About The H1N1 Flu

The H1N1 flu, also referred to as “swine flu,” has caused thousands of hospitalizations and more than 600 deaths in the United States since it was first detected in April 2009.

It is spread through person-to-person contact, often by sneezing or coughing, similar to transmission of the seasonal flu virus. Symptoms of the H1N1 flu and the seasonal flu both include a cough, sore throat, runny nose, body aches, headache, chills, tiredness, and sometimes fever, vomiting, and diarrhea.

About The H1N1 Vaccine

MDS patients are generally advised to get the seasonal and H1N1 vaccines as soon as they become available in their area. The seasonal flu vaccine will not protect against H1N1, so MDS patients are advised to get both vaccines.

Dr. Bart Scott, an MDS specialist at the University of Washington and Fred Hutchinson Cancer Research Center in Seattle, explained, “I think of MDS as not only a disease of low peripheral blood counts, but also of impaired function. Therefore, there is a possibility that MDS patients with normal neutrophils have impaired immunity. For that reason, I recommend that all of my MDS patients receive the standard influenza vaccine.”

The H1N1 vaccine is available in two forms. The nasal spray contains a live but weakened (or attenuated) version of the virus, while the flu vaccine shot, which gets injected into the muscle, contains an inactivated (or dead) version of the virus. MDS patients should only get the flu vaccine shot, which contains H1N1 viruses that have been killed and which cannot make recipients sick with the flu.

In regard to the H1N1 vaccine, Dr. Scott said, “I would not recommend that patients with impaired immune function receive the intranasal version, nor their family members. However, they may benefit from receiving the dead virus vaccination administered as a subcutaneous shot.”

The H1N1 vaccine takes two weeks to create immunity within the body, but protection lasts up to a year. The flu season generally reaches its peak in December or January and can often last into April or May.

At this time, only one dose of the H1N1 flu vaccine is recommended to achieve immunity. However, the vaccine may have lower effectiveness in people 65 and older, as well as those with chronic medical conditions. Although it is considered generally safe for MDS patients, the H1N1 vaccine may not be as effective for them as it is for healthy individuals, since MDS affects the immune system. This is especially true for those MDS patients taking immunosuppressive drugs like anti-thymocyte globulin (ATG) or cyclosporine.

The H1N1 vaccine has no recorded negative interactions with MDS medications. However, it has been suggested by some doctors that patients wait until the end of treatment cycles of drugs such as Vidaza before receiving the H1N1 vaccine.

As long as patients are not currently suffering from other non-MDS illnesses, such as infections or other illnesses that produce fever, the inactivated H1N1 vaccine is considered safe for individuals with MDS. If a patient is experiencing a non-MDS illness, he or she should wait until symptoms, including fever, recede before receiving the vaccine.

The H1N1 vaccine, like any other medication or vaccine, carries risks. Serious complications, such as allergic reactions, are rare, but are distinguished by high fever or behavior changes after vaccination. Serious side effects such as these should be reported to a doctor or specialist right away. Mild reactions to the vaccination include soreness, redness, or swelling at the injection site, body aches, coughing, and fever.

The available 2009 H1N1 vaccine was created using the same processes and facilities used to make the currently licensed seasonal flu vaccine. Both have been tested for safety and effectiveness.

MDS patients are encouraged to speak with their doctors or specialists regarding specific concerns about the vaccine.

In many cases, availability of the H1N1 vaccine is limited, so certain groups have been given priority over others to receive it. Among those given priority are people ages 25 through 64 years of age with chronic health disorders or compromised immune systems, including MDS patients.

So far, families of MDS patients are not part of this priority group. However, family members are encouraged to get vaccinated with the inactivated version of the H1N1 vaccine, especially if circumstances prevent the MDS patient from getting vaccinated.

MDS patients and families who received the 1976 swine influenza vaccine are recommended to also receive the 2009 H1N1 vaccine. The difference between the two viruses is significant enough that the 1976 vaccine will not likely protect against H1N1.

MDS patients and families who have experienced flu-like symptoms since the spring of 2009 should still be vaccinated against H1N1.

Preventing H1N1 Infection

Even if an MDS patient gets the H1N1 vaccine, he or she should continue taking all necessary precautions to prevent infection, since the vaccine may not be as effective in people with compromised immune systems.

Patients and families should wash their hands with soap and water, or alcohol-based hand cleansers, after sneezing or coughing. They should also avoid touching their eyes, nose, or mouth, as well as avoid others who are experiencing H1N1 symptoms. MDS patients should also consider wearing a face mask when in crowded public places or while traveling.

Treating H1N1 Infection

A specific test is needed to determine H1N1 infection. If an MDS patient develops H1N1 or the seasonal flu, their doctor may advise the patient to take an antiviral drug, either Relenza (zanamivir) or Tamiflu (oseltamivir).

Antiviral drugs are prescription medications such as pills, liquid, or inhaled powder that stop flu viruses from reproducing inside the body. These drugs can make illness milder, lead to quicker recovery, and may prevent serious flu complications. Antiviral drugs should be taken within 48 hours or as soon as possible after symptoms begin for maximum effectiveness.

For more information about the H1N1 vaccine, please visit the CDC Web site, the Aplastic Anemia and MDS International Foundation Web site, and previous MDS Beacon coverage of the H1N1 vaccine.

The H1N1 flu, originally known as the swine flu, is responsible for thousands of hospitalizations and more than 170 deaths since the spring. Symptoms of the H1N1 flu and the seasonal flu are similar and include fever, cough, sore throat, runny nose, body aches, headache, chills, tiredness, and sometimes vomiting and diarrhea.

Blood disorders and cancer can increase complications due to the flu. Therefore, MDS patients should take extra precautions to avoid the H1N1 flu and the seasonal flu.

A vaccine for the H1N1 virus is currently undergoing clinical trials and is expected to be available to patients in mid-October. The CDC hoped to have 120 million doses of the H1N1 vaccine available by October 15. However, delays in the manufacturing process have reduced the expected number to only 45 million doses.

It is also still unknown if patients will need one or two doses to receive immunity against H1N1. Initial results from clinical trials conducted in the U.S. suggest that a single dose of the H1N1 vaccination is effective within eight to ten days.

Due to limitations in dose quantities, the CDC is targeting select population groups in the initial round of vaccinations. Patients with MDS are advised to receive the seasonal influenza and H1N1 vaccinations, due to an increased risk for influenza-related complications.

If a person develops H1N1, it can be treated with an antiviral drug, either Relenza (zanamivir) or Tamiflu (oseltamivir). Treatment is most effective if started within 48 hours of the onset of symptoms.

For more information about the H1N1 virus, please visit the Cancer Consultants Web site and the CDC Web site.