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Influenza:

Considerations for Prevention and Treatment

By Dr. Lawrence Rosen

It is not possible to read, listen to, or watch health news today without being confronted by stories about a new type of influenza, or “the swine flu” as it is commonly known.  The intent of these stories theoretically is to raise public awareness about the danger of the illness, and to encourage the public to engage in preventive measures such as vaccination to limit the spread of the flu.  There are so many questions raised by this approach – I hear them every day in my practice.  Below, you can read my answers from an integrative pediatrician’s perspective.   Please consult with your doctor for advice regarding your own health and your children’s health.  Everyone is an individual and should be treated as such.


1.    What is “the swine flu” and what makes it different from the “regular” flu?
Influenza is a virus that typically causes fever, cough, runny nose, sore throat, headache, muscle aches, and sometimes nausea, vomiting and diarrhea.  It usually is present in the winter, though can infect people in the fall and spring as well.  Some seasons are worse than others. It can affect any age patient, although infants, the elderly and those with compromised immune systems or underlying heart/lung conditions are at highest risk for complications from infection.  The “swine flu” is actually a new type of influenza A – more properly termed “novel H1N1.”  In fact, this flu has been “found to be made up of genetic elements from four different flu viruses – North American Mexican influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe."(1)  What makes it worrisome is that we’ve never seen this particular strain before and we do not know how it might change over time.  The CDC site has an amazing amount of information about the novel H1N1 flu for those interested in digging deeper.(2)
 
2.     How bad is this new flu, really?
In a typical year, the CDC estimates 25-50 million influenza cases per year with 36,000 deaths per year.  These numbers are hotly debated.  For example, in 2005, influenza only appeared on the death certificates of 1,812 people in the United States.(3)  How do we reconcile these data?  Well, the mortality rates are estimates based on influenza and pneumonia-related death rates.  In particular, tracking pediatric morbidity and mortality rates is very tricky.  It is estimated that there are 80-100 child deaths per year in the US attributed to influenza.  The novel H1N1 flu initially seemed more dangerous, but many healthcare practitioners have observed that, to date, it is causing relatively mild disease compared with the typical seasonal flu.  According to the CDC, there have been roughly 400 deaths in the US reported to date attributable to novel H1N1 flu; many estimate a million cases of infection or more are probable, given that mild cases are not reported and routine testing is no longer being performed.
 
3.     I keep hearing about a new flu vaccine.  Is this flu vaccine safe?  Does it work?
It is true that several pharmaceutical companies are in the process of making and testing a novel influenza vaccine.  There has been much speculation about its components, including additives.  Children and pregnant women have been targeted as priority vulnerable populations for this new vaccine.  What is not clear is how much testing, if any, can be done prior to the vaccine’s release, in these populations.  According to a news report by the Associated Press: “The vaccines being tested by Novartis and Sanofi Pasteur contain adjuvants — ingredients intended to boost the body's immune response. Adjuvants, which also stretch a vaccine's active ingredient further to make more doses, are used in European flu vaccines but not in the U.S. The WHO has recommended they be used in swine flu vaccines to increase the global supply.  Health officials have said there is little or no information on how vaccines containing adjuvants affect pregnant women and children — two groups thought to be particularly vulnerable to swine flu.”(4)  This information concerns me.  What adjuvants or preservatives are we talking about?  Known ones including toxic heavy metals such as aluminum and mercury?  Or unknown, novel adjuvants not previously well-tested?  Certainly, given these uncertainties, parents must be given the choice to weigh risks and benefits of administering this new vaccine to their children, especially considering how mild in general the disease has been to date. 

4.     Are there other ways to prevent the flu?
I would absolutely recommend common-sense hygiene – hand washing with soap and water, keeping kids home with illness until fever-free for 24 hours, and focusing on proper rest, nutrition and exercise.  What about natural remedies for prevention?  A recently published study in Pediatrics demonstrated that “daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children ages 3 to 5.”(5)  

5.     What’s the best way to treat the flu?
Treatment is usually supportive – hydration and rest.  Remember, the flu is a virus, so antibiotics don’t do anything for it.  Antivirals such as Tamiflu® and Relenza® are sometimes prescribed to treat flu symptoms, but many children find the adverse effects from the medications worse than the symptoms of the flu itself.(6)  Many integrative practitioners recommend the homeopathic remedy oscillococcinum (7) to treat flu at the very first sign of any symptoms.  Additionally, one study of elderberry syrup demonstrated efficacy for shortening the duration of flu symptoms.(8)
 
References: all accessed August 10, 2009
(1) http://en.wikipedia.org/wiki/H1N1#2009_A.28H1N1.29_pandemic
(2) http://www.cdc.gov/flu/
(3) http://en.wikipedia.org/wiki/2009_flu_pandemic
(4) http://news.yahoo.com/s/ap/20090807/ap_on_re_eu/eu_swine_flu_vaccine
(5) http://pediatrics.aappublications.org/cgi/content/abstract/124/2/e172
(6) http://www.guardian.co.uk/society/2009/jul/31/tamiflu-side-effects-children
(7) http://www.oscillo.com/
(8) http://www.ncbi.nlm.nih.gov/pubmed/15080016?ordinalpos
=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed

ResultsPanel.Pubmed_ DefaultReportPanel.Pubmed_RVDocSum


About Dr. Lawrence Rosen


Dr. Lawrence D. Rosen is a board-certified general pediatrician committed to family-centered, holistic child health care. He recently opened his own private pediatric integrative medical practice -- the Whole Child Center (wholechildcenter.org) -- in Oradell, NJ.   He  serves as Medical Advisor to The Deirdre Imus Environmental Center for Pediatric Oncology®. Dr. Rosen is a nationally recognized expert in Pediatric Integrative Medicine, acting as Chair of the Integrative Pediatrics Council, a non-profit foundation dedicated to transforming children's health care. Dr. Rosen is also a founding member of the American Academy of Pediatrics Provisional Section on Complementary, Holistic and Integrative Medicine. He is a frequent speaker at both professional and consumer gatherings, discussing topics such as holistic care of the newborn and the integrative management of autism.

Dr. Rosen is a graduate of New York Medical College and the Massachusetts Institute of Technology. He completed his residency and chief residency in pediatrics at Mount Sinai Hospital in New York and is a Fellow of the American Academy of Pediatrics.
 

9-01-09