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It's that time of year again--flu season. But this year, in addition to the usual viruses that will send countless numbers of people around the world to their beds with aches, fevers, and sore throats, there's The Flu--the dreaded H1N1, or "swine flu"--to contend with. And many HIVers are understandably worried. Fears of an outbreak in San Francisco were heightened after the 41-year-old co-owner of two popular gay bars died of H1N1 in August. The threat of an H1N1 outbreak among HIVers in Washington, D.C., is serious enough that the Whitman-Walker Clinic began stockpiling swine flu testing kits, face masks, and supplies of the anti-flu medication Tamiflu in late summer. But are HIVers really more vulnerable to H1N1? Yes and no, say health experts. Studies have shown that HIV-positive adults in general are no more likely to be infected with H1N1, develop serious complications if they do become ill, or die from the ailment. In fact, most U.S. cases of swine flu and flu-related deaths reported to date have occurred among otherwise healthy young adults ages 25-49 and surprisingly not among typical high-risk groups. However, swine flu, particularly its complications, could be a greater threat to adults with severely weakened immune systems, including those with advanced HIV disease, says Tony Mills, MD, an HIV specialist in Los Angeles. So, what can you do to stay flu-free? The best steps are to adopt basic flu avoidance tips like regularly washing your hands (see "Preventing a Pandemic" below) and to get your annual seasonal flu shot and an H1N1 vaccine--which as of press time was due to become available in mid October--as soon as you can, says Mills. "This year I am strongly recommending both vaccines to all of my HIV patients," he notes, "but especially for those who may have increased susceptibility to influenza due to older age, prior lung infections, significant allergies or asthma, and for those with low T cells and detectable viral loads who may be at risk for opportunistic infections and are also, because of their immunocompromised state, at risk for viral upper respiratory infections including severe bronchitis and pneumonia." Preventing a Pandemic Health experts offer these tips for avoiding infection with H1N1 and run-of-the-mill flu viruses this winter. 1) Get a seasonal flu shot and an H1N1 vaccine. 2) Wash your hands frequently and use hand sanitizer. 3) Cover coughs and sneezes with your hand, sleeve, or a tissue. And wash your hands afterward. 4) Avoid touching your eyes, nose, and mouth. 5) Throw away used tissues. 6) Use a separate bathroom from the rest of your family if possible. And clean it daily with disinfectant. 7) If you're sick, stay home from work until 24 hours after your fever breaks on its own without the help of medication. If your kids are sick, keep them home from school until a day after their fevers break. 8) If you're a health care worker, stay six feet away from patients who are ill; use a respirator mask if working in closer confines. Surgical masks are not recommended. Is It a Cold or the Flu? Symptoms of H1N1 and seasonal flu: * Fever * Cough * Sore throat * Runny or stuffy nose * Body aches * Chills * Fatigue * Diarrhea * Vomiting Unexpected Breeding Grounds Grace Keenan, MD, founder and medical director at Virginia-based Nova Medical Group, warns of five unexpected germy hot spots that are more loaded with pathogens than even a typical school classroom: 1) Shopping carts. They're rarely cleaned, and studies have shown they contain traces of saliva, blood, fecal matter, mucus, E. coli, and even semen. Yuck. 2) The handle on your refrigerator. Also often touched and rarely cleaned. 3) Computer keyboards. Ever coughed or sneezed into your hand and then went right back to typing? So has everyone else. 4) Playground equipment. Used by countless numbers of kids and adults, and rarely if ever sanitized. 5) Swimming pools. Believe it or not, some pathogens are now resistant to the chlorine used to kill them.