Wednesday, September 16, 2009

What Should an FM or ME/CFS Patient Do About the Swine Flu?

What Should an FM or ME/CFS Patient Do About the Swine Flu?

by Dr. Charles Lapp, MD*, September 8, 2009

From the August issue of Dr. Lapp’s free e-newsletter (

In June 2009 the World Health Organization declared that the spread of a novel H1N1 Swine Flu had reached pandemic levels. At the time of this writing, the swine flu has become widespread in the southern United States, especially the Southeast. However, the illness prevalence, the number of doctor visits, and the morbidity is still no worse than the usual seasonal influenza. It is expected that the number of cases will increase as school resumes because H1N1 is rapidly spread by coughing and sneezing, hand-to-hand, or hand-to-body contact.

Many patients have been alarmed by reports of the seriousness and infectivity of this new flu, and have asked if vaccination is advisable. Our usual recommendations on influenza vaccinations are that:

• That they have been known to trigger flares of CFS/ME/FM,

• That many PWCs to do not respond to vaccination anyway,

• And that viral infections are uncommon in most PWCs due to upregulation of the immune system.

Therefore, we would recommend seasonal flu vaccination only if you have tolerated these well in the past and if you are at high risk.

Because the current swine flu is so novel, a new vaccine needs to be produced. This is not expected to be available until late October.

Unlike seasonal influenza, H1N1 mostly attacks younger age groups, particularly under age 24. Vaccine availability will be limited, so it will be offered to specific target groups first. These include:

• Pregnant women,

• People who live with or care for children younger than 6 months of age,

• Healthcare and emergency medical services personnel,

• Persons between the ages of 6 months and 24 years old,

• And people ages of 25 through 64 years of age who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

We do NOT consider the immune system in CFS/ME to be compromised to the point of being “high risk” unless there is a history of frequent viral infections and/or pneumonia.

Based on information available at this time, H1N1 immunization may not be available to the majority of our patients until late Fall, perhaps well after the swine flu peak. Therefore, we are recommending that our patients:

• Avoid crowds and sick people (especially coughers and sneezers!),

• Wash your hands frequently or use alcohol-based hand cleansers,

• Avoid touching your eyes, nose, or mouth with your bare hands.

The symptoms of novel H1N1 flu virus in people include fever, cough, sore throat, and runny nose, body aches, headache, chills and fatigue, possibly diarrhea and vomiting. If you suspect that you have contracted swine flu:

• Immediately contact your primary care office or Hunter-Hopkins for advice and possibly medication

• Avoid contact with others for at least 24 hours after the fever subsides

• Consider wearing a surgical face mask if others are around you

• Recognize these warnings signs and seek medical assistance immediately for difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, increased confusion, severe or persistent vomiting, and flu-like symptoms that improve but then return with fever and worse cough.

In lieu of swine flu vaccination two antiviral medications can be taken to reduce the symptoms and severity of the illness.

These must be started within 48 hours of illness onset, and are not recommended for prevention of the flu. The adult doses of these medications are:

Tamiflu / oseltamivir (75 mg tablets taken twice daily for 5 days) or

Relenza / zanamivir (two inhalations twice daily).

For more information go to the Center for Disease Control website at

* Dr. Charles Lapp, MD
Hunter Hopkins Medical Center
Charlotte, North Carolina
10344 Park Road, Suite 300 - until October, then:
721 Carmel Executive Park Drive, Suite 320
Charlotte, North Carolina 28226
Note: This information has not been evaluated by the FDA. It is general and should not replace the attention and advice of your personal physician. Nor is it meant to prevent, diagnose, treat or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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