Common herb has flavonoids that fight flu virus

A commonly used Chinese herb for cold and fever contains ingredients that can fight influenza viruses, a study in China suggests.

Elsholtzia rugulosa (野拔子 ye ba zi), a common Chinese herb, is widely used in the treatment of cold and fever. A group of researchers of the Chinese Academy of Medical Sciences and Peking Union Medical College, as well as University of Macau investigated the anti-flu functions of the ingredients of this plant.
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In order to elucidate the action mechanism and the active principles from the plant against anti-influenza virus, the influenza virus neuraminidase (NA) activity assay and in vitro antiviral activity assay were established, and the isolation of the active principles was guided by NA activity.

Their study established that five active constituents were found in ye ba zi and they are all flavonoids.

What are flavonoids? Flavonoids (or bioflavonoids) are a class of plant secondary metabolites fulfilling many functions including producing yellow or red/blue pigmentation in flowers and protection from attack by microbes and insects. The widespread distribution of flavonoids, their variety and their relatively low toxicity compared to other active plant compounds (for instance alkaloids) mean that many animals, including humans, ingest significant quantities in their diet. Flavonoids have been referred to as “nature’s biological response modifiers” because of strong experimental evidence of their inherent ability to modify the body’s reaction to allergens, viruses, and carcinogens. They show anti-allergic, anti-inflammatory, anti-microbial and anti-cancer activity.

Consumers and food manufacturers have become interested in flavonoids for their medicinal properties, especially their potential role in the prevention of cancers and cardiovascular disease. The beneficial effects of fruit, vegetables, and tea or even red wine have been attributed to flavonoid compounds rather than to known nutrients and vitamins.

The five constituents are:

1. apigenin
2. luteolin
3. apiin
4. galuteolin
5. luteolin 3′-glucuronyl acid methyl ester

According to the researchers, these constituents all possessed anti-influenza virus activity. Among them, apigenin and luteolin exhibited the highest activities against influenza virus (H3N2).

What is apigenin? Apigenin is described as a nonmutagenic bioflavonoid which is presented in leafy plants and vegetables (e.g., parsley, artichoke, basil, celery) and has significant chemopreventive activity against UV-radiation. Current research trials indicate that it may reduce DNA oxidative damage; inhibit the growth of human leukemia cells and induced these cells to differentiate; inhibit cancer cell signal transduction and induce apoptosis (cell death); act as an anti-inflammatory; and as an anti-spasmodic or spasmolytic.

Apigenin is also reported to be useful in fighting against antiestrogen-resistant breast cancer.

Apigenin is a bioflavone, considered to have a bioactive effect on human health as antioxidant, radical scavenger, anti-inflammatory, carbohydrate metabolism promoter, immunity system modulater.

What is luteolin? Luteolin is a flavonoid thought to play an important role in the human body as an antioxidant, a free radical scavenger, an agent in the prevention of inflammation, a promoter of carbohydrate metabolism, and an immune system modulator. These characteristics of luteolin are also believed to play an important part in the prevention of cancer. Multiple research experiments describe luteolin as a biochemical agent that can dramatically reduce inflammation.

Luteolin inhibited the excess production of TNF-alpha, which directly causes inflammation and apoptosis. Luteolin also offers hope to develop a novel type of anti-inflammatory and anti-allergic drugs.

Luteolin is most often found in leaves, but it is also seen in rinds, barks, clover blossom and ragweed pollen. It has also been isolated from Salvia tomentosa. Dietary sources include celery, green pepper, perilla and camomile tea.

Allergic Eczema

Allergic eczema (atopic dermatitis) is an allergic rash that is usually not caused by skin contact with an allergen. This condition is commonly associated with allergic rhinitis or asthma and features the following symptoms:

* Itching, redness, and or dryness of the skin
* Rash on the face, especially children
* Rash around the eyes, in the elbow creases, and behind the knees, especially in older children and adults (rash can be on the trunk of the body)

Placebo effect may be at play in acupuncture studies: analysis

Reuters Health – Acupuncture can bring some relief to people with knee arthritis, but the benefits may be at least partly from a placebo effect, a new research review suggests.

In an analysis of 9 clinical trials from the past 15 years, researchers found that acupuncture generally seemed to improve knee arthritis sufferers’ pain and stiffness in the short term. The patients had osteoarthritis, a degenerative joint disease associated with age, as opposed to arthritis associated with an autoimmune disorder.

However, a closer look showed that the benefits were limited to trials that compared acupuncture with doing nothing or with “usual care,” such as anti-inflammatory medication.

In trials that compared acupuncture with “sham” acupuncture, on the other hand, there was no clear evidence that the real therapy was more effective.

Sham acupuncture is accomplished by using non-penetrating needles, or inserting needles only into the superficial layer of skin, at random sites rather than the specific points used in real acupuncture. In studies that evaluated electro-acupuncture, the sham version involved phony electrodes and “mock” electrical stimulation of acupuncture points.

The point is to keep study participants from knowing whether they were receiving the real or the placebo treatment. This helps separate the specific effects of a therapy from any placebo effects — where people feel better simply because they believe they’ve been treated.

The new findings suggest that the benefits of acupuncture for knee arthritis are at least partly due to patients’ expectations, the study authors report in the Annals of Internal Medicine.

However, that doesn’t mean acupuncture is not worthwhile, according to the researchers, led by Eric Manheimer of the University of Maryland School of Medicine in Baltimore.

Research does suggest that acupuncture has a “genuine biological effect,” and there was evidence in some studies that the real therapy resulted in somewhat better short-term effects than sham acupuncture, the researchers note.

For their study, Manheimer and his colleagues combined the results of nine clinical trials conducted in Europe, the U.S. and Thailand. The trials included a total of more than 3,500 subjects.

Each trial included a patient group that received acupuncture for knee arthritis, as well as a “control” group. In some studies, control patients were placed on a waiting list for acupuncture, while in others they received some standard therapy that acupuncture patients did not. Control patients in other studies received sham acupuncture.

In general, the Manheimer’s team found, only studies that pitted acupuncture against doing nothing, or against standard care, showed clear benefits. The results of the sham-controlled trials were too mixed to show any benefits, according to the researchers.

The investigators do not, however, dismiss the potential benefits of acupuncture for knee arthritis. Indeed, they note, a possible explanation for the mixed results is that sham acupuncture had some actual biological effects.

Given the overall safety of acupuncture, the researchers conclude, patients can still consider it as one option in a “multidisciplinary approach” to treating knee arthritis.

Red yeast rice may lower blood lipid levels

CM NEWS – Replacing daily intake of white rice with red yeast rice may have a positive lipid-lowering effects in patients with primary hyperlipidemia, a meta-analysis of 93 randomized trials concludes.

The study was released in Chinese Medicine journal and was a joint study by alternative medicine experts in Norway and traditional Chinese medicine researchers in Shanghai and Beijing.

The meta study analyzed data from 93 randomized trials which include a total of 9625 participants. Researchers find that hyperlipidemia patients who have consumed red rice show significant reduction of serum total cholesterol levels (weighted mean difference -0.91 mmol/L, 95% confidence interval -1.12 to -0.71), triglycerides levels (-0.41 mmol/L, -0.6 to -0.22), and LDL-cholesterol levels (-0.73 mmol/L, -1.02 to -0.043), and increase of HDL-cholesterol levels (0.15 mmol/L, 0.09 to 0.22), compared to placebo groups.

Researchers emphasize that the positive effect on lipid levels by red rice shown by these studies indicates short term benefits. Whether red rice should be recommended as an alternative treatments for primary hyperlipidemia requires further studies.

According to Medline, red yeast rice contains several compounds collectively known as Monacolins, substances known to inhibit cholesterol synthesis. One of these, “Monacolin K” is a potent inhibitor of HMG-CoA reductase, and is also known as Mevinolin or Lovastatin (Mevacor®, a drug produced by Merck & Co., Inc).

Medline also says:

There is limited evidence about the side effects of red yeast. Mild headache and abdominal discomfort can occur. Side effects may be similar to those for the prescription druglovastatin (Mevacor®). Heartburn, gas, bloating, muscle pain or damage, dizziness, asthma, and kidney problems are possible. People with liver disease should not use red yeast products.

In theory, red yeast may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. A metabolite of Monascus called mycotoxin citrinin (CTN) in fermentation may be harmful.

Dan shen’s effect for stroke patients lacks strong evidence

Health Behavior News Service, by Bruce Sylvester – The traditional Chinese medicine dan shen (丹参, Salviae miltiorrhizae), a standard treatment for ischemic stroke in China, lacks strong scientific evidence to support such use, according a new review of studies.Nevertheless, based on the available data, dan shen treatment showed a tendency to improve short-term neurological deficits in stroke patients, say researchers at Sichuan University in Chengdu, China.

However, the short-term result “should be interpreted cautiously because of the poor methodological quality of included trials and the small numbers of patients,” said review co-author and neurology professor Ming Liu.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews drawevidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Obstruction of a blood vessel supplying blood to the brain can result in ischemic stroke, which accounts for about 83% of all strokes.

In China, post-stroke use of herbal medicine is part of standard care in both Western-style hospitals and in traditional Chinese medicine hospitals. Dan shen, in various pill, tablet and injection formulations, is the herb most commonly given for ischemic stroke; its use in that context spans more than three decades.

However, few researchers have tested the herb’s effectiveness in rigorous clinical trials that approach current international standards.

The reviewers found six studies that met inclusion criteria for the review — randomized or quasi-randomized and controlled — involving 494 acute ischemic stroke patients.

The Cochrane reviewers found that methods of randomly assigning study subjects to dan shen or placebo were unclear, and that this could have led to results exaggerating a positive treatment effect by 30% to 41%. “It is therefore plausible that dan shen is truly ineffective and the apparent benefits are simply due to bias arising from the methodological weaknesses of the studies,” they say.

Since treatment and follow-up in these studies ranged from 14 to 28 days, it was not possible to assess the long-term effects of dan shen.

“We found no evidence to support the routine use of dan shen agents for ischemic stroke,” Liu said. “However, if the apparently beneficial effects on neurological impairment were confirmed in methodologically rigorous trials, it would lead to a useful treatment for stroke being identified,” she added.

Ted Kaptchuck, O.M.D., associate professor of medicine at Harvard Medical School, said, “in Chinese society, at this time, basic science and laboratory evidence seems to be enough to gain widespread acceptance and adoption for the use herbal and other medications. In the West, we think it is a long shot to go from basic laboratoryevidence to demonstrated clinical efficacy in randomized trials. We are not at the point where it is clear that a traditional Chinese herb has a major role in health care.”

Liu agreed: “The designs of these trials need to be improved in the future research, not only in the clinical trials on dan shen agents, but also in trials on other Chinese herbal medicine.”

[Dan Shen agents for acute ischaemic stroke (Review). Cochrane Database of Systematic Reviews 2007, Issue 2.]

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search forevidence in the form of clinical trials and other studies of interventions.

Pandemic is a blink away

U of Maryland – A new study by University of Maryland researchers suggests that the potential for an avian influenza virus to cause a human flu pandemic is greater than previously thought. Results also illustrate how the current swine flu outbreak likely came about.
As of now, avian flu viruses can infect humans who have contact with birds, but these viruses tend not to transmit easily between
humans. However, in research recently published in the Proceedings of the National Academy of Sciences, Associate Professor Daniel Perez from the University of Maryland showed that after reassortment with a human influenza virus, a process that usually takes place in intermediary species like pigs, an avian flu virus requires relatively few mutations to spread rapidly between mammals by respiratory droplets.

“This is similar to the method by which the current swine influenza strain likely formed,” said Perez, program director of the University of Maryland-based Prevention and Control of Avian Influenza Coordinated Agricultural Project, AICAP. “The virus formed when avian, swine, and human-like viruses combined in a pig to make a new virus. After mutating to be able to spread by respiratory droplets and infect humans, it is now spreading between humans by sneezing and coughing.”
In his study, Perez used the avian H9N2 influenza virus, one that is on the list of candidates for human pandemic potential. Using reverse genetics, a technique whereby individual genes from viruses are separated, selected, and put back together, Perez and his team created a hybrid human-avian virus. Their research hybrid has internal human flu genes and surface avian flu genes from the H9N2 virus. Though it comes from a different strain of avian flu than the one that contributed to the
hybrid virus now causing the swine flu outbreak, Perez’s research virus is similar in origin to the swine flu virus, in that both involved a combination of avian and human influenza viruses.

Perez infected ferrets (considered a good model for human influenza transmission) with the virus he created, and allowed the virus to mutate in the species. Before long, healthy ferrets that shared air space but not physical space with the infected ferret had the virus, showing that the virus had mutated to spread by respiratory droplets.

When the genetic sequences of the mutant virus and original hybrid virus were compared, the only differences were five amino acid mutations, three on the surface, and two internally. Two of the surface mutations were determined to be solely responsible for supporting respiratory droplet transmission. Because so few mutations were necessary to make the hybrid H9N2 transmissible this way, they concluded that after an animal-human hybrid influenza virus forms in nature, a human pandemic of this virus is potentially just a few mutations away.

“We do not know if the mutations we saw in the lab are the same that have made the H1N1 swine flu transmissible by respiratory droplets,” Perez said. “We will be doing more research on the current swine flu strain to study its specific genetic mutations.”

Perez found that one of the two of the genetic mutations in his lab strain that enabled respiratory transmission between mammals was on the tip of the HA surface protein, one of the sites where human antibodies created in response to current vaccines would bind.

“Because the binding site of the mutant virus is different from the virus upon which the vaccine is modelled, it may mean that current vaccine stocks would not be as effective against the H9N2 mutant strain as previously anticipated,” said Perez. “We should keep this in mind when designing vaccines for an avian flu pandemic in humans.”

However, scientists cannot predict what the actual mutations will look like if and when they occur in nature, or even which strain of avian influenza will mutate to infect mammals.

“This is just the tip of the iceberg,” said Perez. “Many more studies have to be done to see which combinations of mutations cause this type of transmission before we can design the appropriate vaccines.”

Perez will be talking this week with the NIH and the CDC to discuss his team’s role in researching the current swine flu virus strain. Perez will likely do studies related to vaccine development, virus transmission between humans and animals, and the pathogenesis of the virus.

A virus vaccine is derived from the virus itself. The vaccine consists of virus components or killed viruses that mimic the presence of the virus without causing disease. These prime the body’s immune system to recognize and fight against the virus. The immune system produces antibodies against the vaccine that remain in the system until they are needed. If that virus, or in some cases a closely similar one is later introduced into the system, those antibodies attach to viral particles and remove them before they have time to replicate, preventing or lessening symptoms of the virus.

The immune system also retains antibodies to a virus after being infected with it, so humans have general immunity to human strains of avian influenza strains. But humans do not generally have immunity to avian flu strains because they have not been infected by them before. The surface proteins are sufficiently different to escape the human immune response. Avian flu strains are therefore more dangerous for humans because the human immune system cannot recognize the virus or protect against it.

‘Longevity’ Gene May Cut Dementia Risk

By Denise Mann
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 12, 2010 — The so-called “longevity gene” may do more than add years to your life. It may also help stave off age-related cognitive decline, and this discovery is paving the way for new drugs to treat Alzheimer’s disease, a study shows.

The longevity gene is a variant of the cholesteryl ester transfer protein (CETP) gene, which was discovered in 2003. This variant has been shown to improve cholesterol levels by increasing HDL “good” cholesterol and regulating the size of cholesterol particles. As a result, it has been linked to longevity and lower heart disease risk, but how or if this variant affects the cognitive decline that is known to occur with aging was not known — until now.

The study is published in the Jan. 13 issue of the Journal of the American Medical Association.

Researchers analyzed the blood of 523 people aged 70 and older with no signs of cognitive decline to see which copy or copies of the CETP gene they carried. People in the study also underwent standard neuropsychological and neurological testing each year from 1994 to 2009 and performed tests to measure memory, attention span, and the time it takes to process and react to a signal (psychomotor speed).

During 4.3 years of follow-up, there were 40 new cases of dementia seen among this group. Those participants who had a specific variation of the CETP gene were less likely to experience a decline in memory and to develop dementia.

“We found that people with two copies of the longevity variant of CETP had slower memory decline and a lower risk for developing dementia and Alzheimer’s disease,” says study researcher Amy E. Sanders, MD, assistant professor in the Saul R. Korey Department of Neurology at the Albert Einstein College of Medicine in the Bronx, N.Y., in a news release.

“More specifically,” she says, “those participants who carried two copies of the favorable CETP variant had a 70 percent reduction in their risk for developing Alzheimer’s disease compared with participants who carried no copies of this gene variant.”

This variant alters the gene so that the protein it encodes for will functions less efficiently than usual, the researchers explain. Now, drugs are now being developed that mimic this effect.

“These agents should be tested for their ability to promote successful aging and prevent Alzheimer’s disease,” says study researcher Richard B. Lipton, MD, the Lotti and Bernard Benson Faculty Scholar in Alzheimer’s Disease and professor and vice chairman in the Saul R. Korey Department of Neurology at Albert Einstein College of Medicine, in a news release.

Can novel H1N1 swine flu be prevented with a vaccine?

The best way to prevent novel H1N1 swine flu would be the same best way to prevent other influenza infections, and that is vaccination. The CDC has multiple recommendations for vaccination based on who should obtain the first doses when the vaccine becomes available (to protect the most susceptible populations) and according to age groups. The CDC based the recommendations on data obtained from vaccine trials and infection reports gathered over the last few months. The current (October 2009) vaccine recommendations from the CDC say the following groups should get the vaccine as soon as it is available:

* pregnant women,

* people who live with or provide care for children younger than 6 months of age,

* health-care and emergency medical services personnel,

* people between 6 months and 24 years of age, and

* people from the ages of 25 through 64 who are at higher risk because of chronic health disorders such as asthma, diabetes, or a weakened immune system.

Currently, the CDC is stating that people ages 10 and above are likely to need only one vaccine shot to provide protection against novel H1N1 swine flu and further suggest that these shots will be effective in about 76% of people who obtain the vaccine. New vaccine trial data showed that healthy adults produce protective antibodies in about 98% of people in 21 days. Unfortunately, the vaccine shot in children ages 6 months to 9 years of age is not as effective as it is in older children and adults. Consequently, the CDC currently recommends that for ages 6 months up to and including 9 years of age, the children obtain two shots of the novel H1N1 vaccine, the second shot 21 days after the first shot.

Pregnant women are strongly suggested to get vaccinated as stated above. Although some vaccine preparations (multidose vials) contain low levels of thimerosal preservative (a mercury-containing preservative), the CDC still considers the vaccine safe for the fetus and mother. However, some vaccine preparations that are in single-dose vials will not have thimerosal preservative, so those pregnant individuals who are concerned about thimerosal can get this vaccine preparation when it is available.

Another type of vaccine (currently named Influenza A [H1N1] 2009 Monovalent Vaccine Live, Intranasal) has been made available during the first week in October 2009. It is a live attenuated novel H1N1 flu vaccine that contains no thimerosal, is produced by MedImmune, LLC, and is sprayed into the nostrils. This vaccine is only for healthy people 2-49 years of age, and some data suggest that it is less effective in generating an immune response in adults than the vaccine injection. The dosing schedule is as follows:

* Children 2-9 years of age should receive two doses (0.1 ml in each nostril; total equals 0.2 ml per dose) — the second dose should be given the same way about one month after the first dose

* Children, adolescents and adults, 10-49 years of age should receive one dose — (0.1 ml in each nostril; total equals 0.2 ml per dose)

The CDC occasionally makes changes and updates its information on vaccines and other recommendations about the current flu pandemic. The CDC states, “for the most accurate health information, visit http://www.cdc.gov or call 1-800-CDC-INFO, 24/7.” Caregivers should check the vaccine package inserts for more detailed information on the vaccines when they become available. This article has an updated timeline for novel H1N1 swine flu attached (see below) and provides the reader with current details about the pandemic. The following is a list of the CDC-approved H1N1 vaccines and the companies that name and manufacture them as of 10/29/09:

* Influenza A (H1N1) 2009 Monovalent Vaccine by Sanofi Pasteur

* Influenza A (H1N1) 2009 Monovalent Vaccine by Novartis

* Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal by MedImmune, LLC

* Influenza A (H1N1) 2009 Monovalent Vaccine by CSL Limited

The CDC says that a good way to prevent any flu disease is to avoid exposure to the virus; this is done by frequent hand washing, not touching your hands to your face (especially the nose and mouth), and avoiding any close proximity to or touching any person who may have flu symptoms. Since the virus can remain viable and infectious for about 48 hours on many surfaces, good hygiene and cleaning with soap and water or alcohol-based hand disinfectants are also recommended. Some physicians say face masks may help prevent getting airborne flu viruses (for example, from a cough or sneeze), but others think the better use for masks would be on those people who have symptoms and sneeze or cough. The use of Tamiflu or Relenza may help prevent the flu if taken before symptoms develop or reduce symptoms if taken within about 48 hours after symptoms develop. Some investigators say that administration of these drugs is still useful after 48 hours, especially in high-risk patient populations .However, taking these drugs is not routinely recommended for prevention for the healthy population because investigators suggest that as occurs with most drugs, flu strains will develop resistance to these medications. Recently, the CDC made further suggestions about the use of these antiviral medications. Dr. Schuchat, a CDC official, indicated that three modifications were being suggested (Sept. 8, 2009) to the interim guidelines for use of Tamiflu and Relenza:

1. Patients with high-risk factors should discuss flu symptoms and when to use antiviral medications; doctors should provide a prescription for the antiviral drug for the patient to use if the patient is exposed to flu or develops flu-like symptoms without having to go in to see the doctor.

2. “Watchful waiting” was added as a response to taking antiviral medications, with the emphasis on the fact that those people who develop fever and have a preexisting health condition should then begin the antiviral medication.

3. The antiviral medications are the first-line medicines for treatment of novel H1N1 swine flu, and most current cases of flu are novel H1N1 and are, to date, susceptible to Tamiflu and Relenza.

Your doctor should be consulted before these drugs are prescribed.

In general, preventive measures to prevent the spread of flu are often undertaken by those people who have symptoms. Symptomatic people should stay at home, avoid crowds, and take off from work or school until the disease is no longer transmittable (about two to three weeks) or until medical help and advice is sought. Sneezing, coughing, and nasal secretions need to be kept away from other people; simply using tissues and disposing of them will help others. Quarantining patients is usually not warranted, but such measures depend on the severity of the disease. The CDC recommends that people who appear to have an influenza-like illness upon arrival at work or school or become ill during the day be promptly separated from other people and be advised to go home until at least 24 hours after they are free of fever (100 F [37.8 C] or greater), or signs of a fever, without the use of fever-reducing medications. The novel H1N1 swine flu disease takes about seven to 10 days before fevers stop, but new research data (Sept. 14, 2009) suggests waiting until the cough is gone since many people are still infectious about one week after fever is gone. The CDC has not yet extended their recommendations to stay home for that extra week.

What is the history of swine flu (H1N1) in humans?

In 1976, there was an outbreak of swine flu at Fort Dix. This virus is not the same as the 2009 outbreak, but it was similar insofar as it was an influenza A virus that had similarities to the swine flu virus. There was one death at Fort Dix. The government decided to produce a vaccine against this virus, but the vaccine was associated with neurological complications (Guillain-Barré syndrome) and was discontinued. Some individuals speculate that formalin, used to inactivate the virus, may have played a role in the development of this complication in 1976. There is no evidence that anyone who obtained this vaccine would be protected against the 2009 swine flu. One of the reasons it takes a few months to develop a new vaccine is to test the vaccine for safety to avoid the complications seen in the 1976 vaccine. New vaccines against any flu virus type are usually made by growing virus particles in eggs. A serious side effect (allergic reaction such as swelling of the airway) to vaccines can occur in people who are allergic to eggs; these people should not get flu vaccines. Individuals with active infections or diseases of the nervous system are also not recommended to get flu vaccines.

Can novel H1N1 swine flu be prevented with a vaccine?

The best way to prevent novel H1N1 swine flu would be the same best way to prevent other influenza infections, and that is vaccination. The CDC has multiple recommendations for vaccination based on who should obtain the first doses when the vaccine becomes available (to protect the most susceptible populations) and according to age groups. The CDC based the recommendations on data obtained from vaccine trials and infection reports gathered over the last few months. The current (October 2009) vaccine recommendations from the CDC say the following groups should get the vaccine as soon as it is available:

* pregnant women,

* people who live with or provide care for children younger than 6 months of age,

* health-care and emergency medical services personnel,

* people between 6 months and 24 years of age, and

* people from the ages of 25 through 64 who are at higher risk because of chronic health disorders such as asthma, diabetes, or a weakened immune system.

Currently, the CDC is stating that people ages 10 and above are likely to need only one vaccine shot to provide protection against novel H1N1 swine flu and further suggest that these shots will be effective in about 76% of people who obtain the vaccine. New vaccine trial data showed that healthy adults produce protective antibodies in about 98% of people in 21 days. Unfortunately, the vaccine shot in children ages 6 months to 9 years of age is not as effective as it is in older children and adults. Consequently, the CDC currently recommends that for ages 6 months up to and including 9 years of age, the children obtain two shots of the novel H1N1 vaccine, the second shot 21 days after the first shot.

Pregnant women are strongly suggested to get vaccinated as stated above. Although some vaccine preparations (multidose vials) contain low levels of thimerosal preservative (a mercury-containing preservative), the CDC still considers the vaccine safe for the fetus and mother. However, some vaccine preparations that are in single-dose vials will not have thimerosal preservative, so those pregnant individuals who are concerned about thimerosal can get this vaccine preparation when it is available.

Another type of vaccine (currently named Influenza A [H1N1] 2009 Monovalent Vaccine Live, Intranasal) has been made available during the first week in October 2009. It is a live attenuated novel H1N1 flu vaccine that contains no thimerosal, is produced by MedImmune, LLC, and is sprayed into the nostrils. This vaccine is only for healthy people 2-49 years of age, and some data suggest that it is less effective in generating an immune response in adults than the vaccine injection. The dosing schedule is as follows:

* Children 2-9 years of age should receive two doses (0.1 ml in each nostril; total equals 0.2 ml per dose) — the second dose should be given the same way about one month after the first dose

* Children, adolescents and adults, 10-49 years of age should receive one dose — (0.1 ml in each nostril; total equals 0.2 ml per dose)

The CDC occasionally makes changes and updates its information on vaccines and other recommendations about the current flu pandemic. The CDC states, “for the most accurate health information, visit http://www.cdc.gov or call 1-800-CDC-INFO, 24/7.” Caregivers should check the vaccine package inserts for more detailed information on the vaccines when they become available. This article has an updated timeline for novel H1N1 swine flu attached (see below) and provides the reader with current details about the pandemic. The following is a list of the CDC-approved H1N1 vaccines and the companies that name and manufacture them as of 10/29/09:

* Influenza A (H1N1) 2009 Monovalent Vaccine by Sanofi Pasteur

* Influenza A (H1N1) 2009 Monovalent Vaccine by Novartis

* Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal by MedImmune, LLC

* Influenza A (H1N1) 2009 Monovalent Vaccine by CSL Limited

The CDC says that a good way to prevent any flu disease is to avoid exposure to the virus; this is done by frequent hand washing, not touching your hands to your face (especially the nose and mouth), and avoiding any close proximity to or touching any person who may have flu symptoms. Since the virus can remain viable and infectious for about 48 hours on many surfaces, good hygiene and cleaning with soap and water or alcohol-based hand disinfectants are also recommended. Some physicians say face masks may help prevent getting airborne flu viruses (for example, from a cough or sneeze), but others think the better use for masks would be on those people who have symptoms and sneeze or cough. The use of Tamiflu or Relenza may help prevent the flu if taken before symptoms develop or reduce symptoms if taken within about 48 hours after symptoms develop. Some investigators say that administration of these drugs is still useful after 48 hours, especially in high-risk patient populations .However, taking these drugs is not routinely recommended for prevention for the healthy population because investigators suggest that as occurs with most drugs, flu strains will develop resistance to these medications. Recently, the CDC made further suggestions about the use of these antiviral medications. Dr. Schuchat, a CDC official, indicated that three modifications were being suggested (Sept. 8, 2009) to the interim guidelines for use of Tamiflu and Relenza:

1. Patients with high-risk factors should discuss flu symptoms and when to use antiviral medications; doctors should provide a prescription for the antiviral drug for the patient to use if the patient is exposed to flu or develops flu-like symptoms without having to go in to see the doctor.

2. “Watchful waiting” was added as a response to taking antiviral medications, with the emphasis on the fact that those people who develop fever and have a preexisting health condition should then begin the antiviral medication.

3. The antiviral medications are the first-line medicines for treatment of novel H1N1 swine flu, and most current cases of flu are novel H1N1 and are, to date, susceptible to Tamiflu and Relenza.

Your doctor should be consulted before these drugs are prescribed.

In general, preventive measures to prevent the spread of flu are often undertaken by those people who have symptoms. Symptomatic people should stay at home, avoid crowds, and take off from work or school until the disease is no longer transmittable (about two to three weeks) or until medical help and advice is sought. Sneezing, coughing, and nasal secretions need to be kept away from other people; simply using tissues and disposing of them will help others. Quarantining patients is usually not warranted, but such measures depend on the severity of the disease. The CDC recommends that people who appear to have an influenza-like illness upon arrival at work or school or become ill during the day be promptly separated from other people and be advised to go home until at least 24 hours after they are free of fever (100 F [37.8 C] or greater), or signs of a fever, without the use of fever-reducing medications. The novel H1N1 swine flu disease takes about seven to 10 days before fevers stop, but new research data (Sept. 14, 2009) suggests waiting until the cough is gone since many people are still infectious about one week after fever is gone. The CDC has not yet extended their recommendations to stay home for that extra week.

What treatment is available for swine flu (H1N1)?

The best treatment for influenza infections in humans is prevention by vaccination. Work by several laboratories has recently produced vaccines. The first vaccine released in early October 2009 was a nasal spray vaccine. It is approved for use in healthy individuals ages 2 through 49. This vaccine consists of a live attenuated H1N1 virus and should not be used in anyone who is pregnant or immunocompromised. The injectable vaccine, made from killed H1N1, became available in the second week of October. This vaccine is approved for use in ages 6 months to the elderly, including pregnant females. Both of these vaccines have been approved by the CDC only after they had conducted clinical trials to prove that the vaccines were safe and effective. However, caregivers should be aware of the vaccine guidelines that come with the vaccines, as occasionally, the guidelines change. Please see the sections below titled “Can novel H1N1 swine flu be prevented with a vaccine?” and the timeline update for the current information on the vaccines.

Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are zanamivir (Relenza) and oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their interim guidelines that pregnant females can be treated with the two antiviral agents.

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