Diabetes and Influenza

Continuing from my previous post “Are you considered HIGH RISK for influenza complication?“, I am going to highlight the risk for people with diabetes. I am a person living with diabetes.

Actually, I know nothing about the risk for influenza complication for people with diabetes. I am going to take this as an opportunity to educate myself, as well as my readers.

Diabetes (from Diabetes Australia)
Diabetes is a chronic condition. In people with diabetes, insulin is no longer produced or not produced in sufficient amounts by the body. Insulin is a hormone, essential for the conversion of glucose (sugar) from food into energy. Hence, when people with diabetes eat glucose, from food such as breads, cereals, fruits, rice, noodles, starchy vegetables, milk, yoghurt and sweets, it cannot be converted into energy (due to the lack of insulin). Instead of being converted into energy, the glucose stays in the blood.

Influenza and Diabetes
From the Centers of Disease Control and Prevention (CDC), people with diabetes are three times more likely to be hospitalised from the flu and three times more likely to die from the flu and its complications than other people. Falling ill with flu may also affect blood glucose levels.

At the same time, people with diabetes need to know that diabetes can weaken our immune system, according to Flu.gov. This means that our body will have to fight much harder against the flu virus. At the same time, being down with influenza can raise our blood glucose and prevent use from eating properly.

Prevention
The best way for people with diabetes to protection themselves from influenza is through YEARLY vaccination.

According to a clinical report published on American Diabetes Association, ‘Influenza Vaccination: An Unmet Need in Patients With Diabetes‘ (open access), it is reported that “influenza vaccinations remain low in people with diabetes” despite the high complication risk and rising number of people diagnosed with diabetes.

Remember, the vaccine used in flu shot is made from killed virus. We cannot get the flu from the flu shot.

Of course, practicing proper personal hygiene is one big step in preventing yourself from the flu virus.

(Note: It is mentioned in flu.gov and in CDC that the nasal spray vaccine is not safe for people with diabetes. It is recommended to get a flu shot instead of nasal spray. As far as I know, Singapore does not have nasal spray for influenza vaccine.)

Influenza complications
Some examples of flu-related complications:

• may worsen diabetes condition
• pneumonia (due to chest infections)
• bronchitis
• sinus infections
• ear infections
• tonsillitis
• meningitis
• encephalitis, etc.

What to do if you have diabetes and is ill with influenza?

1. Contact your health care provider immediately.
2. Follow sick day rules as discussed with your health care provider.
3. Continue with your diabetes medications.
4. Increase the frequency of blood glucose test and keep track of the results.
5. Increase fluids (calorie-free) and try to eat as you normally would.

Hence, it is important that people with diabetes should start discussing with their health care provider, as soon as possible, on preventing and treating influenza.

Speaking of which, I should make an appointment to get my influenza vaccination soon.

Singapore Influenza Publications

I was rather interested to find out more about the various publications and advisories regarding influenza which the various Ministries in Singapore have produced over the past years of tackling varying degree of influenza situations.

What first caught my interest in searching for these publications was the comic strip Chew On It!, created by Lee Chee Chew. If you find the above characters or drawing style familiar, you would understand what I mean. Lee’s depicts the lives of Singaporeans through comics drawings and his comics strip are published in comics section of The Sunday Times and maybe also in the Opinion section of The Straits Times.

In my quest of online and library search of advisories and publications regarding influenza from various agencies in Singapore, here is a list of what I have found.
(Do note that some of the hyperlinks leads you to the individual posts about the material, some leads you to the actual online copy.)

Resources websites:

• Ministry of Health – Influenza resources in the form of posters, and pamphlets, booklets and informational advertisements. ( This is the load of resources)
• Health Promotion Board, Singapore – Soap Stops Your Flu from Becoming Someone Else’s

Advisories, Guides and Publications (not exhaustive):

• Protect yourself, your loved ones and those at risk. Do it the right way. (Hardcopy only)
• Frequently asked questions on influenza A (H1N1 – 2009)  (Hardcopy only)
• Preparing for a Human Influenza Pandemic in Singapore    (Hardcopy / Online)
• Flu Pandemic Business Continuity Guide    (Online)
• H1N1 Advisory for Patients   (Online)
• Advisory for Caregivers and Contacts  (Online)

The list will get updated along the way. Do come back and have a look.

Advisory for Caregivers and Contacts

Similar to the “Advisory for Patients” version, this is an advisory for caregivers and contacts.

The online copy of this advisory can be found here.

H1N1 Advisory for Patients

This advisory booklet was created by the Ministry of Health and Singapore Health Promotion Board. You will find the drawings familiar as these is done by the creator of Chew On It!, Lee Chee Chew.

The advisory informs people who are unwell with influenza-like illness to practice the following:

• Be Socially Responsible
• Observe Good Personal Hygiene
• Emergency Warning Signs in Adults and in Children

The online copy of the advisory booklet can be found here.

    

Page images of the advisory was obtained from Money4Invest.com.

Preparing for a Human Influenza Pandemic in Singapore

Booklet title: “Preparing for a human influenza pandemic in Singapore”
Library: Lee Kong Chian Reference Library Lvl 11
Call Number: English 614.518095957 PRE
Creator: Singapore. Ministry of Home Affairs
Publisher: Singapore: Ministry of Home Affairs, c2009.
Notes: Book is available for borrowing at Central Public Library and Bukit Merah Public Library
Soft copy of the book is also available through Ministry of Home Affairs here.

Cover page of the book

 

 

 

Frequently asked questions on influenza A (H1N1 – 2009)

Booklet title: “Frequently asked questions on influenza A (H1N1-2009)”
Library: Lee Kong Chian Reference Library Lvl 11
Call Number: English 614.518095957 FRE (R Sing)
Creator: Singapore Health Promotion Board
Publisher: Singapore: Health Promotion Board, 2009.
Notes: Parallel title and text in English, Chinese, Malay and Tamil.

English view of the booklet:

Cover page of the booklet

Page 1

Page 2

Page 3

Page 4

Note from author: Soft copy of this booklet could not be located from the Ministry’s resources.

Protect yourself, your loved ones and those at risk. Do it the right way.

Booklet title: “H1N1:Protect yourself, your loved ones and those at risk. Do it the right way.”
Library: Lee Kong Chian Reference Library Lvl 11
Call Number: English 614.518095957 H (R Sing)
Creator: Singapore Health Promotion Board
Publisher: Singapore: Health Promotion Board, 2009.
Notes: Parallel title and text in English, Chinese, Malay and Tamil.

English view of the booklet:

Cover page of booklet

Page 1: Washing your hands with soap

Page 2: Covering your mouth and nose with tissue, Wearing a surgical mask if unwell

Page 3: Leading a healthy lifestyle

Note from author: Soft copy of this booklet could not be located from the Ministry’s resources.

Influenza situation in Hong Kong – flu vaccines on the way

This news article was published on South China Morning Post yesterday: Flu vaccines on the way to Hong Kong but government might delay giving out jabs.
(Note: South China Morning Post has restricted number of news articles you can read per day if you are a non-subscriber.)

Hongkongers will finally get a vaccine effective against this year’s deadly flu strain in late May – by which time the flu season may be over, health chiefs say.

By the end of winter yesterday, 409 Hongkongers had died of flu, a situation exacerbated by the fact the World Health Organisation’s prediction of the dominant flu strain was incorrect, and the vaccine ordered by the city was aimed at the wrong strain.

Plans are now under way to offer free injections of the new vaccine to elderly people, who are at high risk, the Centre for Health Protection says.

But should another wave of the flu hit this summer, the 100,000 shots of the newly acquired vaccine – costing HK$4 million – might not offer adequate protection as the next outbreak could involve a different virus, centre controller Dr Leung Ting-hung warned.

Experience from the past 10 years indicated the strain prevailing in summer was not always the one that flared up the previous winter, Leung said.

“Such a situation can always happen,” he said.

Still, Secretary for Food and Health Dr Ko Wing-man hoped the new vaccine, which could be effective for about nine months, would cover next winter as well.

That was why health authorities opted to delay jabs of the southern hemisphere formulation of the Vaxigrip vaccine from Zuellig Pharma by a month after its arrival in the city late next month or early in May.

“We will look for an appropriate time to let the vaccine be effective during the flu surge in the coming [summer] season and during the winter peak,” Ko said.

He acknowledged that the current flu surge might be over next month.

Leung said jabs would go first to all tenants of homes for the elderly, and then to general outpatient clinics under the Hospital Authority for patients aged over 85. The programme could also be extended to younger people later.

Private doctors who take part in the vaccination programme for residential care homes will get a HK$50 refund per dose. Details will be worked out soon.

Dr Chow Chun-bong, chairman of the centre’s vaccine committee, said priority was based on the level of risk for different groups.

During the winter, “we found that about 50 per cent of the mortalities occurred in those aged above 85;,30 per cent lived in residential homes and 90 per cent had chronic illnesses”, Chow said.

The city saw 559 serious cases of the flu over winter. The predominant viral strain is H3N2.

The winter season influenza situation in Hong Kong was due to incorrect prediction of the dominant flu strain, resulting in the order of vaccine targeted at the wrong virus.

However, other than waiting for vaccine, perhaps every citizen in Hong Kong should be a socially responsible citizen, which should help to control the spread of the influenza virus in their community.

You can read up this post “The spread of flu: how it works, and how to stop it” to get an idea of what to do if you are down with flu.

Current Influenza situation in Hong Kong

Just two evenings ago, while reading my Facebook newsfeed, a post from the Channel 8 news page caught my eye:

Screenshot of the post from Channel 8 news’ FB page

For those who are not able to read Chinese, the title of the post translates to “The H3N2 influenza in Hong Kong has claimed 400 deaths (in this influenza season).”

The FB post by Channel 8 news provides a link to their ‘News & Current Affairs’ page, which has the video of the news report embedded – 香港流感疫情肆虐 已夺走400条人命 – 8频道新闻及时事节目.

I totally forgot about this article till this morning. Strangely, I was not able to locate this news on Channel News Asia, the English news platform of Singapore. However, a quick search directed me to Outbreak News Today, with the news headline “Hong Kong flu update: More than 400 deaths, Southern hemisphere seasonal flu shot recommended”.

Here is the news article from Outbreak News Today (published on 20 March 2015):

The number of seasonal influenza deaths reported in Hong Kong has surpassed 400 with the latest tally at 408 since the beginning of the season.

Hong Kong/CIA

This includes four additional flu deathsreported in the past 24 hours.

To date, the total number of cases ofinfluenza-associated admission to intensive care units is now 541. The CHP notes, in the last winter season in early 2014, 266 cases (133 deaths) were filed.

In addition, Hong Kong health officials welcomed the recommendations on the use of the southern hemisphere seasonal influenza vaccine (SH SIV) by the CHP’s Scientific Committee on Vaccine Preventable Diseases (SCVPD).

“The SH SIV contains the currently predominant influenza A/Switzerland/9715293/2013 (H3N2)-like virus strain. Based on the risk assessment, the SCVPD recommends the elderly to be the priority group to receive the SH SIV to protect them from the possible summer influenza season. Besides, the SCVPD recommends all persons living in residential care homes for the elderly (RCHEs) to receive the SH SIV for the prevention of influenza outbreaks,” Dr Leung Ting-hung said today.

“The elderly, particularly the very old elderly, are the most vulnerable in this season as reflected by the high proportion of severe and fatal cases affecting the elderly, the high influenza admission rate among the elderly and the high proportion of RCHEs having outbreaks of influenza-like illness (ILI),” Dr Leung explained.

“The SH SIV, when available, may be given by phases starting from the oldest age group, such as those aged 85 or above, in the community first as they are at higher risk of developing severe illness after infecting influenza. Most of them also have pre-existing underlying illnesses predisposing them to severe illness,” Dr Leung remarked.

The first 100,000 doses of SH SIV is expected to be delivered in late April or early May, the vaccination program is preliminarily planned to be conducted in May and June.

In an earlier post on the Outbreak News Today (published 18 march 2015), the news reported “Hong Kong still reporting 5 flu deaths a day“.

While Hong Kong health officials note that the latest surveillance data shows that the overall influenza activity continues to decrease in the city, they also say flu activity is still above the baseline.

3D influenza/CDC

In the past 24 hours, the Hong Kong Centre for Health Protection (CHP) reported five additional cases of influenza-associatedadmission to intensive care units or death (including four deaths) among adults aged 18 or above.

With the newest cases reported, this brings the total ICU flu admissions to 529, including 399 fatalities. This compares to 266 cases (133 deaths) reported during the same period in 2014.

The CHP reports they are still seeing approximately five flu-related fatalities daily though that number is slowly decreasing. Specifically, last week (from March 8 to 14), 36 cases (29 deaths) were recorded. Separately, a daily average of 6.9 cases (5.1 deaths) were filed in the last seven days (from March 11 to 17), compared with 6.1 cases (5.4 deaths) in the preceding seven days (from March 4 to 10).

As of March 15, about 255,000 doses and 246,000 doses of influenza vaccines had been administered to eligible groups under the Government Vaccination Program and the Vaccination Subsidy Schemes 2014/15 respectively, an eight per cent and five per cent increase from the same period of last year.

Are you considered HIGH RISK for influenza complications?

Everyone of us has gotten influenza (flu) at least once. Flu can make anyone ill. However, different people respond to flu or recover from it differently. Some people might even develop serious flu-related complications, which may result in being hospitalised or death.

If you belong to any of the groups mentioned below, you are considered to be at high risk of influenza complications.

People who are at high risk (information from Centers for Disease Control and Prevention):

• Children younger than 5, especially children younger than 2 years old
• Adults 65 years of age and older
• Pregnant women (and women up to two weeks post partum)
• People who have medical conditions including:
  • Asthma
  • Chronic lung disease (such as chronic obstructive pulmonary disease)
  • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
  • Blood disorders (such as sickle cell disease)
  • Endocrine disorders (such as diabetes mellitus)
  • Kidney disorders
  • Liver disorders
  • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
  • Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)
  • People younger than 19 years of age who are receiving long-term aspirin therapy
  • People who are morbidly obese (Body Mass Index, or BMI, of 40 or greater)

Why do I have to worry if I fall under the high risk category?
For people with pre-existing medical conditions listed above, influenza can worsen your health condition.

Examples

Medical Condition	Influenza complication
Asthma	May experience asthma attacks while having flu
Chronic congestive heart failure	May experience a worsening of this condition that is triggered by the flu
Diabetes mellitus	Drastic changes in blood sugar levels, increased risk of developing pneumonia from the flu

What should I do if I am at high risk?

1. Get your flu vaccine, YEARLY.
   • People whom are in close contact with you should also be vaccinated yearly.
   • At the same time, ask your doctor about getting a pneumococcal vaccination too.
   • You can read more about flu vaccination here.
2. If you are sick with flu,
   • Seek early treatment with flu antiviral medications (best started within 2 days of getting sick)
   • Check with your doctor promptly.
   • REST well.

Source:
http://www.cdc.gov/features/fluhighrisk/