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CDC Flu Webinar: Protecting People with Chronic Conditions from Influenza/Flu

November 6, 2019


Julie Yegen: Hi, everybody. Thank you for joining today’s
briefing on the importance of flu vaccination for individuals
with chronic conditions. My name is Julie Yegen and I
work with CDC on its National Influenza
Vaccination Campaign. Before we begin, I just wanted
to go over a few housekeeping items for today’s call. Today’s briefing
will be one hour long, and please note that it is being
recorded for archiving purposes. We will be distributing a PDF
of these slides as well as our speakers’ bios
following the briefing, and please feel free to contact me
directly if you don’t receive them. My email address is on the
screen and will be posted again at the end of the session. And finally, after the
moderator panel discussion, we’ll open the floor up to
questions from attendees. So, please feel free to type and
send your questions to “host” in the dropdown menu next to the
Q&A at any time throughout the session, and during the final
portion of the briefing we’ll get to as many
questions as possible. Okay. So, now to introduce
today’s panelists. First, Dr. Seema Jain. She is a Medical Epidemiologist
for the Epidemiology and Prevention Branch in the
Influenza Division of the National Center for Immunization and
Respiratory Diseases at the CDC. Her current research focuses
on influenza and pneumonia, pediatric influenza,
influenza complications, and includes work on
understanding factors associated with being at high risk for
influenza and its complications. Dr. Otis Brawley is Chief Medical
and Scientific Officer and Executive Vice President of
the American Cancer Society. He’s responsible for promoting
the goals of cancer prevention, early detection, and
quality treatment through cancer research and education. A special thanks to Dr.
Brawley for joining us today. Dr. Len Lichtenfeld with
American Cancer Society was originally slated to speak on
today’s briefing but actually had an emergency eye surgery earlier
this week and couldn’t make it. But thanks again to Dr. Brawley. We’re really looking
forward to hearing from you. Dr. Vincent Bufalino, he’s the
Senior Director of Cardiology for the Advocate Medical Group,
a physician led medical group practicing throughout
Chicago and Bloomington Normal. He’s responsible for overseeing
the work of 100 cardiologists practicing in a network of 10
hospitals in the Chicago area. He currently co-chairs
American Heart Association’s International Committee
and serves on the Heart Association’s Consumer Health
and Quality Science Advisory and Corporate Relations Committee. Next up is Dr. John Anderson. He’s immediate past President
of Medicine and Science of the American Diabetes Association. He’s also a board certified
internist and just completed a term as president
of the Frist Clinic, a 31-member internal
medicine multispecialty group in Nashville, Tennessee. He has more than 20 years of
experience in the practice of internal medicine with a focus on
the care of people with diabetes. Next is Dr. Mitchell Grayson. He’s currently an Associate
Professor of Pediatrics, Medicine, Microbiology, and
Molecular Genetics at the Medical College of Wisconsin. Dr. Grayson has been the
recipient of several NIH research grants and oversees an
active laboratory studying the role that viral infections play in
the development of allergic disease. He’s an active fellow of the
American Academy of Allergy, Asthma, and Immunology as
well as the American College of Allergy, Asthma, and Immunology. And finally Pamela Coleman. She’s a member of Women Heart,
the National Coalition for Women with Heart Disease whose mission
is to improve the health and quality of life of women living
with or at risk of heart disease. She has always lived with heart disease
and continues to battle it daily. Pam is the mother of an
18-year-old and makes sure she teaches him about
healthy living and eating. She also continuously educates
women about heart disease in her various community
service events. So, thank you to all of our
panelists for joining today. We’re really looking
forward to hearing from you. And before we start the panel
portion of today’s discussion, I’d like to turn it over to Dr.
Seema Jain with CDC to kick us off with an overview of
current flu activity and CDC’s recommendations
for flu vaccination. So, with that I will pass it
over to you, Dr. Jain. Dr. Seema Jain: Great.
Thank you so much. Well, I think let’s just start
off by talking about what’s going on right now. So, I think everybody
hopefully knows this, but flu activity remains
high and widespread nationally. Right now the predominant virus
so far this season is 2009 H1N1, which is the same strain of
influenza that was predominant during the 2009 pandemic but has
also been circulating every season. However, this season it’s the most
predominant strain that we’re seeing. All of the vaccines that are
available for the 2013 to 2014 season are designed to protect
against this particular strain of influenza virus. If this flu season continues on
this track with 2009 H1N1 being the predominant strain, then
flu elements will continue to greatly affect young
and middle-aged adults, especially those with
chronic conditions. Everyone six months or older
needs an annual flu vaccine. There is a special emphasis
on people at high risk of flu-related complications, which
includes people with chronic conditions such as
asthma, diabetes, and those also with
neurologic disorders. In addition, pregnant women,
children younger than five but especially those who are
younger than two years old, and then older adults who are 65 years
and older should get vaccinated. In addition, those patients or
people who live with and care for those who are at high risk,
including health care workers need to get vaccinated. There are a lot of variety
of vaccine options this year. We have our website
that’s listed here. At this point we have no
specific recommendations that we give at CDC. I think the most important message
here is to get a flu vaccine. It’s certainly not too
late to get a vaccine. People with underlying medical
conditions such as asthma, diabetes, heart, and lung
disease or neurologic conditions are at risk for
flu complications. There’s a complete list at
the website that’s listed here. Flu can make chronic health
problems like asthma or heart failure or COPD worse. And people with chronic
conditions are more likely to suffer from flu-related
complications that result in either hospitalization or in death. People with chronic disease
should get a flu shot and not the nasal mist. Flu vaccination is your
first line of defense. So, again, as I said
before, this is the time, get vaccinated if you
haven’t already done so. An important adjunct and second
line of defense is antiviral medication that can help treat
flu illness and also can help prevent complications. So, if you’re feeling sick
or think you have influenza, please get in touch with your doctor
and see if you need flu antivirals. These are CDC’s take three
actions to fight the flu. Number one, take the
time to get a flu vaccine. It’s our first line of defense. Number two, take everyday
preventive actions to stop the spread of germs. And number three, take flu
antiviral drugs if indicated. Please follow what’s going on
with flu activity this season. This is our website where
you can access Flu View, which gives local data on what
flu strains are circulating and how activity is going. Lastly, this is our website and our
flu inbox for any kinds of questions. Julie: Thanks, Dr. Jain. And just to reiterate to folks
on the phone and who are joining via webinar, we will be
sending these slides around. So you will be able to
access the links shared here. So, now before we again move
on to the panel discussion, I did just want to
see if Pamela Coleman, who is joining the call today,
if she could give – share a bit about her personal experience
living with a chronic condition and the importance of flu
vaccination for her personally. So, Pam, thanks for joining
us and please take it away. Pamela Coleman: Yes. Thanks, Julie.
I appreciate it. Good afternoon, everyone. I was born with a congenital
heart valve defect which was detected at birth. I had three open heart
surgeries by the time I was 30. My first surgery was at age
seven to repair my valve, and unfortunately that was
not successful and at age 13 my valve was replaced. And at that time I was put on blood-thinning medication for life. At age 30 I was 33 weeks pregnant
and I went into heart failure. A clot had formed on my aortic
valve and prevented it from opening and closing. Doctors feared the
clot would break off, travel to my brain, I
would have a stroke, and we both would die instantly. I delivered my son, thankfully, weighing
3 pounds 8 ounces via C-section. And 24 hours later I was back
in the operating room having my valve replaced for
the second time, thus my third surgery. Heart disease has always
been a part of my life. And a few years ago I wanted to
give back to the community and help others become aware of heart
disease and how to prevent it. So, I became a
Women Heart Champion. And just a little
bit about Women Heart, it’s a nonprofit patient
advocacy organization. And their members include
women heart patients and their families, health care
providers, advocates, and consumers who are committed
to helping women live longer, healthier lives. Women Heart supports, educates,
and advocates millions of American women living with
or at risk of heart disease. Being high-risk it
was always recommended, and as long as I can remember,
I always got the flu vaccine to prevent endocarditis or any other
valve problems that I may encounter. So, every October my son
and I get our vaccine. My son gets his for two reasons. One, he has
respiratory problems; however, even if he
was not high-risk, I would still have him
vaccinated as a caregiver. So, I want to
protect myself as well. It’s very important
that if he gets sick, that I don’t get sick. I do recall a few years
ago he did get the flu, a sinus infection, and
bronchitis all at once. And when I took
him to the doctors, they checked me out immediately
and put me on antibiotics as a preventative measure. So, it is important that family
members also consider getting vaccinated as well. Women Heart supports flu
vaccination for women living with heart disease because they
know how important it is for women with heart
disease to stay healthy. Women Heart educates women
about the importance of flu vaccinations through webinars
such as this and information on their website, which
is womenheart.org. In closing, I want to thank
Women Heart for the opportunity to partner with CDC to spread
the word about the importance of the flu vaccine for women
living with heart disease. And lastly, I want to encourage
women living with heart disease to talk to their health care
provider about whether they should or should not
get the flu vaccine. In my experience every situation
is different and it’s always best to seek medical advice
rather than to do something on your own or something
that you don’t normally do. So, Julie, I want to thank
you again for the opportunity to share my story and my
experience with Women Heart and living with heart disease. Julie: Thanks so much, Pam. I think that it’s always helpful
when we’re having a discussion like this to hear from someone
who’s experiencing it firsthand. So, we appreciate your being
here and sticking around for the Q&A at the end of the session. So, now on to our
panel discussion. So, so far this flu season the
vast majority of adults and over half of children hospitalized
with flu have had a medical condition that puts them at high
risk for flu-related complications. So, I’d like to ask each of the
panelists to start by explaining the potential impact of flu
for people who suffer from the particular condition
that you specialize in. So, Dr. Bufalino, I’ll ask you
to kick off and then I’ll go ahead and prompt the other folks
on the call to jump in with their information. Dr. Bufalino: Thank you. Good afternoon. And I’m a cardiologist. And heart disease and stroke
are very important to me and the group we represent. And we know that people with
heart disease and stroke are clearly at higher risk for developing serious complications from the flu. And if you look at the
adults hospitalized last season, the 2012, 2013 flu season, heart
disease was the most commonly incurring chronic condition. Forty five percent of the adults
that were hospitalized had some form of heart disease. So, we know that influenza is
also associated with increased risk of heart
attacks and strokes. And the flu vaccine obviously
gives us an opportunity to prevent that. We know that patients in
the vulnerable age group, that 18 to 64 group
with heart disease, only 48 percent were
vaccinated in the 2011, 2012 cycle, which was better
than it had been over the 2007 to 2011 seasons. But as you see, clearly
we’re missing half the folks. So, from our perspective we
believe that all patients with heart disease should receive
the flu vaccine along with the pneumococcal vaccine to
protect them against pneumonia. Pneumonia’s a serious
complication related to the flu that can actually
lead to premature death. So, we think both the flu
vaccine and the pneumococcal vaccine are very important for patients
with underlying heart disease. Julie: Great. Thanks, Dr. Bufalino. Dr. Anderson,
I’ll pass it to you. Dr. Anderson: I’m an internist in Nashville, Tennessee. So, I do a lot of primary care
in addition to having a special interest in diabetes. And one of the most common
fallacies that I see around some of my patients with diabetes is
that if their diabetes is really well managed, they really
are not at increased risk of influenza and they have sort
of a lackadaisical approach to getting the flu shot every year. And the actual facts are
is if you have diabetes, you are almost three times more
likely to be hospitalized for your influenza and you’re going
to get more complications than other people. In addition, if
you do get the flu, even if you’re
well-controlled, influenza, just like any infectious disease
can really wreak havoc with your blood glucose levels. It can cause huge fluctuations
that are out of your predictable day-to-day pattern and makes it
a lot harder to manage diabetes, particularly if we’re on insulin
and on a complicated regimen. It can cause glucose levels to
rise because of the infection, the fever, the inflammation. And the body releases stress
hormones such as cortisol that can cause blood
glucoses to go way up. In addition, you can also
have low blood glucose levels. If you’re on insulin or any
agents that have the potential for lowering blood sugar below
normal levels and causing what we call hypoglycemia, you may
experience this because you have a decreased appetite. You may not be eating. You may have nausea. Then you can see your
glucose levels go down. But one of the things we tell
our patients is you have to measure, and I’ll talk about
this a little later today, because even if
you’re not eating, the inflammation can cause
glucose levels to surge. And it’s a common fallacy well,
if I’m nauseated and not eating, then I’m okay. So, if you have diabetes, you
just got to monitor carefully. In addition, you have a greater
risk of developing the pneumonia that Dr. Bufalino
just alluded to. You’ve got a greater risk of
developing pneumonia by itself or after the flu. So, that’s why everyone who
takes care of people with diabetes recommends an annual –
a pneumococcal vaccination even if you’re below 65. Julie: Dr. Grayson, we’ll pass it to you now. Dr. Grayson: Okay. Great. Thanks. I’m going to sound a little
bit like a broken record here, but we’re going to
talk a bit about asthma, which obviously is a lung
illness and obviously flu is a lung infection. So, it’s not surprising
that people with asthma, if they have
uncontrolled asthma, that a flu infection will
actually make their asthma worse, but what
people sometimes forget, and this is similar to what
Dr. Anderson just said about diabetics, is that even if
your asthma’s well-controlled, a flu infection can actually
make your asthma exacerbate just like any other
respiratory viral kind of thing. And so people with asthma
really are much more likely to have breathing problems if
they get the flu regardless of whether they’re
well-managed or not. Obviously if their
asthma’s not well-managed, they’re at much more
risk, but either way. And these asthma attacks with the
flu can even lead to pneumonia. So, just like you’ve just
heard with Dr. Anderson and Dr. Bufalino, we recommend getting
the pneumococcal vaccine even though that’s not really what
we’re talking about today as well as the flu vaccine
in anyone who has asthma. And one thing to
remember about asthmatics, that while they are more likely
to have a worse outcome from flu, they’re not more likely
to get flu than anybody else. But if they do get the flu
and they do have these exacerbations they’re found to have
pneumonia more often. And one last little piece about
asthma and the flu is that if you look at children that have
been hospitalized with the flu, the most common chronic medical
condition they have is asthma. So, it’s one of the big risk factors
for them getting hospitalized. And a last thing, although
Dr. Jain mentioned this, remember with asthmatics you
always because we’re talking lung disease, we never
want to give flu mist. We always want to give
the inactivated virus shot. So, I’ll stop
there for right now. Julie: Okay. Thanks so much. Dr. Brawley, I wanted to pass
this question to you about the potential impact of flu for people
who are struggling with cancer. Dr. Brawley: Hello. We don’t know if cancer patients
and survivors are at greater risk for infection with the flu. However, we do know that cancer
patients and survivors are at higher risk for
complications from the flu, including hospitalization
and death if they get the flu. And a recent study found a
significant decrease in deaths in cancer patients vaccinated
against the flu compared to those who did not
have the vaccination. Chemotherapy and cancer
both can reduce the number of infection-fighting white blood
cells and make it harder for patients to fight infections,
especially when they’re being treated with chemotherapy. And patients with cancer should get
a flu shot and not the nasal spray. Julie: Okay. Thanks so much for
that information. Dr. Jain, I was wondering if you
could tell us a little bit about the high risk of complications
associated with obesity. Dr. Jain: Sure. And I guess I just
wanted to add one thing, which is, you know, in addition
to my role at CDC I am also a practicing clinician and
internist and infectious disease specialist in the community. And a lot of my patients are
at the VA here in Atlanta. And one of the things that
we really probably kind of uncovered really more during
the 2009 H1 pandemic were risk factors of obesity
and morbid obesity. So, you know, let’s just
stop for a moment and say, you know, what is that? Obesity and morbid obesity are
defined on body mass index or most of us will
refer to it as the BMI, which is a measure of body fat based
on a person’s height and weight. And the cutoffs for obesity are
a BMI of 30 or greater and then morbid obesity is a
BMI of 40 or greater. And what we found during the
pandemic was that people who were morbidly obese were at
higher risk for flu related complications than those
who were not morbidly obese. And because of this finding and
because we found it also during the pandemic, which is,
again, as I stated before, the current strain that is
circulating is the same strain that we had in 2009. So, during this time we found
out that morbid obesity put people at higher risk for
flu-related complications. And during that time it became
part of the ACIP recommendation for flu vaccinations. So, essentially
the bottom line is, you know, if you are morbidly
obese but don’t actually know that you have any of the other
medical problems that all the other panelists have
been talking about, whether that’s heart
disease or diabetes, et cetera, the recommendation
is for getting a flu vaccine. And I think it’s important to
talk a little bit about sort of what we’re seeing this season. So, in addition to the fact
that 2009 H1N1 is the most predominant strain
that’s circulating, our data when you look at
flu-related hospitalizations here at CDC, show that
out of all the flu-related hospitalizations
that we’ve seen so far, 43 percent of these
hospitalizations have occurred in adults who are obese. So, bottom line is if you’re
either obese or morbidly obese, number one, get the flu shot. If you do develop illness, you really
should seek medical care right away. Julie: Thanks for that, Dr. Jain. I think that, you know, from
this first question here it’s clear that it’s important to
get the flu vaccination but it’s especially important for people
who suffer from any of these chronic conditions to get an
annual flu vaccination because of that high risk
for complications. So, let me move on to
the second question here. It’s about why it’s important
for people who live with or care for someone with a chronic
disease to get vaccinated. So, Dr. Brawley, I thought you
could talk to us a little bit about why this is a necessity for
caregivers of people with cancer. Dr. Brawley: Sure. By getting a flu vaccination you
protect yourself and those around you. This means that your flu vaccine
helps reduce the chance that you’ll spread the
flu and, therefore, reduces the chance that the
persons who live with you will actually get the flu. Indeed, most experts believe the
flu virus is spread mainly by droplets made when
people with the flu cough, sneeze, or talk, and these
droplets land in the mouths or noses of people who are nearby. Less often a person might
also get the flu by touching a surface or object that has
the flu virus on it and then touching their own
mouth, nose, or eyes. Most with the flu can spread it
to others about six feet away, by the way, when sneezing
and coughing and things. And most healthy adults may be
able to infect others from one day before they actually have
symptoms to about five to seven days after they get sick. This means that there’s a whole
bunch of people who can pass the flu to someone and not even
realize that they’re sick or that they’re actually
passing the flu along. Children and people with
weakened immune systems can shed the virus for longer and still
might be contagious past five to seven days, by the way, especially
if they still have symptoms. Julie: Thanks, Dr. Brawley. I think that that question helps
put in context why this is an important topic even for those who
don’t suffer from a chronic condition. It’s about the importance of
getting yourself vaccinated to stay healthy yourself and to
not spread the germs to others. So, our next question is
about pediatric health. And we have folks joining us
today who focus on children’s issues and children’s health. So, Dr. Jain, I was wondering
if you could talk about the importance of flu vaccination
for young children specifically? Dr Jain: Sure. I guess I’ll add
my other hat here, which is a mom of
three, all six and under. So, I think, you know, the
number one point here is that we know that influenza is – that
children both under five and, as I mentioned earlier, children
who are under two are at greater risk for flu complications. That includes both
hospitalization and death. And that is true
in most seasons. And then this particular again
with H1N1 being the circulating strain, it’s some of these older
children and younger adults who are at risk. So, I think a few things that
one needs to understand about kids is that kids are a little
bit different than big people, as we all know. Some kids that are six months
through eight years of age actually need two
doses of the flu vaccine. And children in this age group
who are getting vaccinated for the first time as well as
some who have been vaccinated previously might need two doses. So, it’s really important when
you’re talking about the flu vaccine with your doctor, to
understand what your previous vaccination records have been and
how many doses you actually need. So, that’s one of the sort of
more specific points about kids and the flu vaccine. I think the other thing to
think about is that every year we see that children who get
infected with influenza die. This season so far we’ve had
28 influenza-related pediatric deaths as of January 18th. Last season, 2012, 2013, we
had a total of 171 flu related pediatric deaths. And during the pandemic
– so, during the 2009, 2010 season, we had
three hundred and fifty eight influenza-associated
pediatric deaths. So, you can see that during
the time when we had H1N1 circulating during the
pandemic, we had many more, almost twice as many
deaths than we saw last season. Again, this is the same strain
that is currently circulating. And from the data that we’ve
seen through our surveillance systems here at CDC, what we
found is among children who are six months or older, about 80
to 90 percent of flu-related pediatric deaths occur in those children
who did not get a flu vaccine. So far, many of these children,
about half when we’ve looked at it, have chronic conditions
that we’ve already talked about, but half of them actually don’t have
any chronic conditions as well. So, I think the bottom line is
kids are really an important group to think about when we
think about flu vaccine and also antivirals during this
season and any season. Julie: Thank you. We focused largely on the
importance of preventing flu, especially for people that are at
high risk for severe complication. So, let’s talk for a minute
about what people with some of these chronic conditions
should do if they get the flu. So, Dr. Bufalino, if
you’ll kick us off, then I’ll ask Dr. Anderson and
Grayson to talk about what to do if someone with diabetes
or asthma gets the flu. So, Dr. Bufalino. Dr. Bufalino: Thank you. I guess I’m most worried about Dr.
Jain with three kids under six. If they get the
flu at their house, they’ve got a real handful. So, good luck with that. So, I’m glad you’re
all getting vaccinated. Dr Jain: Well, we get vaccinated. Dr. Bufalion: Thank God for that. So, you know, for us obviously
we’re concerned about people who are high risk for the flu,
that they need to get in and see their doctor promptly. You know, if you listened
to Pam Coleman’s story here, three valve replacements, she’s
clearly somewhat at high risk. Particularly in our
heart failure patients, those are our most sensitive group of
folks who are many times tenuous. And so even if
they’ve been vaccinated, if they get sick, we want them
to get in and see their doctor quickly because many of these
folks will need to be treated with antiviral drugs. And, you know, it’s sort of
based on what their syndrome is, but the opportunity to
treat them shows that, you know, we can maybe make that
episode of the flu milder or that the time that they’re
ill a shorter period of time. So, that’s important for us to
help lead to preventing these complications because if you
have an underlying condition like heart disease, you know, it
may mean the difference between a quick brief illness and
something serious that could end up with a hospitalization or a
very prolonged hospitalization with a stay in intensive care. So, we think that the
antivirals work best within the first two days of the flu
symptoms once they first appear, although the data suggests that
they’re beneficial out to about five days after getting sick. So, it’s very important
for that high-risk group, as I said earlier, because
that’s the folks who are likely to get the sickest and probably need to
be treated early on in their illness. Thank you. Julie: Thanks, Dr. Bufalino. Dr. Anderson? Dr. Anderson: Yes. As I said before, people
with diabetes can have real fluctuations in their blood
sugars because of being ill. In addition, if anybody’s –
all of us have been ill before. You know it keeps you
from eating properly. You’re nauseated. That can further affect
blood glucose levels. But I think one of the most
important things to tell your patients is continue to take your
oral medicines or your insulin. Don’t just assume because you’re
ill and you’re not eating as much that you are to
stop your medication. And this is a time to be on
the phone with your health care provider or in communication
with their office so you can be guided through this illness. I mean you may even need more
insulin with the inflammation and the fever and the illness
than you had before even if you’re not eating much. And then the other part of this
is you need to be checking your glucoses rigorously. We recommend every four
hours, before breakfast, lunch, and
dinner, and at bedtime. And then not just check them
but keep track of the results because if you’re not
following the trends, then you’re not going to be able
to make the right decisions. The other part of this
for people with diabetes, and this is probably true for
all people who get influenza, drink extra fluids. Stay hydrated. And for people with
diabetes, that means non calorie containing
liquids, not Mountain Dew. Okay. But you also try to eat
as normally as you can. And if you don’t
feel like eating a lot, eat small meals. Eat soft foods. Try to get enough carbohydrate
in to match the regimen and the medications that you’re on. And then we tell our
patients to weigh every day. We know that when you’re losing
weight rapidly in an illness, especially if you have diabetes,
it’s a sign not only of possible dehydration but also that
your glucoses may be soaring. And then we also advise
our patients to check their temperature in the
morning and in the evening. Keep a sign, keep a log of the
trend and report that back to your health care provider. I think the last thing I’d like
to say about this is when you feel lousy and you’re
terribly ill with something like influenza, that’s not the time
to make up your mind to decide what to do. I think every patient needs to
have that discussion with their health care provider if they
have diabetes about what should my sick day protocol look like
so that you have an action plan before you get sick. Thanks. Julie: Thanks, Dr. Anderson. Dr. Grayson? Dr. Grayson: Well, so for
someone with asthma, the first part about if they get the
flu is the same as anyone else. If you get sick
with flu symptoms, you want to call your doctor. And if your
doctor recommends it, take the antiviral drugs. And it’s important to call as
soon as possible because the treatment with the
antiviral drugs works best, as actually Dr.
Bufalino has said, when started early, preferably
within the first two days of the onset of symptoms. And the drugs that we have for
treating the flu are oseltamivir or Tamiflu, which
is the pill form. You require a
prescription to get that. So that’s why you got
to call your doctor. And it fights by keeping the flu
from replicating and making more copies of itself. Now, for people with asthma
there’s a couple of issues. There’s another anti-flu
drug, zanamivir or Relenza, which is actually
an inhaled medicine. And we don’t recommend this for
people with asthma or any lung disease because it’s been shown to
actually make lung disease worse. So, if you have asthma, you
really want to make sure you get the pill, the
oseltamivir or Tamiflu. The other issue with somebody
with asthma is you should have an asthma action plan kind of
like what Dr. Anderson just mentioned for diabetes, but we
have an asthma action plan with the green, the yellow, and the
red zones as far as how your breathing is going. And when you begin to
have symptoms of flu, that’s the time to start
thinking about moving into the yellow zone. Again, you’ll be talking to your
doctor and letting them know. So, I think that’s an important
thing to remember because that’s going to try and
keep your lungs, for a person with asthma, from
getting any worse and hopefully preventing an asthma
exacerbation down the road. Julie: Thanks so much. Okay. So, our last question for
this moderated portion of the discussion is about steps
to take to prevent flu. So, Dr. Jain, you touched
on this at the start of the briefing, but is there anything
that you’d like to leave us with now or reiterate before we take a
few questions from the audience? Dr Jain: Sure. I mean I think everybody
here has really emphasized, and I think the most important
thing is that getting an annual flu vaccine is always the
best way to prevent either flu complications and also
the spread of influenza. So, particularly people with
high-risk conditions as we stated before should get the flu
shot and not the nasal spray. So, that’s always number one. And as long as
flu is circulating, which it is now, everybody can
benefit from having a flu vaccine. I think, you know, number two
which we’ve also talked about before is if folks do get
sick, to get in touch with their doctor about whether or
not antivirals are needed. Then there are a lot of other
preventative ways to stop the spread of germs,
particularly influenza. A few that I can talk
about a little bit is, one, covering your nose and
mouth with a tissue when you cough or sneeze and then
obviously throwing the tissue away when you’re done and
then washing your hands. Avoiding close
contact with sick people. Staying at home when you’re sick
and then while sick limiting contact with others as much as
possible to keep from infecting them. And a few other things would
be avoiding touching your eyes, nose, or mouth because that’s
another way that influenza and other germs can spread. And then not last – not,
you know, what is it? Last not before least is that
washing your hands often with soap and water is very key to
stopping the spread of influenza and other germs as well. And if soap and
water are not available, then alcohol-based hand
rubs are also effective. Julie: Great. Thank you. So, now for the audience
Q&A portion of the session. Feel free to type your
question in the Q&A box, and I will – we’ll scroll
through those questions if they come in. And while you’re kind of
thinking about your questions, I did just want to post this
slide with website and social media links to the organizations
each of our panelists are representing today. As I said, these slides,
along with our panelists’ bios, will be sent to you
following the briefing. So you’ll be able to
capture these links then. If you don’t receive them or if
you have any further questions, you can feel free to contact me
and I’ll help you get connected to the right resource. My email is
[email protected] And for those of you who
are on the phone only, I’ll just real
quickly spell that out. It’s J-U-L-I-E-Y-E-G-E-N
at W-E-S-T-A-T.com. Let me go back to
our Q&A section. If anybody has any questions,
again feel free to type any in. I do see one coming in now. Are there any medical conditions
that people should not get a vaccine for if they have them? I’ve heard people with a chicken
allergy should not get vaccinated. Dr. Jain, that might be a question
for you to start off answering. Dr. Jain: Sure. The biggest group is
folks with egg allergies. So, even though now we actually
have some vaccines that folks with egg allergies could get,
but one does have to ask their doctor about that. But other than that there really
are not any particular groups that I can think of. I think the key here is what
we’ve been talking about is that there are differences between
getting a flu shot and getting the flu mist. And so those with chronic
conditions that we’ve been talking about shouldn’t get the
mist but can get the flu shot. And then folks with egg allergies
should talk to their doctor. Dr. Grayson: This is Mitch Grayson. I’m just going to jump in. Most of the people, most of
the kids with egg allergy, it’s not a problem. They’ll tolerate
it fine, but, yeah, they should talk
to their doctor. Sometimes they have to get
divided doses just to make sure they’re not going to react. Dr. Bufalino: Vince Bufalino
on the heart side. I would just add in it’s
actually the opposite. We want our sickest
patients to be included, our heart transplant patients, our
mechanical heart device folks. Those are the folks that
we’re most worried about. So, we wouldn’t
exclude anybody on our side. Dr. Jain: Yeah. I think
that’s absolutely true. I think that goes for
really every group. Julie: Thanks, all. Another question we got is what
if someone got the flu already this season? Should they still
get vaccinated? Dr. Jain: Yeah. Well, I think I
could probably deal with that. This is Dr. Jain again. Yes, actually they should. And just a little bit of a
more complicated answer to this question, but, you know, what we
often see in influenza is that you have like right now what
we’re seeing is that we’re seeing that influenza A,
specifically H1N1 is the circulating strain. However, there are
other strains of influenza. And often after we
see influenza A, we actually see a little bit later
influenza B outbreaks occurring. Currently the vaccines all have
at least one B strain and then there’s the quadrivalent vaccine,
which has two B strains in it. So, you know, we recommend
vaccination even if you already got sick this season
for multiple reasons, but one of the main ones is
because we can never predict with influenza
what’s going to happen, but often after we
see an A epidemic, we will often then see
a B epidemic as well. Julie: Thanks, Dr. Jain. It looks like one of our
attendees has a question, and I’m going to go
ahead and unmute your line. Jackie Boche, did you have
a question that you wanted to share with the group? Jackie: I think it’s already been
answered about summarizing each of the speakers to clarify
and summarize which vaccination method, the shot
versus the mist, is really recommended
for each of the diseases, but I think we
already covered it. Julie: Great. Yeah, I think that what we
covered was that the flu shot is recommended over the vaccine. I’m sorry, over the nasal mist. One other question
that we’ve got in. If kids under six
months can’t be vaccinated, what’s the best
way to protect them? And, Dr. Jain, I’ll go ahead and pass
this one to you too if you don’t mind. Dr. Jain: Sure. No problem. So, the key for this
group is their moms. So, we really want mom –
pregnant women need to get vaccinated because that’s their
main way – the main way for children under six months to have –
to be protected for influenza. But not just the moms but
all the family members who are living with and around children under
six months should get vaccinated. And then some of the other
measures are the things that I had talked about earlier in
trying to prevent germs in general using good hand hygiene
and avoiding contact with an infant under six
months if you’re ill. And I’ll put one
more plug in is for, you know, the health care
workers in hospitals and clinics and institutions that are
taking care of infants. The greatest way you can
help is by getting a vaccine. Julie: Okay. Thanks. And in the similar vein there’s
a question about for people with chronic disease is there an age
group that is more at risk than another or does chronic disease at any
age put you more at risk in general? And if any of our other
panelists want to jump in on that before if, Dr. Jain, you
want to comment too, feel free. Dr Bufalino: This is Vince
Bufalino on the heart side. You know, unfortunately our
oldest patients tend to be the sicker group in general although
obviously we have younger people with significant underlying
structural heart disease who would be at risk. But, you know, our elderly
population is always the group that we’re concerned
about and frankly, you know, we have a
growing elderly population. The number of folks that we have
in their 80s and early 90s is a number that is climbing. And so obviously those are the
folks we’d probably have the most concern about. Dr. Anderson: This is Dr. Anderson.
I agree. You know, both my patients with
diabetes and without diabetes, our elderly population is
particularly vulnerable. So, we not only talk to them
about the musts of a flu shot but also good behavior during
peak flu seasons when we have epidemics around. Dr. Grayson: This is Dr. Mitch Grayson. I’m going to take the
opposite side for asthma. We’re really worried about
the kids more so than adults. But again, elderly
are also a problem, but in the case of asthma it’s a
lot more kids that are ending up in the hospital. Dr. Jain: This is Dr. Jain again. Let me add in that I
think it’s complicated. I think that for all of
these groups it’s true that when you’re looking at heart
disease and diabetes, it’s more likely that you
have heart disease or diabetes because you’re older. Flu is really interesting
because generally we have influenza that
affects the very young, so children under five,
and then also the very old. And we talk about
elderly, but when we say that, we’re talking about 65
years and older and sometimes even 50 years or older. But what’s so interesting about
this influenza season is that the H1N1 virus predominantly
affects actually younger adults from age 18 to 49. And some of those patients and
people will have some of these chronic conditions and
some won’t. So, really the key message
is that there is a universal vaccine or a recommendation so
that people are covered annually for whatever flu
virus is circulating. Julie: Thanks. Another question is to all
the panelists who are currently practicing medicine. They’re wondering if you’ve seen
patients personally who have been affected by flu and kind
of talking about your experience dealing with it firsthand. Dr. Anderson: Well, I guess I can jump
in since I’m an internist and a primary care physician. We had a little bit of a bump in
December with some of the influenza. And we’ve had a lot of positive
nasal swabs in our emergency room. As a primary care
physician, you know, we try desperately to keep these
patients out of waiting rooms and our hallways. So, we’re very careful about
taking a history and sometimes even without nasal swabs, we
will treat prophylactically if the patient’s really
sick and as we’ve all said, trying to get it
within the first 48 hours. The only other part I’d like to
say as a primary care physician is it used to be that the flu
shot was the purview of your health care provider. One of the things I emphasize to
my patients now is I don’t care where you get your
influenza vaccine. I mean they are at pharmacies. They are at schools. They are at places of work. They are
available in our office. So, I always tell my patients
get the most convenient location and get it done. Don’t let the need to come to the
physician’s office be a barrier. Julie: Thanks, Dr. Anderson. Is there anybody else who
wanted to comment on that one? Dr. Bufaliono: This is Vince Bufalino
on the cardiology side again. You know, we had a
flurry of this in January. We had at several of our
institutions a number of folks with congestive heart failure
admitted with significant influenza illnesses. And, you know, as
I said earlier, it really tips the balance
in these folks who may be borderline compensated and
it pushes them over the edge. Some of them get dehydrated and
it affects their kidney function. You know, we have to
adjust all of their drugs. They develop low
blood pressure and, you know, need to be hospitalized
and replaced with fluids. A number of things happen in terms
of disrupting their stable state. And so, you know, we’re always very
wary of this time of the year. Julie: Thanks. Okay. I’ll leave the question section
open as I close out here a few minutes early. I did want to give the panelists
each a chance since we do have just a couple of minutes. Is there anything else that
you’d like to add or kind of close out with, you know,
knowing that this topic of flu vaccination for chronic
conditions is so important? I just wanted to give everybody a
chance to say a final few words. So, maybe, Dr.
Bufalino, if you don’t mind, I’ll kick off with you
for closing remarks. Dr. Bufalino: Sure. Our biggest concern is that only half
the folks are getting vaccinated. It’s a real problem from our
perspective because people don’t realize, you know, you’re doing
well and feel compensated so you don’t think you need it, but the truth
is all of our patients need it. So, we would implore
particularly the group of folks with underlying heart disease
to make sure they get vaccinated each and every year. Julie: Thanks. Dr. Brawley, and I apologize
that Dr. Lichtenfeld’s name is still on the slide. And thank you again so
much for joining us today. Dr. Brawley: Not a problem. Julie: Is there anything that you’d
like to leave us with at the end of this session? Dr. Brawley: Yeah. I would say that the
major thing that all of us have said is there are very few, very few
downsides to getting the flu vaccine; tremendous upsides. And I would encourage people to
get the flu vaccine because it actually is one of the few
things that we have in medicine that so clearly saves lives
and clearly reduces suffering. Julie: Thank you. That’s a great message. Dr. Anderson? Dr. Anderson: I think the only thing I
would close on is this is an ongoing conversation with
your patient population. I think the public awareness
about the importance of a flu vaccine has really taken off
in the last 5 to 10 years. I hear very few of those
patients who still remain that say well, you know, the last
time I had the flu vaccine I got ill from it. And I think that’s a
credit to our public awareness. But I agree. We still have a long way to go. And this should be just a part
of routine general conversation with your patients every time
the fall and winter seasons start to come along. Julie: Great. Thanks. And Dr. Grayson? Dr Grayson: So, get vaccinated. Get vaccinated. Get vaccinated. I mean I think
that’s the key point. And obviously
people with asthma, if they do come down with a
respiratory disease like the flu, that they should
follow their asthma action plan. But really the key thing
is like everybody’s saying, get vaccinated. Julie: Thanks. And, Pam, thanks
for sticking with us. I’m curious to know, you know,
as someone who is living with a chronic condition, you
know, what does hearing this information from
all of these experts, you know, how that makes you feel
about the importance of vaccination. Pamela Coleman: Absolutely. I feel like each and every
one has been speaking to me personally because I do
have the chronic disease. I have an aortic
prosthetic valve. So, as Dr.
Bufalino had mentioned, you know, I am at higher risk
for the bacteria and everything to develop around
the heart muscle. So, that is a big
concern of mine. And having a son
that has asthma, both of us having two chronic
diseases in the household, he’s been getting his flu shot
since he was six months old, and he had the double dose
because he has food allergies. So, he had the one
dose and the second one. But he is highly recommended by
his pediatrician to get the flu shot every year, as am I. And it’s just wonderful to know
that we’re doing the right thing to stay healthy in our house and
how I will continue to encourage other people who have their
doubts about getting the flu shot how important it is,
especially if there’s someone with a chronic disease in
their household or they, themselves, have a
chronic disease, to get a flu vaccine. So, I want to thank everyone
personally for this information because I definitely will
take it away and share it with co-workers and
family and friends. Julie: Thanks so much, Pam. And, Dr. Jain, I just wanted to give you
a moment to offer any closing remarks. Dr. Jain: Sure. I mean I think I’m just going to
reiterate what everybody said, which is vaccine,
vaccine, vaccine. However, I think, you know, I
think it was Dr. Bufalino who talked about how our population
is not well-vaccinated, and I’d like to make a point
that again because the H1N1 virus is the main
circulating strain right now, we do know that amongst the
people who are at highest risk, so that group from 18 to 49,
they’re also the least likely to get vaccinated. And so right now from fall
estimates only 30 percent of people who are age 18 to
49 were getting vaccinated. And that’s at least 10 points lower than our national average is. So, you know, as providers the
message needs to get out that this group is at risk,
particularly this season. So, that’s the number
one take-home message. And the second is for both for
people who are patients who are on the line but then also
clinicians who are providing care, all of the groups here
represent groups that are at high risk for getting
flu-related complications. So, these groups when they come
into outpatient clinics or in hospitals and if they’re coming
in with influenza or suspected influenza, really
should get antivirals. So, that’s the other message to
get out there because we don’t use influenza antivirals as
much as we should be either. Julie: All right. Thank you so much. And a big thank you to all six
of our panelists for providing information about flu vaccination
and these high-risk conditions. Thank you also to all who
joined today’s briefing. We hope that you heard some
valuable information that you can then use, whether
it’s on a website or a blog, newsletter, social media,
anywhere that can really help us spread the word about the
importance of flu vaccination. My contact
information is up on the slide. And again, we’ll send these out
to you and please feel free to follow up with any
questions that you might have. And with that,
another thank you, and I will close the session. Thanks, everybody.

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