It took a few days, but we have answers to many of the questions that came in during Monday's H1N1 show. They're from Richard Leman, a medical epidemiologist with Oregon's Public Health Division.

Cirrus wrote:

I think my family and I already had swine flu last Spring.  We had all the flu symptoms, just a little more spread out than usual.  And we had the normal flu vaccine.  Should we still get the vaccine?

Leman's answer:

Yes. Unless someone had influenza that was specifically confirmed by special testing to be pandemic H1N1 (swine flu), we recommend getting the pandemic H1N1 vaccine.

Annarch1 asked:

I am 68 years old and had the Asian flu in 1957, a pandemic from what I remember.  On a recent public radio program about H1N1, it was said the Asian flu is so similar that those of us who had it (it was miserable) were probably immune to H1N1.  Comment?

Leman's answer:

Not sure it was the Asian flu of 1957, but it does look as though many people over the age of 60 have some immunity to pandemic H1N1.

Curious asked:

What are the chronic health conditions, besides diabetes, that indicate one should get the vaccine as a priority person? Is hypertension one of them?

Leman's answer:

Hypertension (high blood pressure) isn't one of the priority health conditions. Chronic conditions that can put people at risk for more severe illness from flu include heart disease, lung disease including asthma, kidney, blood or metabolic diseases including diabetes, decreased immunity including low immunity caused by medication or HIV, and conditions that lead to chronic swallowing difficulties. In addition, pregnancy and long-term aspirin treatment in people aged 6 months to 18 years are high risk conditions.

Pbog asked:

I am at home today sick. I came down with a sore throat and aches last night and it's worse this morning. Do I have the flu? I think of flu as being a much more severe illness with days of fever. What's the differences between just a cold and the flu?

Leman's answer:

Colds typically present with a bit of a snuffy nose that goes away after a few days. Flu tends to hit much harder than a cold. If you have a fever and muscle aches along with cough and sore throat, flu seems more likely. If the sore throat is severe, particularly if there is no cough, strep throat is also a possibility. Your health care provider can help you sort this out.

And belle asked:

I am pregnant, with twins, having complications, and on bedrest. It's very early in the pregnancy and under the circumstances I feel like I'm probably too vulnerable to be getting a vaccine. But I'm also concerned that if I did get the flu I might be more vulnerable to that as well. I find myself really stressed about the decision. Are the vaccine risks for pregnant women more or different or are there risks to the fetus? Are the risks of getting the flu when pregnant more or different? Again, are there risks to the fetus? Is this a decision between the lesser of two evils?

Leman's answer:

Both seasonal and pandemic H1N1 flu vaccine are recommended for pregnant women. You might want to talk with your health care provider about this, but there is no restriction on use of flu vaccination by injection during pregnancy. (The nasal form of flu vaccine isn't recommended in pregnant women.) On the other hand, pregnant women are at increased risk for severe complications from both seasonal and pandemic H1N1 influenza. This is why vaccination is specifically recommended for pregnant women.

We also got a question that seemed more appropriate for our guest Rob Hendrickson, the ER doc who chairs OHSU's emergency planning committee. LauraAJ wrote:

I am currently 7 months pregnant and have a 4-year-old daughter.  I was warned at a prenatal appointment by my provider that area hospitals will probably soon been banning children 12 and under from entering as visitors because of the H1N1 flu.  Can you explain the reasoning behind this and do you think there will be exceptions for children that have been vaccinated?  It is important to me to have my daughter be able to visit her new brother and be with her family in the days after his birth.

Rob Hendrickson responded:

Believe me, we all had the same thoughts when we formulated the policy. I’ll try to answer both of your questions.

1. Why are we currently prohibiting children under 12 years old from visiting inpatients?  The reason for the restrictions is first and foremost to protect our patients.  For the vast majority of people, H1N1 influenza will feel like a seasonal flu and will not require hospitalization or medications.  They will just feel really sick for a few days.  But at OHSU, we have a lot of patients who are at very high risk of catching influenza and developing very severe illness and potentially dying.  We have patients who are very young, patients who have received transplants (e.g. heart, lung, kidney, liver, etc), recently had surgery, and who are on chemotherapy and we want be very pro-active to protect them.  By being pregnant, you fit into another high risk group for catching and developing a severe infection with H1N1.  It is for that reason that we are trying to protect inpatients who are at high risk by limiting their exposure to H1N1. The reason that we chose children under 12 years old is because there is some evidence that children are infectious (contagious) for a longer period of time than adults.  Young children may also not have the ability to describe symptoms like muscle aches, fatigue, and sore throat.  Finally, pre-school aged children do not perform the infection control procedures that are necessary to stop the spread of the disease.  Children simply do not consistently cover their cough, sneeze into a tissue, or frequently wash their hands.  Believe me I realize that this is a major inconvenience.  We all thought of your exact scenario when we  were developing the policy, but felt that with the information that we have now, the best thing to protect our patients is to limit visitation.

2. Will there be exceptions for kids that are vaccinated?  We will be revisiting the policy continually as more information comes in.  Once people begin to get vaccinated and once we have more information on how severe the H1N1 influenza is this Fall, we will update the policy.  I hope that we’ll have much more information in 2 months when you deliver!