Reviewing the statistics to enter this website we can see the growing interest in the Influenza A (H1N1) patients who have Crohn's and specifically the big question that haunts the minds of all ell @ s is whether or not vaccinated against this virus with vaccines purchased and guaranteed after the checks required by the European Medicines Agency. Chronically ill patients who are immunosuppressed by medication effects, special care should be taken as they are considered a risk group. Since it was kicked out for vaccinations last day 16 in Spanish clinics are available and scheduled vaccinations with those included in the risk groups for those with inflammatory bowel disease.
The best measure is prevention and is a series of hygiene recommendations:
- Wash hands frequently and correctly
- Cover your mouth and nose with a tissue when sneezing or coughing, immediately throw away the tissue in the trash.
- Clean more often our home and more often ventilate by opening windows.
- If you believe you are sick, avoid infecting others on the advice of health professionals.
- Avoid kissing, close contact, sharing cups, cutlery and other items that have been in contact with saliva or secretions.
The Ministry of Health indicates that there is no need to confirm the diagnosis in all patients by evidence, or needed to perform these same tests or other relatives or contacts. It is necessary in these cases, to be achieved the appearance of suspicious symptoms, to whom should contact their doctor.
a) Those diagnosed with inflammatory bowel disease should follow the general recommendations concerning vaccination against H1N1 (Swine Flu). The mere diagnosis of inflammatory bowel disease does not imply the need for vaccination.
b) those who are receiving immunosuppressive therapy of any kind (see below) or it is foreseeable that it will receive in the near future, vaccination is indicated AS SOON AS POSSIBLE from the moment you start the vaccine campaign officer.
c) In the case of flu symptoms appear, follow the general recommendations established for the population. If the clinical picture is severe, immunosuppressive treatment should be stopped and the advice of the specialist.
The symptoms of swine flu are similar to seasonal flu, although it seems that fever is more abrupt and high, more intense myalgias and sore throat is very characteristic. Among the laboratory data, stressing the possible elevation of CPK. Suspected swine flu during the pandemic, any person is given by:
- Fever (temperature over 38 ° C)
- More than any of the following symptoms: cough, sneezing, runny nose, sore throat, myalgias
- In patients with inflammatory bowel disease IBD -RISK also be considered during the pandemic flu suspected in the absence of fever, provided that you give at least two other symptoms
- Throughout pneumonia should consider infection with influenza A virus
You only need to confirm the diagnosis by laboratory tests in some individual patients: those very serious, or belonging to a population at risk. In our case, it would be patients in the IBD-risk, or where complications have arisen, as the presence of pneumonia.
The patient should be placed soon after the onset of symptoms contact your primary care physician, who will suggest the need for and availability of these tests in a health center or if you should contact your hospital:
- Naso-pharyngeal culture for H1N1 PCR: must be a shot from nose to throat swab with a flexible and long, with his head extended back. The processing of this sample was done according to local regulations.
- Chest X-ray: if you decide to apply, will be done urgently, because the risk of pneumonia is higher in 48-72 h, it is not necessary in all cases, but in those with risk factors and in which this complication is suspected.
Vaccination against flu is found safe and effective in immunocompromised individuals. Since it was kicked out for vaccinations on 16, in Spanish clinics are available and scheduled vaccinations with those included in the risk groups for those with inflammatory bowel disease and that, being immunocompromised for taking inmunosuprores , are at high risk of complications from infection with the pandemic virus A (H1N1). Scientific protocols recommend that, in a situation like this, be advised vaccination. - The flu vaccine is recommended in all patients with inflammatory bowel disease, regardless of severity and treatment. This is because not a particular patient nor doctor knows if, throughout the year, will be accurate immunosuppressive treatments.
- It should be administered influenza vaccine prepared from inactivated (administered by intramuscular injection). Contraindications to vaccination with live attenuated virus prepared is administered intranasally.
- The contact of an immunosuppressed with a subject which has received an intranasal live attenuated virus is not considered a particular risk.
- It is also recommended vaccination against germs that could complicate a picture of influenza A, including the flu itself is common and pneumococcus.
- There are no definitive data indicating that the response to vaccines in general is diminished in patients with inflammatory bowel disease, but it may be true in some cases
- The response to influenza vaccination appears to be unaffected by treatment with steroids.
- In rheumatic diseases, may have a lower response to influenza vaccine in people treated with certain immunosuppressive drugs, but this has not been proven in inflammatory bowel disease.
- Vaccination is useful in people treated with infliximab or adalimumab, and is recommended in patients treated with any of these drugs.
Se considerará tratamiento inmunosupresor la toma de corticoides [prednisona (Dacortin®), prednisolona (Urbason ®), budesonida (Entocord ® Intestifalk ®), beclometasona (Clipper ®), deflazacort (Zamene ®)], azatioprina (Imurel ®), mercaptopurina (Mercaptopurina ®), metotrexato (Metoject®), infliximab (Remicade ®), adalimumab (Humira ®), ciclosporina (Sandimmun ®), tacrolimus (Prograf ®, Advagraf ®), o micofenolato (Cellcept ®). En caso de duda con respecto al tratamiento que se esté tomando hay que consultarlo con su médico.
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Sources:
www.informaciongripea.es
www.geteccu.org
GETECCU document with recommendations on influenza for health professionals
