Information on the H1N1 Flu Virus and Individuals with Chronic Medical Conditions

Updated: June 22, 2010

• Know What to Look For
• Signs of Severe Illness
• Protect Yourself and Others
• H1N1 Flu Vaccine
• Antivirals for Treatment of the Flu
• Considering the Options – Getting the Flu versus Vaccines and Antivirals

Everyone is at risk of catching the H1N1 flu virus but individuals with chronic medical conditions are at increased risk of developing serious complications from the flu, such as pneumonia or respiratory distress. In particular, people with the following medical conditions are at increased risk:

H1N1 Flu Virus: Know What to Look For

Like seasonal flu, some people who get the H1N1 flu virus will have a mild illness while other people may become very sick. To date in Canada, most cases of the virus have been relatively mild and sick individuals have recovered quickly.

An average flu sickness (either H1N1 or seasonal) may show the following symptoms:

Almost Always:	Common:	Sometimes:
Sudden onset of: Fever Cough	Fatigue Sore throat Decreased appetite Muscle aches Headache Runny nose	Nausea Diarrhea Vomiting

Early treatment can help to reduce the risk of complications if you develop the flu, so it’s important to speak to a medical professional if you develop flu symptoms.  If you develop flu symptoms, stay at home until your fever is gone and you are back to your normal activity level, usually within one week. Drink plenty of fluids and if you have a fever use fever-reducing medications such as acetaminophen or ibuprofen.

H1N1 Flu Virus: Signs of Severe Illness

If you develop the following symptoms, seek immediate medical attention:

Protect Yourself and Others

• Wash your hands often with soap and warm water for at least 20 seconds. Alternatively, if your hands are not visibly dirty you can also clean them with a hand sanitizer with an alcohol content of at least 60-90%.
• Cough and sneeze in your arm, not your hand.
• Know the symptoms of the flu.
• Stay home if you have symptoms of the flu until you are symptom-free and are feeling well and able to participate in your normal daily activities. If you have a fever you should stay home until you are fever-free without the use of fever-reducing medication such as acetaminophen (Tylenol) or ASA (Aspirin).
• Check with your health care provider about getting immunized with the H1N1 flu vaccine and the seasonal flu vaccine.
• If you are on medication for your chronic medical condition, talk to your health care provider about having a two-week supply of medication on hand in case you get sick and cannot leave your home.
• Also, if you are on medication for your condition, keep on taking that medication if you develop the flu unless your health care provider says not to.
• Take caution in crowds where you will have little control over personal contact. Be vigilant about hand washing and carry a hand sanitizer to reduce the risk of picking up a virus in these types of settings.
• If you require ongoing medical care for your condition such as chemotherapy or dialysis, talk to your health care provider about how you can, or if you should, access these treatments if you have the flu or develop flu symptoms.

For more information about the H1N1 flu and the seasonal flu, such as information about how to take care of someone at home with the flu, please visit www.fightflu.ca or call 1800 O-CANADA, TTY 1-800-926-9105.

H1N1 Flu Vaccine

Getting an H1N1 flu vaccine is the single best way to protect yourself from the H1N1 flu virus. A vaccine produces immunity to a disease by stimulating the production of antibodies (proteins in our bodies that fight diseases).

This year, there will be two flu vaccines – the regular seasonal flu vaccine and the H1N1 flu vaccine. Talk to your health care provider to help you decide which flu vaccine you should get - the seasonal flu vaccine, the H1N1 flu vaccine or both vaccines. For more information, please see our backgrounder on vaccine recommendations.

Antivirals for Treatment of the Flu

If you develop the flu, your health care provider may prescribe antivirals for treatment of the flu.

Antivirals are prescription medications used to treat the flu. While they do not make you immune to the virus, if taken shortly after getting sick (within the first 48 hours), they can reduce flu symptoms, shorten the length of illness and may reduce serious complications.

Antivirals may not be suitable for everyone.  You should talk to your health care provider about treatment options. If you are on medication for your condition, keep on taking that medication if you develop the flu unless your health care provider says not to.

Considering the Options – Getting the flu versus getting a vaccine or taking an antiviral

When considering your options about vaccination there are a number of factors that you need to think about. This chart explains the risk of getting the flu versus the benefits and risks of getting an H1N1 flu vaccine and/or taking antiviral medication if you do get the flu.

If you catch the H1N1 Flu

If you have a chronic medical condition and become sick with the H1N1 flu there is a chance you could develop severe flu symptoms and be hospitalized.

Knowledge is your best defence. Take steps to protect yourself.

	Getting the H1N1 Flu Vaccine	Taking antivirals after getting the H1N1 flu.
Benefits / Facts	Vaccines have proven benefits. Getting the H1N1 flu vaccine is the single best way to protect yourself from the H1N1 flu virus.	Antivirals may decrease the severity of sickness.
	You cannot get the flu from the flu vaccine.	Antivirals MUST be taken within the first 48 hours of the onset of symptoms.
	Vaccines are safe. The dangers from vaccine-preventable diseases (like the flu) are many times greater than the risk of a serious reaction to the vaccine.	If you have the flu, talk to your health care provider about treatment options. Antivirals may be one of the treatment options that they recommend.
	With the H1N1 flu vaccine you will have some immunity to the current strain of the H1N1 flu virus within 10 days.	Recently Health Canada approved the use of antivirals for H1N1 (oseltamivir, known as Tamiflu) for children less than one year of age.
Risks	Vaccines can have side effects but they are usually mild. You need to weigh the risks of side effects with the risks of serious health problems if you catch the flu.	There is a risk of side effects with any medication including antivirals. The most common side effects of the antiviral oseltamivir include nausea, vomiting, diarrhea, abdominal pain and headaches.
	The most common side effects of the flu vaccine are soreness in the arm where the vaccine was given, sore or red eyes, itchiness and for some a mild fever. Most people experience no serious side effects from the flu vaccine.	The H1N1 flu virus can adapt and develop resistance to a specific antiviral drug – this means that the drug would no longer be effective in treating the H1N1 flu.
	About one person for every 100,000 doses of vaccine distributed will have a severe reaction to a flu vaccine, including anaphylaxis or Guillain-Barré Syndrome (GBS).	Rare cases of anaphylaxis and serious skin reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiform, have been reported with the antiviral oseltamivir.
Myth Busting	Thimerosal is a form of mercury used in the H1N1 flu vaccine to stabilize it and maintain its quality during storage. Thimerosal is a different form of mercury than the mercury known to cause health problems. The amount in flu vaccines is much less than the daily limit recommended – for example a can of tuna fish has more mercury than the thimerosal in the H1N1 flu vaccine.	Antivirals are not appropriate for everyone. Talk to your health care provider about whether taking antivirals to treat the flu is appropriate for you.
	If you receive the H1N1 flu vaccine you are at no greater risk of acquiring Guillain-Barré Syndrome (GBS), a neurological condition that occurs in approximately two in 100,000 people per year and is most often associated with foodborne infections. The possible risk of acquiring GBS from the flu or the flu vaccine is very small.	Antivirals are usually taken in pill form (Tamiflu) or as an inhaled medication (zanamivir).
	An adjuvanted vaccine is a vaccine that includes a substance that boosts an individual's immune system and increases their response to a vaccine. An unadjuvanted vaccine has no “booster” element. Adjuvants are included in common vaccines such as tetanus and hepatitis B.  The adjuvant in Canada’s H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E.	Antiviral drugs given for treatment of the flu usually need to be taken for five days.