groups include:

• pregnant women
• diabetics
• people with heart disease
• people with lung disease, including asthma and COPD
• people who are seriously ill

It is important to realize that antiviral treatment is most effective when started within 48 hours of the initiation of symptoms.  So if you are in a high risk group you might consider asking your doctor for a prescription now -- before you have any symptoms at all.  If you never get the flu you can discard it.  But if you develop symptoms of fever, cough and body aches on a Friday evening you will be able to begin the medicine when it is most effective.

It is worth noting that a significant percentage of children who died of H1N1 infection had a simultaneous serious bacterial infection.  Severe viral infections, such as flu, can make patients more likely to pick up a bacterial infection just as they are beginning to recover.  So if your child has flu-like symptoms, begins to feel better and then develops a new fever, pay attention.  Remind your doctor of the association between H1N1 infection and bacterial infection and request a prescription for antibiotics.

Given that both the H1N1 and seasonal flu can be fatal, why aren't all flu sufferers getting treated with antivirals?  The CDC's goal is to prevent high risk people from dying of flu while minimizing the development of resistant viral strains.  If antivirals are overused now they may lose their effectiveness in the future.  This is an important public health concern and I am glad that the CDC is addressing it.  However, does that mean that you cannot request a prescription for Tamiflu or Relenza if you develop the flu - whether or not you are in a high risk group?  No, it doesn't.  That decision is between you and your doctor.