Weekly Update

Disease Activity

46 states now report widespreaed disease. Interestingly, South Carolina is in the minority 4 reporting only regional disease prevalence. Remember, we were one of the first to report widespread disease. In "typical" outbreaks of flu it peaks and then starts its' decline within 8 weeks of increasing activity taking another 8 weeks to reach it's baseline again. We are in week 9 of increasing activity of H1N1 nationwide and the increase continues at a steep incline having doubled in the last 4-5 weeks. The CDC breaks the activity down into regions and our region had noted a slight downward trend in the previous 2 weeks but then has started to rise again in the last week of reporting ending Oct 17th. Unfortunately, with all the statistics being monitored, we are at a loss at any attempt to predict what will happen next.

The Vaccine

No news is NOT good news and that is all we have. No change has occurred since the last post. We invite you to still check back frequently as any change will be posted the day it happens.

The Test

There still seems to be a fair amount of misunderstanding regarding testing for H1N1. Yes there is a rapid test for influenza A. H1N1 "Swine" flu is a strain of influenza A. However because of the newness of this strain, the test is highly unreliable and a negative test does not mean that you do not have Swine Flu. If you are in a high risk category which has been defined in previous blogs, and have symptoms that highly suggest that you have this flu, then you need to be on Tamiflu. Do not be relieved if you are tested and the test is negative. We in our office test rarely, mainly for surveillance purposes, if testing for another virus such as RSV which is becoming more active and can look just like flu at the onset, and if the child is hospitalized, which I don't think that has happened yet in our patient population. There was a very prominent case this past week in the Midwest in which treatment was delayed because of a negative rapid test that lead to yet another communication from that CDC to all physicians yet again reemphasizing this point.

Prevention Of Pneumococcal Infections Secondary To Seasonal And 2009 H1N1 Influenza

Pneumococcal disease is an infection caused by a type of bacteria called Streptococcus pneumoniae (pneumococcus). When these bacteria invade the lungs, they can cause pneumonia. They can also invade the bloodstream (bacteremia) and/or the tissues and fluids surrounding the brain and spinal cord (meningitis). Pneumococcal infection kills thousands of people in the United States each year, most of them 65 years of age or older.

Influenza infections can make people more likely to develop bacterial pneumonia. Pneumococcus is the most common cause of bacterial pneumonia. Pneumococcal infections are a serious complication of seasonal and 2009 H1N1 influenza infections.

There are 91 strains of pneumococcal bacteria. Pneumococcal conjugate vaccine (Prevnar)protects against 7 of them. These 7 strains are responsible for most severe pneumococcal infections among children. Since Prevnar came into use, severe pneumococcal disease has dropped by nearly 80% among children under 5. This vaccine is part of your child's routine immunization schedule and is given in 4 doses at 2,4, 6, and 12 months. If your child is up to date on their check up schedule through 12 months of age then they should have completed this series.


Pneumococcal polysaccharide vaccine (Pneumovax) protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease and is only effective in children over 2 years of age. A single dose is effective.

The CDC has come out in the past week highlighting the need for certain people to receive this vaccine in addition to the Prevnar as an additional step in preventing complications of influenza in certain at risk people.

Pneumovax is recommended for:

People who are 65 years of age and older

People 2 years of age and older who have a chronic illness such as

-Cardiovascular Disease- This would primarily be children who have cyanotic congenital heart disease or other uncorrected heart lesions that may be on medication for the same.
-Lung disease- This would include children with Cystic Fibrosis or other lung conditions that require daily medication for control of symptoms.
-Sickle Cell Disease
-Diabetes
-Alcoholism
-Chronic Liver Disease
-Cerebrospinal Fluid (CSF) Leak- This would be a post surgical or trauma induced condition.
-Cochlear Implant
-People 2 years of age and older with a weakened immune system
Due to illnesses such as:
-HIV infection
-AIDS
-Chronic Renal Failure
-Nephrotic Syndrome
-Organ or Bone Marrow Transplantation
-Hodgkin’s disease
-Leukemia
-Lymphoma
-Multiple Myeloma
-Generalized Malignancy
-Those receiving immunosuppressive therapy (e.g., steroids at a dose of 20 mg daily or greater on a long term basis)
-Those who have had their spleen removed or whose spleen is dysfunctional due to an illness such as sickle cell disease.
-Residents of nursing homes or long-term care facilities
-People 19 through 64 years of age who smoke cigarettes or have asthma.

This list is rather extensive though should only be applicable to a small percentage of our patient population. If you have questions regarding the need for this vaccine for your child then please call our office.