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Liver Lines - October 2, 2009

Flu season is fast upon us and this year we are faced with the prospect of two flus and possibly two flu vaccines. We are hearing lots about the H1N1 flu and the concerns about how this flu may manifest in the fall. Let’s not forget that the regular yearly seasonal flu is also on the horizon and needs to be prepared for as well.

How do these flus affect people with liver disease and should people with liver disease get vaccinated? Seasonal flu is common and can cause significant illness. On average, 36,000 Americans die each year from the seasonal flu. The seasonal flu vaccine is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions, such as liver disease. Currently, it is recommended that all people with liver disease get the yearly seasonal flu vaccine in order to lessen the likelihood of catching the seasonal flu. Yearly flu vaccination should begin in September or as soon as vaccine is available and continue throughout the influenza season, into December, January, and beyond. This is because the timing and duration of influenza seasons vary. While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later. People with allergies to eggs or those who have a febrile illness should not take the seasonal flu vaccine. The seasonal flu vaccine does not protect against the H1N1 flu.

The H1N1 flu is a horse of a whole different color. This virus is a new influenza virus causing illness in people. This virus was first detected in people in the United States in April 2009. It is spread from person-to-person, probably in much the same way that regular seasonal influenza viruses spread. In June 2009, the World Health Organization signaled that a pandemic of 2009 H1N1 flu was under way. There is a vaccine that will be available soon for the H1N1 virus. Current recommendations for who should be vaccinated are limited and include pregnant women, household contacts and caregivers for children under 6 months of age, health care and emergency medical personnel, all people from 6 to 24 years of age and persons between 25 and 64 years of age who have health conditions associated with a higher risk of medical complications from influenza. Patients with advanced liver disease (those with cirrhosis), regardless of cause of liver disease, should therefore receive the H1N1 vaccine. The first vaccine which is to be made available is a nasal spray containing live virus, and people with cirrhosis should not get this vaccine but wait the arrival on the injectable vaccine which contains inactivated virus. Once there is more available vaccine, all people with liver disease should be vaccinated.

You can do your best to prevent the flu, regardless of type by following certain basic steps. First, get vaccinated. Second, cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, an alcohol-based hand rub can be used. Avoid touching your eyes, nose and mouth. Germs spread this way. Try to avoid close contact with sick people. If you are sick with flu-like illness, it is recommended that you stay home for at least 24 hours after your fever is gone except to get medical care of for other necessities. Your fever should be gone without the use of a fever-reducing medicine. Keep away from others as much as possible to keep from making others sick.

Dr. Bernstein is the director of Hepatology for the North Shore-Long Island Jewish Health System. You may write to Dr. Bernstein, c/o Anton Community Newspapers, 132 E. Second Street, Mineola, NY 11501 or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

(Disclaimer: The views and opinions represented are those of the author and meant for informative purposes only. For your specific questions, consult your physician.)