According to the CDC, about 70 million doses of vaccine are now available, and supply will be increasing in coming weeks, CDC Director Thomas Frieden, said in a conference call with reporters. Fewer infections, coupled with additional doses of the H1N1 vaccine offers a “window of opportunity” to vaccinate more people, improve immunity and head off the possibility of a new wave of infections.

“We’re far from out of the woods, but we have an opportunity to get more people protected in case there’s another surge or wave in future months,” said Frieden.

As National Influenza Vaccination Week winds down, do your part. Take the time to find a flu clinic near you and get vaccinated. You can find out more about the safety and effectiveness of the H1N1 vaccine here. In addition, following simple tips, such as washing your hands and disinfecting frequently touched surfaces, will help reduce your risk of contracting H1N1, prevent the spread of germs and potentially minimize the impact of a “third wave” of H1N1 as we head into peak flu season.

(Chris J. Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council).

Scientists confirmed this theory recently in a report published in The Journal of the American Medical Association, which found that one-third of California patients hospitalized with H1N1 flu were given a rapid test that came back negative. A different test that uses more sophisticated technology confirmed they had H1N1.

The discrepancy is caused by the high specificity (80-90 percent) and the low sensitivity (10-70 percent) of the rapid test for influenza A. The test often does not identify influenza A, especially in adults, who don’t shed as much virus as children. Therefore, correctly identifying those with influenza A, which could be either H1N1 or seasonal flu, is the real issue with the rapid tests. Since about 90 percent of circulating influenza A is H1N1, doctors can be fairly sure that anyone with flu-like symptoms who is also positive for influenza A – either on the rapid or more advanced tests – has H1N1 flu. But, there is still a 10 percent chance that it is seasonal flu.

Regardless, many are not taking the chance that their illness could be something other H1N1. Dartmouth pediatrician Hank Bernstein, who’s on the American Academy of Pediatrics’ infectious diseases committee, said in a recent USA Today article, if symptoms look like the flu, “it’s H1N1 until proven otherwise, almost.”

Stephen Baum, an infectious-disease physician at New York’s Albert Einstein College of Medicine, in the same USA Today story, says: “If you test positive, you got it. If it’s negative, you may still got it.”

Therefore, it is important to understand the symptoms of flu versus a common cold. Those symptoms, not the test results, should be the trigger to take relevant action – either treatment or protecting others from exposure. Further, a negative test shouldn’t make one complacent in taking steps to prevent spreading the flu. Learn what you can do to keep your family healthy this winter by visiting the “Prevention and Treatment” section on the Centers for Disease Control and Prevention H1N1 website.

(Jerod M. Loeb, PhD, is Executive Vice President, Division of Quality Measurement and Research, The Joint Commission, and a member of the Water Quality & Health Council).

In its weekly update on flu activity, the CDC reported that:

• The number of states experiencing widespread flu cases during the week that ended Nov. 21 had fallen to 32, down from 43 states the week before and a high of 48 states in late October.
• Influenza-like illnesses accounted for 4.3 percent of all visits to doctor’s offices during the week, down from nearly double that proportion in October.

Yet, officials warned that the number of people getting infected with the H1N1 virus remains high, and cases could surge again. Therefore, federal health officials are trying to avoid creating the impression that the outbreak is over.

“We’re far from being out of the woods,” said Thomas Skinner, spokesman for the CDC. “There’s still a lot of flu out there. And we wouldn’t be surprised to see another uptick in activity as we approach the end of December and beginning of January, when kids come back from Christmas break.”

Other experts argue that if there is another surge, it will be relatively mild because most people will have either been exposed to the virus or will have received the H1N1 vaccine.

Thus, federal officials urge people to continue seeking the H1N1 vaccine, despite the current drop in H1N1 influenza cases. According to a Dec. 1 article in the Washington Post, more than 60 million doses of vaccine have become available and officials are predicting millions more will be shipped to states in the coming weeks.

In the meantime, people should protect themselves by:

• Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your elbow or shoulder; not into your hands.
• Disinfecting surfaces by wiping them down with a disinfectant according to the directions on the product label.
• Washing your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoiding touching your eyes, nose or mouth. Germs spread this way.
• If you are sick with flu-like illness (fever with sore throat and/or cough), CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care or for other necessities.

For more on stopping the spread of H1N1, please visit www.fluandhealth.com or the CDC’s H1N1 information page.

(Ralph Morris, M.D., M.P.H., is a preventive health and public health physician, and a member of the Water Quality and Health Council)

A recent survey by the Water Quality and Health Council shows that despite constant warnings from health officials and a recent study showing a 31 percent chance of infection through hand contact with contaminated surfaces, few Americans frequently clean the public surfaces they use. At the same time, not many have faith that others are cleaning them either. Regardless of this, just one in ten is inclined to do the job themselves.

Knowing that flu viruses can live on inanimate surfaces for hours or even days should motivate people to take personal responsibility to protect themselves; disinfecting surfaces when feasible, using disinfecting wipes or chlorine bleach – especially at home and at work – as well as washing hands and practicing good personal hygiene habits. Contacting school administrators, office managers and even health club managers will help you understand their cleaning and disinfecting protocol and how you can better safeguard against the flu.

To help people prevent the spread of H1N1, The Centers for Disease Control and Prevention (CDC) recommends keeping surfaces clean by wiping them down with a disinfectant according to the directions on the product label. Also, in addition to cleaning surfaces, the CDC advises a number of helpful tips. For more information on how to prevent the spread of H1N1 through surface disinfection, please visit www.fluandhealth.com.

Fact: A well-stocked space in your home could make all the difference.

Individuals and families should prepare for potential pandemic flu-related isolation from their communities for an extended period of time. Dr. Ralph’s Flu Preparedness Closet is a helpful checklist of what you need to have on hand.

• Food and bottled water

Ideally, a 6-8 week supply stored in the home.

• Portable power sources

An ample supply of energy resources (batteries, propane, etc.) to heat, light and operate necessary

home functions, including your home computer.

• Household products and sanitary items

Paper products (Kleenex, toilet paper, paper towels), plastic products (garbage bags, re-sealable

bags), cleaning supplies, non-water hand sanitizer, personal hygiene products, etc.

• Prescription drugs

Vital for diabetics, heart, lung and other chronic conditions that require daily medication.

• Over-the-counter medications and first aid supplies

For the treatment of fever, fl u, colds, etc. including a fully stocked fi rst aid kit for the treatment of

minor injuries and illnesses.

• A supply of household chlorine bleach

For use as an emergency water purifi er and to sanitize surfaces.

• Communications equipment

A battery-operated radio and several fully charged cell phones to maintain an open information

channel with family, friends, local authorities and community information sources.

• Home computer system/Internet services

To provide access to local, national and global news, health-related information and pandemic related news updates. Also vital to allow some individuals to continue participation at their

place of employment or school.

• Pet supplies

Food, medication and sanitation supplies for family pets.

• Neighborhood service directory

A directory of medical, emergency and community services and their locations.

• Money

Without access to ATMs and banking services, cash on-hand could be necessary to replenish supplies and purchase necessary services.

Download a pdf file

Controlling viral populations on household surfaces is an effective way to cut down on the spread of seasonal and H1N1 flu. Although flu viruses require live host cells to multiply and spread, they can live on inanimate surfaces for hours or even days. Good hygiene requires more than just cleaning. Proper disinfection provides an additional safeguard for areas where people come into contact with contaminated surfaces.

Some common surface areas are “hot spots” for germs, including doorknobs, counters, table tops, dials, handles and switches. In fact, it can take up to 3 days for viruses on surface areas to die. To use chlorine bleach for general surface area disinfection, use a fresh mixture of ¼ cup of household bleach with one gallon of cool water (if you need a small amount, use one tablespoon of bleach in a quart of water). Apply to surfaces. Leave wet for 10 minutes, then rinse.

Disinfectant wipes also can be used to eliminate viruses on everyday items, such as telephones, cell phones, computer keys, computer mouse, arm rests and children’s toys.

If washing by hand, use very hot water and use a diluted bleach solution in the rinse water to disinfect. The right mix is 1/4 cup of household laundry bleach in one gallon of water.

According to a 2004 study by the National Institute of Nursing Research, households that use hot water and bleach in the laundry experience almost 25% less infections than households that do not bleach

Management Plan Obtain the flu vaccine, preferably in October or November. Cover mouth and nose when coughing or sneezing. Wash hands often for 15-20 seconds at a time (long enough to sing “Happy Birthday”). Disinfect surfaces with diluted chlorine bleach solution (1/4 cup per gallon water). Remind children to practice healthy habits.

As swine flu progresses across the globe, raising the specter of a pandemic, the critical need for surface disinfection is highlighted by public health officials as a practical way to stem the rate of infection. As important as canned foods and emergency water, a bottle of chlorine bleach should be an essential part of your family’s emergency preparedness kit.

Every fall, millions of Americans rush to be vaccinated against the influenza virus, or “flu,” in the hope of avoiding the worst of the seasonal symptoms of fever, headache, fatigue, cough, sore throat, runny nose, congestion and muscle aches. According to the U.S. Centers for Disease Control and Prevention (CDC), getting an annual flu vaccine is the best way to prevent this disease.

A sound risk management plan for avoiding flu infection maximizes all known preventive measures, including “flu shots” for everyone six months old and older, frequent hand washing and smart use of a common household product–chlorine bleach.

How Viruses Operate and Propagate

A virus consists of a small collection of genetic material surrounded by a protective protein shell. As very simple microbes, viruses cannot reproduce on their own, but only by “hijacking” various living host cells, including bacteria, plant, animal and human.

Viruses inject their genetic material into the DNA of host cells and manipulate them to manufacture millions of new virus particles. And to ensure the efficient spread of the newly produced virus particles, the coughing and sneezing of human flu sufferers send droplets of virus-laden mucous streaming into the air and onto human skin, including mouths or noses of people nearby, and other surfaces. Dr. Dennis Clements, a professor of pediatrics and infectious diseases at Duke University, estimates that a single sneeze can send flu-infested water droplets as far as three feetⁱ.

Equipped with a mode of transportation to new, fertile host cells, the virus thrives, even if, statistically speaking, most organisms fight the infection successfully. Most important to the virus’ survival, it is on the move, ever seeking and infecting new hosts.

Outsmarting the Flu Virus With Chlorine Bleach

Although viruses require live host cells to multiply and spread, they can live on inanimate surfaces for up to two hours or more, giving them a convenient window of opportunity to be picked up by unsuspecting organisms, namely, us. Likely points of infection are commonly touched surfaces: doorknobs, desks, counters, dials and handles. Managing the viral populations on these surfaces is an effective way to cut down on the spread of flu. Chlorine bleach is a logical germ-busting, readily available product to turn to for this task. It works by penetrating the protective shells of viruses.

An EPA-registered chlorine bleach solution or a dilute solution of regular laundry bleach (1/4 cup of bleach in a gallon of cool water) is an effective and inexpensive all-purpose disinfectant, used commonly in homes and healthcare facilities. Some health clubs keep spray bottles of chlorine bleach solution on hand for members to use to disinfect exercise equipment. The active ingredient in chlorine bleach, sodium hypochlorite, is one of the chlorine disinfectants routinely added to municipal drinking water to control waterborne disease. Since the introduction of water chlorination to the U.S. in 1908, death rates due to typhoid fever, cholera and hepatitis A have declined dramatically. In addition to water disinfection, chlorine bleach solutions are approved by the Environmental Protection Agency (EPA) and the Department of Agriculture (USDA) for use in safe food production, including food preparation and service in healthcare facility kitchens and cafeterias. Chlorine bleach is used routinely to kill common food pathogens such as Campylobacter, Salmonella and E. coli.

A recent study by the National Institute of Nursing Research showed that hot water and bleach are more effective in reducing viral infections, such as flu, than antibacterial products. This is not unexpected because antibacterial products work only on bacteria, whereas bleach destroys both viruses and bacteria. According to the study’s author, Dr. Elaine Larson, PhD, RN, Associate Dean for Research at Columbia University’s School of Nursing, households reporting bleach use for laundry at the beginning of the study experienced approximately one-fourth the rate of infection of households that did notⁱⁱ.

Children And Flu: Special Considerations

According to the U.S. Department of Education, approximately one-fifth of the U.S. population attends or works in schools. Additionally, large numbers of American families rely on day care facilities for full-time or after-school child care.

Compared to adults, children have fewer antibodies for fighting off illness, which allows viruses to multiply more quickly in children’s bodies. With more viruses in their bodies, youngsters can spread viruses more easily. Children under age two often suffer gastrointestinal problems when they are infected with the flu, and their stool contains the virus. Add to this the less-than-perfect hygiene practiced by many young children, and the risk of infection from contact with youngsters rises.

The CDC has issued advice for preventing the spread of flu in childcare settings. In addition to vaccinating all children between six and 23 months of age, recommendations include teaching proper hand washing and keeping childcare environments clean. Frequently touched surfaces, such as toys and other commonly shared items, should be disinfected daily with either an EPA-registered hospital disinfectant or EPA-registered chlorine bleach solution. According to the recommendations, if an EPA-registered chlorine bleach is not available, generic chlorine bleach may be used by mixing ¼ cup chlorine bleach with 1 gallon of cool water.

Getting Through Flu Season With the Help of An Old Friend

Understanding how viruses use us to sustain their existence in the great web of life is an aid to developing the best flu risk management plan possible. Getting a flu shot, limiting contact with the infected, washing hands frequently and thoroughly, and mixing up an effective germ-busting solution of water and familiar household laundry bleach will go a long way to protecting us from nature’s seasonal flu scourge.

Flu Statistics

• The time from when a person is exposed to flu virus to when symptoms appear is about one to four days, with an average of about two days.
• The US normally vaccinates a larger proportion of its population than any other country except Canada.
• Two-thirds of the US supply of flu vaccine usually goes to adults between 18 and 65. Yet 90 percent of deaths from flu occur in those over 65 years of age.
• On average, approximately five to twenty percent of US residents get the flu, and more than 200,000 persons are hospitalized for flu-related complications each year.
• The yearly death toll in the U.S. from flu varies from 17,000 to 51,000.

ⁱⁱ Wart, P.J. (2004, Oct. 12). The virus fighting duo: Hot water and bleach, HEALTH Plus Health and Wellness, Vanderbilt University. On-line. Available: http://vanderbilttowc.wellsource.com/dh/cotent.asp?ID=1388

ⁱⁱⁱ Karlen, A. (1995). Man and Microbes: Disease and Plagues in History and Modern Times. New York: Simon & Schuster.

That is especially true in the case of schools where large numbers of children are in close contact. When exposed, those children become a reservoir for spreading the infection at home and in other settings. When I read that many schools now wipe down desks regularly, I wondered why they hadn’t been doing this already. This would prevent not only the flu, but also the spread of other viruses and germs.

As a public health professional, I know that cleaning and disinfection are always a part of a smart prevention strategy. In schools, disinfection is critically important for areas where students come into contact with contaminated surfaces, including bathroom fixtures, doorknobs, handrails, athletic equipment and desktops. Diseases can be readily transmitted via all these surfaces. The use of an effective cleaning agent followed by a proven disinfectant such as chlorine bleach after cleaning can effectively help prevent the spread of disease.

Add good hand washing with the appropriate use of hand sanitizers, and you have the recipe for healthy students and a healthy school.