The flu (influenza virus infection) can be a very serious illness

H1N1and Seasonal  Flu Vaccine Information

The flu (influenza virus infection) can be a very serious illness, especially for someone with cancer. The flu is not the sniffles, sore throat, or an upset stomach that goes away in a few days, even though some people think it is. The flu often causes fever, body aches, tiredness, and a cough that can last for weeks. Up to 1 in 5 Americans gets the flu each year, and more than 200,000 (on average) are put in the hospital because of it. The number of people with the flu varies widely from year to year. Between 3,000 and 49,000 people each year die from problems caused by the flu.
Right now, there is a newer type of flu. First found in the United States in 2009, it is called H1N1 or "swine flu". Last winter it caused an estimated 12,000 US deaths. It is expected to go around again this winter, along with seasonal flu.
H1N1 causes the same problems as seasonal flu, with fever, aches, cough, and the risk of more serious illness. Last year, a new vaccine was developed to prevent this new type of flu. You might have gotten 2 flu shots: the seasonal flu vaccine and the H1N1 flu shot. This year (2010-2011), the H1N1 vaccine is in the seasonal flu shot, so you only need one shot.

What should adults with cancer know about the flu this season (2010-2011)?

For the first time this year, the Centers for Disease Control and Prevention (CDC) experts recommend that everyone age 6 months and older get the flu shot, unless there is a good reason not to get it. (For instance, anyone who is very sick or getting cancer treatment should talk to their cancer doctor before they get a flu shot.)
CDC expects both swine flu (H1N1 flu) and seasonal flu to cause illness this year. Cancer patients and survivors are more likely to have serious problems from the flu. They are more likely to end up in the hospital or even to die from these problems. Getting the flu shot early in the flu season can help reduce your risk of the flu and its complications.

I have had cancer in the past, but I have no signs of cancer now. Is this still true for me?

Yes. If you have had cancer, you may be at higher risk of having serious problems if you get the flu, even if you are cancer-free now.

Are cancer patients and survivors more likely to get the flu than others?

No one knows for sure if cancer patients and survivors are at greater risk for being infected with either H1N1 (swine) flu or seasonal flu. But they are at higher risk for having serious problems from both seasonal and H1N1 flu. Even if cancer patients have the same risk of getting the flu, once they get any type of flu they are at higher risk of complications.

Should I get the 2010-2011 flu vaccine even if I got the H1N1 vaccine last year?

Yes. The flu vaccine is changed each year to protect against the 3 flu viruses that look like they will cause the most illness. The 2010-2011 flu vaccine helps protect against H1N1 and 2 other viruses that weren't in last year's vaccines. Plus, the immune response to vaccines does fade over time, so last year's shot may not protect you during the 2010-2011 flu season.

What can I do to protect myself from the flu?

The best way to keep from getting the flu is to get the vaccine. This year, the vaccine for swine flu was produced early enough that it could be part of the seasonal flu shot.
For extra protection, encourage everyone in your household older than 6 months to get the flu shot. This lessens their chance of illness, and lowers the risk they will bring the flu home to you.
Swine flu and regular seasonal flu are spread in the same ways. Even if you haven't had the vaccine, there are things you and others can do to try to prevent the spread of flu viruses and many other germs.

• Wash your hands often. Use soap and warm water or alcohol-based cleaners or wipes.
• Do not touch your eyes or nose. Keep your fingers away from your mouth.
• Cover your mouth and nose with a tissue when you cough or sneeze. Then throw the tissue in the trash and wash your hands.
• Try to stay away from sick people. At least 6 feet is thought to be a safe distance.
• Try to stay away from small children who spend their days in group settings like daycare or school -- germs spread easily in these places.
• Be ready just in case you do get sick. Have the things you may need at home (food, tissues, hand cleaners, medicines for cough and fever, and so on) so that you don't have to go out in public.
• Take care of yourself. Follow public health advice about things like school closings and avoiding crowds.

In some cases, prescription flu medicines and anti-viral drugs can be used to try to prevent the flu in someone who has just been near someone with it. They can also be used to treat people who have been infected. (See the sections, "Can the flu be treated if I already have symptoms?" and "When should cancer patients and survivors get anti-viral drugs to prevent the flu?")

What else can I do to be prepared?

Make plans ahead of time with your doctor about what to do if you get sick. Talk with your doctor about:

• When you should call the doctor
• Whether or not you will need anti-viral medicine
• How to get a prescription for anti-viral medicine quickly if needed
• Making sure your vaccines are up to date

Keep a written record of these important facts in a place you can find them quickly:

• The type of cancer you have or have had
• Treatment you have received and when you received it
• The name and contact information for your doctor
• A complete list of medicines you are taking

What about patients who are getting cancer treatment?

People being treated for cancer often have weak immune systems. For them, the flu can lead to serious, even life-threatening problems. People who are at high risk for problems if they get the flu includes anyone with a weak immune system due to cancer treatment with x-rays (radiation) or drugs (chemotherapy). The flu shot is recommended for most people with cancer.
Many people with cancer worry that the flu shot will make them sick or react with other medicines they are taking. Talk to your doctor about this -- he or she knows your situation best and can tell you if you should get the shot and when is the best time to get it. Some people do get mild symptoms, such as a low-grade fever or achy muscles, after a flu shot. These symptoms are caused by the immune system's response to the flu shot and should go away in a day or so. The flu shot cannot cause the flu.
The CDC says that people with a high risk of having serious problems if they get the flu should get flu shots every year before flu season begins. It is best if they are vaccinated as soon as it is available, or before December. (Flu season is usually from November to April and peaks in January and February each year.)
The CDC also recommends that people who live with or care for a person at high risk for flu-related problems get the vaccines, too. This means that if you are in cancer treatment, your family members, caregivers, and children at home should get the flu shot, too.
Remember that if you are allergic to chicken eggs you might have an allergic reaction to flu shots. Talk with your doctor about this and any other allergies you have before you get the flu shot.

What types of flu vaccines are recommended for people with cancer?

Cancer patients do have to be careful about the type of flu vaccine they get. There are 2 main forms of flu shots:

• Live vaccines, made up of weakened live virus and given as a nasal spray -- which people with cancer should not get
• Inactivated vaccines, made up of killed, dead virus, that are given as actual shots or injections

People with cancer should get the inactivated flu shots, NOT the nasal spray. Family members of a person with cancer can safely get the nasal spray unless the patient is being cared for in a germ-protected area. For example, household members should not get the nasal spray after a family member recently got a stem cell or bone marrow transplant.

What about the new high-dose flu shot for people 65 and older?

Approved in late 2009, Fluzone High-Dose® is a new flu shot made for people who are 65 years of age and older. Immune defenses become weaker with age, which can lessen the body's immune response after a flu shot. This means the standard flu vaccine may not work as well in older people.
The higher-dose vaccine is designed to boost immune response to better protect against flu. Even though the immune response looks better on lab tests, it is not yet certain that this vaccine will prevent more influenza. Studies are still being done.
Because it is an inactivated vaccine, most people with cancer can take it. If you are 65 or older, ask your doctor if this might be something you want to try.

When should cancer patients and survivors get anti-viral drugs to prevent the flu?

If you have been within 6 feet of someone known or suspected to have the flu, and you:

• Have had cancer treatment like chemotherapy or radiation treatment within the last month

OR

• Have a blood or lymph cancer (such as leukemia, lymphoma, or myeloma)

Call your doctor right away. Your doctor may give you anti-viral drugs to help prevent the flu.

Can the flu be treated if I already have symptoms?

Prescription flu medicines like Tamiflu® and Relenza® can be used to treat and prevent swine flu as well as seasonal flu.
Other prescription anti-viral drugs can also be used. They work by keeping the virus from reproducing in your body. They can make the flu symptoms milder and can help you feel better faster. They can also help keep the infection from causing severe problems. Anti-viral drugs work best if they are started within 2 days after getting sick.
If you are a cancer patient or survivor, and you think you have the flu, follow the steps below.

• Contact your health care provider and follow his or her instructions.
• Stay home and away from others as much as possible to keep from making them sick. Avoid public activities like work, school, travel, shopping, social events, and public gatherings. Stay home for at least 24 hours after your fever is gone (without the use of fever-reducing drugs). Only go out to get medical care or other things you must have.
• If you need to go to the doctor, emergency room, or any other health care facility, cover your mouth and nose with a face mask if you can. If not, cover your mouth and nose with a tissue when you cough or sneeze. Let the staff know right away that you are there because you think you may have the flu.

What are the symptoms of seasonal and H1N1 (swine) flu?

Common symptoms of the flu include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue (tiredness)

A few people may have vomiting and diarrhea as well. But other people may have the flu, including H1N1, and only have a cough, sore throat, or stuffy head without a fever.

What else do I need to know?

Flu vaccine causes the body to make antibodies that protect it against influenza virus infection. It takes up to 2 weeks after the shot for the body to do this. This is why you should get the flu shot as soon as you can. That way your body can have more time to form the protection you need.
Keep in mind that any former immunizations, including last year's flu vaccine or the 1976 swine flu vaccine, will NOT protect you against the current strains of flu.
People with cancer should get the 2010 flu vaccine, even if they got the H1N1 vaccine last year. People who live with or care for people with cancer, including health care workers, should also get the vaccine.
In most people, flu is a limited illness that is not life-threatening. But the flu can be serious in people with cancer. Make it a priority to get your flu vaccine.