Lucy Tompkins, MD, Discusses the H1N1 Virus, Vaccines and Stanford Hospital Preparedness
As medical director for hospital epidemiology and infection control at Stanford Hospital & Clinics, Lucy Tompkins, MD, monitors infectious diseases on a daily basis. She recently talked about the coming influenza season—and the precautions people should take.
Lucy Tompkins, MD, Medical
Director, Infection Control and Epidemiology Department at
Stanford Hospital & Clinics.
H1N1 Virus and Vaccine
Question:
What do we know about the new H1N1, so-called “swine flu”?
Tompkins: We know that symptoms of this influenza are very similar to the seasonal influenza. In the United States and in the southern hemisphere we are not seeing an excess number of deaths or hospitalizations from this new pandemic strain, which is actually reassuring. That means there is nothing particularly virulent about this new flu strain.
Question:
Should we be concerned about the H1N1 flu? Even scared?
Tompkins: Well, it’s not as virulent as we thought it might have been, but flu is still a dangerous disease. And the new strain is striking exactly the same groups of people that it always strikes. In a given year we usually see between 35,000 and 50,000 deaths in the United States related to influenza. Most of those deaths are complications that are set up by flu.
The Centers for Disease Control and Prevention (CDC) have been looking at Australia, New Zealand, and Argentina and at countries in Europe because they have the most developed health-care systems. In those areas the H1N1 flu is paralleling what we saw here in the spring. The death rate is about the same as typical flu, but because the number of people who are susceptible to influenza is much greater, the absolute number of deaths will be greater than in previous years. Pregnant women, those over age 65 and adults with chronic medical conditions are at high risk. Flu is not like the common cold. It accounts for an enormous amount of absenteeism, and billions of dollars are lost every year to influenza.
Question: What precautions are you advising people to take for the flu season?
Tompkins: People should get vaccinated for seasonal flu, as well as for the new strain. There will be plenty of doses of vaccine for seasonal flu, starting now, and doses of the vaccine for H1N1 will be available later in October and throughout the fall.
Question: What are the risks of getting the new flu vaccination?
Tomkins: There could be localized complications. For example, the area where you get the shot may develop some redness or soreness, and some people might get symptoms that are suggestive of the flu, like malaise or a low-grade fever for day or two. Also, people who have severe egg allergy or who have had Guillain Barre Syndrome should not receive the vaccine.
Stanford Hospital Preparedness
Question: What kind of H1N1 vaccine will health-care workers at Stanford Hospital be getting? Tompkins: We don’t use the live-virus vaccine that they squirt up your nose because it’s conceivable that it could be spread to patients who might not be able to handle a live virus. So we use the shot containing a dead-virus particle that’s not capable of causing flu.
Question: How long has Stanford Hospital & Clinics been preparing for something like the H1N1 flu?
Tompkins: We originally started planning a response to bioterrorism in 2001, after 9/11, by forming a task force called the Emerging Diseases and Bioterrorism Sub-Committee. That quickly morphed into a response to a possible SARS epidemic. Then there was H5N1, the bird flu, in 2005, which prompted us to prepare for pandemic influenza. So the hospital, in conjunction with the university, has been planning for this for years, and we were pretty well prepared when the new strain hit last April.
Question:
What is the hospital advising physicians to do?
Tompkins:Dr. Janice Brown from the bone marrow transplantation division has been convening a group to talk about treatment, particularly for critically ill patients. She is leading an effort to put an algorithm on a screensaver that would tell clinicians what diagnostic tests to order, how to interpret them and how to treat patients.
Question:
What precautions will the hospital use to prevent the spread of H1N1 and the seasonal flu?
Tomkins: Traditionally we’ve used surgical masks to prevent the spread of influenza. Now, because the CDC said in April that the new H1N1 is a “novel” virus, California is telling us we have to use respiratory precautions—N95 surgical masks—and, if we have them, negative-airflow rooms. The state is also telling us that we have to put on a new mask for each patient we treat.
Question: Is the Stanford Emergency Department already seeing a lot of flu patients?Tompkins: Dr. Eric Weiss is keeping daily statistics on the number of influenza-like cases that are being seen in the Emergency Department. We are seeing a lot of patients with ILI (influenza-like illness), but right now we’re able to handle them in our current ED. About 50 percent of the patients with ILI are children. We also know that the predominant cause of influenza at this time is the new H1N1 strain. If there are three or four consecutive days when we see more than 200 patients in the ED, or a significant increase in the number of patients with influenza-like symptoms, then we’ll go to the next step. We’ll open up a new waiting room, and we may mask all the adults in it.
So we’re keeping a daily tally of who’s coming through the Emergency Department. And we’re also looking at state public health websites, and at the CDC website, and we get a weekly update from our own virology laboratory about what they’re processing. So far, we’ve only seen H1N1, not any of the old flu strains. But there is an upswing in California, and in states across the nation, in influenza. The CDC believes that influenza may peak much earlier this year, possibly in late October, even before the new H1N1 vaccine is available. However, it is important for people to get this vaccine no matter when it arrives.