Current Issues

H1N1 - what you need to know (and do)

What is it ?

By now you have probably heard of the novel H1N1 influenza (aka the "swine flu"). Although called the "swine flu", it actually does not have anything to do with pigs. This virus is one of several viruses that infect our respiratory system and can lead, in some to severe illness and even death. Closely related to the normal influenza that occurs each year, the H1N1 is more contagious than the regular flu but causes less severe illness in most of those who contract it. It is however an entirely new virus in that it was first discovered only in April, 2009. Because it is a new virus (hence the term novel), most people have little or no immunity to fight it.

What are the symptoms?

The most common symptoms include fever (93%), cough (83%), shortness of breath (54%) weakness (40%), chills (37%), muscle aches (36%), sore throat and runny nose. Vomiting and diarrhea can also occur and are more common than in those who contract the regular flu. Those who have vomiting and diarrhea are also more likely to be hospitalized due to complications from dehydration. Once exposed, it can take up to 1 week to develop symptoms and it is believed that persons shed the virus (and can therefore infect others) for up to 1 week after symptoms resolve. It appears that those in the age range of 5 – 24 are at the highest risk for contracting the illness. However, most deaths from the illness are in the 25 – 49 age group. This is very different from the seasonal flu where 90% of deaths occur in the age 65 + age range.

How do I protect myself?

Short of living in a plastic bubble, it may be hard to entirely prevent exposure to those who have the illness. Those who are ill have the highest concentration of virus within about 3 feet, especially when coughing and sneezing. Hand washing helps but the virus infects us though the lungs so we have to breathe it in to get infected. Of course this is difficult for athletes travelling all over the place on air planes, where close quarters and sometimes poor air quality increase the risk for exposure. Ensuring that your immune system is not run down (ie overtraining) and that you are well rested will help it ensure that your immediate immune defense systems are functioning optimally.

Athletes and key team logistical and support personnel should consider immunizations. The vaccine for regular flu will not protect you from the H1N1 virus and those wishing protection will also need the second type of vaccine. There are also two types of immunization, a nasal vaccine and an injectable vaccine. Both require only one dose (unless less than 9 years of age). It may be better to get the injectable vaccine as studies on the regular flu vaccine demonstrate that the nasal immunization is about 1/2 as effective. Those with a severe allergy to eggs or any of the vaccine component should not get immunized. As the vaccine manufacturing is almost the same as regular flu, anyone who has had a severe reaction to the regular flu vaccine should not get the H1N1 vaccine. The probability of a life threatening severe reaction is extremely low. Local redness and soreness to the injection are common but only last 1 – 2 days. There is nothing in either immunization on the WADA banned list so it is impossible to fail a doping test as a result of a flu immunization.
There are two effective medicines for those infected or exposed

1)Infection can be treated with Oseltamvir (Tamiflu). It is dosed at 60 mg twice daily for five days. To help prevent illness in those exposed to confirmed flu cases, Tamiflu, can taken at a dose of 60 mg twice daily for 10 days.
2)Infection can also be treated with Zanamivir (Relenza).This is an inhaled medicine. It is dosed at 10 mg (two puffs) twice daily for 5 days. To help prevent illness in those exposed to confirmed flu cases, Relenza can taken at a dose of 10 mg once daily for 10 days.

Be aware that there is a clandestine industry selling fake Tamiflu and Relenza. You should not obtain these medications from any internet source as it is likely to be fake. You should have your team physician obtain adequate amounts of the vaccine and medicine for your team. As the virus is thought to be able to develop resistance to these drugs, it is important that you only take the medicine on the advice of a dedicated doctor for your team who understands this illness and can advise you best on how to manage it. Each federation should enable that they have at least one dedicated team physician available, at least by phone, for the season for this purpose.

Why should we be concerned and take action?

It should be apparent that this virus has the potential to be devastating to an individual, team and our sport. Its rapid rate of spread and severe symptoms can interfere with an individual’s training plans and an outbreak at a World Cup could be devastating. To make matters worse, this is an Olympic year and any loss of training time could have serious consequences for those trying to peak for the Olympics. Loss of key support personnel at critical times can be equally devastating (wax-men, team leaders, etc)

What does the IBU Medical Committee recommend?

1)Immunize all athletes and essential team support personnel for both the H1N1 and the regular influenza.
2)Carry a supply of Tamiflu or Relenza with the team and treat those who have symptoms suggesting infection (see above). Also treat close contacts of those infected (room mates, etc). Try and do this on the advice of your team physician, who should assess each case before giving the medicine.
3)Carry a supply of surgical face masks. Those members of your team who may be infected should wear it at all times when around others.
4)Carry a supply of hand sanitizer for each team member and wash hands with them frequently. Keep your hands out of and away from your nose and mouth.
5)Avoid overtraining. Be especially careful after intense workouts or after long training sessions, where the body’s natural viral killing cells can be temporarily suppressed.
6)Ensure good nutrition, hydration, and sleep.(important to maintain proper immune function)
7)Avoid those who are coughing and sneezing.
8)Isolate team members who may be infected (private room, avoid team gatherings, wear mask when around others). Strongly consider sending them home immediately once ill and until their illness has resolved.
9)Do not train when ill, especially if having muscle aches.

Let us all make sure that we have a healthy season and successful Olympics. This year is a unique season that only comes around every 4 years. Take care of yourselves so that our "Family" can also stay healthy this season. Please follow our advice.

Kind Regards

Jim Carrabre MD MPE FACSM
Chair IBU Medical Committee