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HIV-positives advised to get swine flu vaccine
by Matthew S. Bajko
People who are HIV-positive or living with AIDS are being advised to get vaccinated for the H1N1 virus, commonly called the swine flu, later this fall when the vaccine becomes widely available.
Yet San Francisco health officials stress there is no evidence to suggest that people living with HIV are any more susceptible to the swine flu than they would be for the seasonal flu.
"They should think of it as the same as the seasonal flu. Whatever their reaction would be for the seasonal flu should be their reaction for H1N1," said Dr. Susan Fernyak, the health department's director of communicable disease control and prevention. "If they don't care about the seasonal flu, they shouldn't be up in arms about swine flu."
Health officials have long advised HIV-positive people to get vaccinated for the seasonal flu each year, and that is still the case this year. Each year 6,000 Californians die due to influenza.
"It is still a serious disease in California and people should get immunized for seasonal flu," said Amy Pine, director of the health department's communicable disease prevention unit. "Everyone should get [vaccinated], including people with weakened immune systems."
Although people with immunosuppression due to medications or an HIV infection are at a higher risk for contracting the swine flu, they are not considered to be among the groups most at risk, according to health officials, and are being asked to wait until late November or early December to begin the two-dose H1N1 vaccine regimen.
The city is expected to receive its first batch of swine flu vaccine sometime in October and the health department has prioritized giving it to pregnant women; children aged six months to 24 years old; childcare providers; and health care workers, and emergency medical services personnel.
Come November local health officials expect to have enough H1N1 vaccine to distribute it to everyone deemed at risk for contracting the virulent strain of influenza. The state has created a vaccination Web site at to act as a clearinghouse for information about where to get the vaccine and the latest updates about the swine flu.
State health officials have predicted there could be a possible flu pandemic afflicting 25 percent of Californians if its spread is not checked. To date, the virus has claimed 125 lives in California, state Health and Human Services Agency Secretary Kim Belshe told reporters Tuesday, September 1 during a tour of the nine-year-old state Department of Health Services laboratory campus in Richmond, where samples are tested to verify if a person indeed has the swine flu.
Governor Arnold Schwarzenegger joined her on the tour to bring attention to the vaccination efforts.
"We urge everyone to take this very seriously," Schwarzenegger said, citing predictions that the virus could "take thousands and thousands of lives." At a flu forum San Francisco health officials held for medical providers, school officials, and the media last week, Fernyak said it is unclear if this year's flu season will be the worst ever, but it is likely to be severe since there are two strains of flu circulating, the seasonal flu and the swine flu.
"There is no indication the swine flu will be more severe than what we have seen over the last five months. The virus is quite stable, which is great news," she said. "We hope to see that continue through the fall season."
For most people, though, symptoms are mild to moderate. Since April, when San Francisco reported its first case of the swine flu, there has been little evidence to show that people infected with HIV are more at risk of getting the H1N1 strain, said health officials.
But the news last week that Castro bar owner Doug Murphy had died in Palm Springs within weeks of contracting the swine flu has raised concerns within the city's LGBT community about who is at risk. The official cause of death was cardio pulmonary arrest.
Supervisor Bevan Dufty has been working with staff at Magnet, the gay men's health center in the Castro, to become better informed about flu issues. The center already is offering seasonal flu shots and is looking at the possibility of also administering the H1N1 vaccine.
"The basic message is if you have an individual who is very healthy, robust, doing well on their drug regimen, that person is not a high priority for H1N1 vaccine barring other circumstances," said Dufty, who along with drag persona Donna Sachet will get the seasonal flu vaccine today (Thursday, September 3) at the city's travel and immunization clinic to mark its 10th anniversary.
According to interim guidelines issued by the Centers for Disease Control and Prevention and last updated in June, there is "insufficient data available at this point" to known who has the highest risk for contracting the swine flu, though people who are HIV-infected, particularly those with low CD4-cell counts or AIDS "can experience more severe complications of seasonal influenza and it is possible that HIV-infected adults and adolescents are also at higher risk for [H1N1] virus infection complications."
Fernyak said that the vast majority of people who have had the H1N1 flu virus have not had severe cases. The CDC estimates that 1 million Americans have already been exposed to the swine flu.
"With most people who get H1N1, it is a very mild disease," she said. And as reported in the Bay Area Reporter last week, of those who have been hospitalized or died due to swine flu, there is no evidence to suggest they are more likely to be HIV-positive. Fernyak told the paper she would have heard if that were the case.
"We are not seeing people with HIV being harder hit with this disease than other people who don't have HIV," Fernyak said.
Due to state laws restricting how a patient's HIV status can be disclosed, local health officials are not reporting to the state's health department whether those people hospitalized with or who die from the H1N1 virus are also HIV-positive.
"The form does not include such a box because California laws and regulations regarding the reporting of HIV are very strict," explained Ken August, a spokesman for the state health department. "Information on HIV status can only be collected to report HIV positivity to the state AIDS programs and must follow specific guidelines. Reporting forms for other diseases such as H1N1 cannot query HIV status."
Rather, August said there is a question asking about the patient being immunocompromised, which could cover everything from being HIV-positive or cancer patients on chemotherapy to genetic conditions and other factors. "We do expect to see many, many Californians become ill with H1N1 virus, more people hospitalized and more fatalities," said August. "Indeed, the HIV community, as well as all segments of California, will be affected by the H1N1 virus."
Health officials advise anyone who has flu-like symptoms to stay home and call their doctor to avoid infecting others in the waiting room.
Simple precautions such as covering your nose and mouth with a tissue when you cough or sneeze and washing your hands often with soap and water, can help protect yourself from being infected with the flu and prevent spreading it to others.
"Each of us should be taking action now to prevent and prepare for the spread of H1N1," said Schwarzenegger.
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