User login

Enter your username and password here in order to log in on the website:

Forgot your password?

Please note: While some information will still be current in a year, other information may already be out of date in three months time. If you are in any doubt, please feel free to ask.

Swine flu

Should I have my eleven-year-old daughter vaccinated against swine flu? She suffers from cystic fibrosis and she has been vaccinated against common flu.

For this answer we are attaching the current statement of CF centre at University Hospital Motol, Prague, Czech Republic. It draws information from international research and negotiations with Czech Ministry of Health from 1 December 2009.
In accordance with this information, your daughter´s vaccination against swine flu is highly recommended and should be carried out as soon as possible.

CF Team statement: Seasonal and Swine Flu

Much has been said about the danger of swine flu this year. Since available information about it often tends to be controversial, we will try to express our current standpoint on this danger. However, we would like to stress that this standpoint may change depending on the developments in knowledge about the illness and experience with vaccination and progress of the illness in CF patients.

Most CF patients get vaccinated against seasonal flu every year (the epidemic always takes place from autumn till spring). These patients understand that the condition caused by influenza virus can impair their lung functions for several weeks and is often accompanied by bacterial airway infection which has to be treated with the help of antibiotics. It is therefore recommended that CF patients undergo seasonal flu vaccination also at this time, when swine flu has become a threat to human health.

The swine flu virus (H1N1) may cause problems similar to seasonal flu problems at any time during the year. It appears that it can cause serious complications in chronically ill patients (including CF patients) more often than seasonal flu. Lower airway ailments with pneumonia symptoms and respiratory failure are among the most serious complications. It is hard to generally ascertain how great the risk of these complications is.

Guidelines for CF patients: the most effective precautions against swine flu you should take:

1. Get vaccinated. CF patients worldwide are recommended to get vaccined against swine flu regardless of their age. The existing plan in the Czech Republic is to vaccinate children over 10 years of age (in individual cases also younger) and adults. Complications during swine flu endanger especially CF patients with more serious lung problems (e.g.bronchiectasy proved by HRCT or strong airway obstruction proven by spirometry) or with other complications such as liver damage with portal hypertension, diabetes, hemoptysis or cardiomyopathy. Therefore especially CF patients suffering from these complications should get vaccinated.
1. Possible side effects of the vaccine that are usually stated in the media are ascribed to the additive substance that the vaccine contains. The same substance is used also in the seasonal flu vaccine (Fluad) that has been successfully used for several years also in our country to vaccinate especially more senior individuals.
If a patient has had an allergic reaction to the vaccine or is allergic to egg protein, they should inform their doctor about this before vaccination.

2. Wash your hands thoroughly with soap or disinfectant.

3. Cover your nose and mouth when coughing or sneezing. Avoid close contact with coughing or sneezing individuals.

4. If possible, don´t touch your eyes, nose or mouth with unwashed hands.

5. If you have acute infection, avoid contact with healthy individuals.

6. Note possible flu symptoms, which are the same with both seasonal and swain flu (headache, muscle or joint ache, high temperature, fever, cough, cold, sore throat) and inform your doctor about them immediately.

7. Stop going to school or work as soon as any flu symptoms occur.

8. Stop going to school or work if you haven´t been vaccinated yet and there are people with flu at your school or work.

9. If possible, avoid travelling by public transport if an epidemic has been officially announced. During a flu epidemic it isn´t advisable for you to go to the cinema or other places where large numbers of people gather.

10. As a means of prevention, rinse your nose and mouth with salty water or use nasal spray with sea salt. Do this twice a day on a long-term basis.

Contemporary situation in the Czech Republic

The number of patients infected with seasonal flu and swine flu in the Czech Republic is growing at the moment. The situation varies from region to region and can change quickly.

The Czech Republic has only recently received swine flu vaccine, which is starting to be administered to certain groups of people. This vaccine is totally new to the country and the knowledge about its effects is based solely on experience abroad. It seems, however, that positive effects of the vaccine (protection against the illness) definitely prevail over its negative side-effects (e.g.high temperature, nausea, skin reactions such as reddening, swelling or pain in the place of application), especially in the chronically ill (including CF patients).

When more information about experience with this new vaccine comes from abroad, more young children will probably be vaccinated.

At the moment, all CF patients over 10 years of age (in some individual cases even younger) should be vaccinated against swine flue as soon as possible.

According to the latest information, vaccination of children over 10 years of age will start on 14th December 2009 in regional vaccination centres. GPs should inform their patients about these centres and they should also recommend CF patients to get registered with them.

If a patient cannot be vaccinated for some reasons (e.g.they are under 10 years of age or are allergic to egg protein), they should use another available flu medicine – Tamiflu, which should be administered to them as soon as the first flu symptoms occur. The medicine is available in some large pharmacies but the situation changes rapidly. It can also be obtained from some general practitioners. At the moment, Tamiflu is available 24 hours a day from the Motol hospital pharmacy and it can be prescribed by a pediatrician working in its pediatrics ward. The medicine can be picked up also in advance (before the flu starts). Its price, however, remains a problem – one package costs almost CZK 1,000. If an epidemic is announced, the medicine should be funded to a certain extent by health insurance companies. Therefore we recommend every CF patient who isn´t properly protected by the swine flu vaccine to find out about the availability of Tamiflu in their region. It is important for them to be able to pick the vaccine up from their pharmacy as soon as first flu symptoms occur, or have it ready at home.

Dr. J. Brázová
Please note that this Q/A is from November 2009, and that in the last 2 years, there were many changes in the recommendations for H1N1 (swine flu) vaccination and the availability of vaccine against it.
At the moment, in Germany, the seasonal flu shot contains not only the seasonal influenza type, but also the H1N1 subtype, so the seasonal flu shot automatically provides also protection against the so-called swine-flu. I assume that the vaccines used in other European countries are similar, but for detailed information one has to contact national institutes responsible for this or ask the CF-physician or general practitioner, what is covered by the seasonal shot.
According to the guidelines from Malfroot et al. 2005 in the Journal of Cystic Fibrosis "Immunisation in the current management of cystic fibrosis patients" the flu shot is recommended for all Cf patients over 6 months of age.
D. d'Alquen