I am all packed, ready to catch my flight first thing tomorrow morning, heading out to India.  This is not a good time to be traveling and H1N1 is very much on my mind. You can bet I will be using alcohol gel every chance I get. Last thing I want is to arrive at my Mom’s with a load of infection.

Exchange of emails with a CLL friend has brought up an issue that I would like to share with you as well.  For a change I will try to be succinct – no easy task for me!

Consider yourself warned

The projections are roughly 30% of our population is going to catch the H1N1 “swine flu” virus in the next little while.  I hear many folks dismiss the risk – after all this is supposed to be a “mild” influenza virus, no big deal.  Not!

First, anyone who thinks any influenza infection is a mild couple of days affair is in for a rude awakening.  If you got a case of the sniffles in years gone by that lasted a couple of days, no big deal, that was not (repeat, not) influenza.  That was a common cold virus.  Influenza infection is a whole another beast. I know, I had a bout of it in 1957.  I thought I was dying and my mom tells me I almost did.  I was out for 10 days and felt very puny for couple more weeks.

OK, let us say your best laid plans to avoid catching the H1N1 virus fail and you are one of the 30% that got infected.  One can only hope the virus is still sensitive to Tamiflu (swine flu developing drug resistance is very much a worry) and furthermore you are able to get hold of it within 48 hours of first symptoms.  The general consensus is that treating with Tamiflu is not all that useful if you do not start the medication within 24 hours.

But how about this more scary scenario.  You are a CLL patient who has had the usual amount of immune suppressive chemotherapy in recent months /years.  You were not able to avoid H1N1 infection.  You did not take Tamiflu within 48 hours.  What is your game plan now?  Do you “ride it out” because there is not a whole heck of a lot that can be done anyway, now that the Tamiflu window of opportunity has passed?

Double Trouble: influenza increases chances of bacterial infections

Plain vanilla H1N1 Influenza may be the least of your problems in this scenario.  You see, even in the case of healthy people, influenza viral infection makes them much more vulnerable to opportunistic bacterial infections.  You want a credible citation?  Here it is, from the CDC. You can read the full article by clicking on the link.

Bacterial Pneumonia and Pandemic Influenza Planning

Abstract
Pandemic influenza planning is well under way across the globe. Antiviral drugs and vaccines have dominated the therapeutic agenda. Far less work has been conducted on stockpiling and planning for deployment of antimicrobial drugs against secondary bacterial pneumonia, a cause of substantial illness and death in previous pandemics and epidemics. In the event of a pandemic, effective antimicrobial drug measures are expected to substantially benefit public health. We address issues regarding use of antimicrobial drugs as stocks of individual agents are diminished and the role of resistance surveillance in informing such policy. Furthermore, vaccination with polysaccharide and conjugate pneumococcal vaccines is considered as part of a pandemic strategy.Most illness and death from influenza are likely to occur in developing countries, where neuraminidase inhibitors and vaccines may be neither affordable nor available; thus, compared with industrialized countries, the benefits of treating bacterial complications in developing countries may be substantially greater.

Secondary bacterial pneumonia is a common cause of death in persons with seasonal influenza; co-infections have been found with ≈25% of all influenza-related deaths”

Blunt enough for you? 

Mind you, this CDC perspective is for otherwise healthy people.  You, on the other hand, do not have healthy immune systems because of the underlying CLL and because of the therapies you probably have used to date to treat it (think fludarabine, cyclopphosphamide, Campath, steroids, chlorambucil – the list is long). 

Pneumonia is the single biggest cause of death in CLL patients. If you catch the flu bug you need to be carefully monitored for secondary bacterial infections, especially bacterial pneumonia.  And Tamiflu window having passed does not mean you can throw up your hands and indulge in fatalism.  Bacterial infections can still be treated with broad spectrum and possibly intravenous antibacterial drugs. 

There are  no guanrantees in life, not many that you can count on.  But here is one that I will bet on:  being macho and attempting to ride out on your own a bout of flu coupled with deep respiratory infection will be one of the more foolish things a CLL patient can try – and live to brag about it.