<![CDATA[Cold, Flu, and Sinus - Health.com]]> en daily 1 <![CDATA[Respirator or Face Mask? Best Swine Flu Protection Still Debated]]>

In fact, surgical face masks, which are cheaper and easier to wear, may be just as good as N95 respirators. At the very least, researchers can’t prove that one is better than the other. It’s the latest wrinkle in a continuing debate over how to protect health-care workers from the H1N1 virus, also known as swine flu.

Raina MacIntyre, PhD, a professor of infectious diseases epidemiology and the head of the University of New South Wales School of Public Health and Community Medicine, in Sydney, Australia, says the research team didn’t exactly retract the findings.

“We simply did the analysis of the same data differently for the final paper,” she explains.

For the new analysis, the researchers removed a control group of nearly 500 health-care workers and made other statistical adjustments. Ultimately, the difference in infection rates between mask and respirator users was not statistically significant.

“[The study] still shows a likely superiority of N95s, with half the rate of infection compared to surgical [masks],” MacIntyre says. “But the study was probably underpowered to pick up statistical significance when we removed the control group.”

“I would certainly wear an N95 respirator if I were exposed to infectious patients,” she adds.


Next Page: What is an N95 respirator?
The N95 respirator is a tightly fitted facial mask designed to filter out even very fine airborne particles, according to the U.S. Food and Drug Administration (FDA). Looser-fitting surgical masks protect against large-particle droplets, splashes, sprays, or splatter, the FDA says, but they don’t completely block the germs from coughs and sneezes.

To figure out which protective device is best, MacIntyre and her colleagues tracked hospital workers in Beijing, China, who wore surgical masks or N95 respirators, and compared rates of influenza and respiratory illness. Preliminary findings were presented at a meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy in September 2009. Final results have yet to be published.

The only other randomized clinical trial comparing health-care workers’ use of respirators and surgical masks was published online in October 2009 in the Journal of the American Medical Association. Canadian researchers reported no difference in influenza rates among nurses using one type of protective device versus the other.

Both studies helped inform an Institute of Medicine (IOM) panel that, in September 2009, issued a report recommending the use of fitted N95 respirators by health-care workers who interact with patients with confirmed or suspected cases of H1N1. (MacIntyre was also a member of that panel.) However, because the two studies were preliminary, the committee said that it could not draw conclusions from either.

“The take-home message for me is that, in clinical settings, wearing a mask or an N95 appears to be essentially equivalent,” says Mark E. Rupp, MD, a professor of infectious diseases at the University of Nebraska Medical Center in Omaha and president of the Society for Healthcare Epidemiology of America (SHEA).

Data presented at the IDSA meeting also highlighted the problems with N95 respirators, Dr. Rupp says. Health-care workers say that the respirators are uncomfortable and more difficult to wear than face masks, and that they make it hard to speak with patients, among other problems, he explains. They’re more expensive too.

Although respirator use made sense at the beginning of the swine flu pandemic, it now appears that H1N1 behaves similarly to seasonal influenza, Dr. Rupp says, so “it doesn’t make much sense to be using different precautions for seasonal flu than we use for H1N1.”


Next Page: Should federal guidelines change?
The SHEA would like to see federal guidelines revised, he says.

Still, government health and safety organizations are standing by the more stringent standard of protection.

IOM spokeswoman Christine Stencel says that the National Institute for Occupational Safety and Health and others have provided “convincing data” on the ability of the respirators to filter out a large percentage of tiny particles.

“Based on all the available evidence and data that the committee had to look at, [it recommended] that the N95 respirator afforded the best potential protection against airborne transmission of the virus, and therefore that was the recommendation for health-care workers in terms of respiratory protection,” she says.

The Centers for Disease Control and Prevention (CDC) developed its policy independently of the IOM and the MacIntyre study, explains CDC spokesman Jeff Dimond. However, it’s similar in terms of respirator use. The CDC recommends that health-care workers in close contact with people with suspected or confirmed H1N1 influenza use a properly fitted, disposable N95 respirator, or something that offers similar or better protection.

The current recommendation is based on unique conditions associated with the current pandemic, including low levels of population immunity to 2009 H1N1, the potential for health-care personnel to be exposed to H1N1 patients, and other factors, Dimond says.

In October 2009, the Occupational Safety and Health Administration (OSHA) said it would soon issue a “compliance directive” to ensure that health-care facilities have controls in place to protect workers from occupational exposures to swine flu. OSHA said its directive would closely follow the CDC’s guidance.

In Dr. Rupp’s opinion, the respiratory protection debate has distracted from other crucial flu-fighting measures. These include:

  • Quickly identifying and isolating patients with influenza-like illness.
  • Preaching respiratory etiquette programs. Patients who are ill should be asked to wear a surgical mask to contain their secretions, he says, and they should use tissues and wash their hands frequently to prevent touch contamination.
  • Encouraging hospital visitors to stay home if they’re sick and urging health-care workers to stay home when they’re sick.
  • Getting seasonal and H1N1 vaccines. “For health-care workers, that is by far the best way to protect them,” he says.
]]> Istockphoto <![CDATA[Studies: Swine Flu Hits Young the Hardest]]>

Almost all critically ill patients in the studies were sick for only a few days before rapidly progressing to more severe symptoms and respiratory failure, which required treatment with a breathing machine, according to three studies published in the Journal of the American Medical Association.

The mortality rate ranged from 14.3% to 41.4%, depending on the country. The findings may help shine some light on what the 2009 H1N1 flu season may bring, and who may be hit the hardest by the swine flu during the next few months.

“These studies are telling us that young people are at risk for bad complications of H1N1 and under usual circumstances, [seasonal] flu does not cause acute respiratory failure in younger people,” says Neil Schachter, MD, the medical director of the respiratory care department at Mount Sinai Medical Center, in New York City, and the author of The Good Doctor’s Guide to Colds and Flu.

The analysis of cases in Australia and New Zealand looked at people who developed severe acute respiratory distress syndrome (a condition in which the lungs fill with fluid) and were put on a life-support system known as extracorporeal membrane oxygenation (ECMO). This artificial heart and lung machine system, which puts oxygen into the blood and then carries this blood to the body tissues, is considered risky and expensive; as a result, it is not readily available in every hospital. The mortality rate was 21% for these patients, although it may have been higher without the treatment, the authors say.

“These studies provide important signals about what clinicians and hospitals may confront in the coming months,” Douglas B. White, MD, and Derek C. Angus, MD, of the University of Pittsburgh School of Medicine, write in an editorial accompanying the new studies. In young, healthy patients, H1N1 can quickly cause respiratory failure that can’t necessarily be reversed with mechanical ventilation, although such patients are not currently a priority group for H1N1 vaccination, they note.


Next Page: The Canadian and Mexican studies
In the Canadian study, about 30% to 40% of the patients had lung disease, were obese, or had high blood pressure, a history of smoking, or diabetes. Overall, 14.3% of 168 critically ill people with confirmed or suspected H1N1 died within 28 days.

The mortality rate in the Mexican study was strikingly higher. In Mexico City, where the H1N1 pandemic was first reported, 41.4% of 58 critically ill people died within 60 days of developing the flu.

Those people who died from H1N1 got sicker earlier in the course of their illness, had extremely low levels of oxygen in their blood, and had multiple organ failure. Their average age was 44 years old, and 54 of 58 patients needed mechanical ventilation. Other signs of more severe H1N1 included fever and severe trouble breathing.

In the Canadian study (in which the average age was 21.4), the critically ill tended to be hospitalized within four days of developing flu symptoms, and there was about a one-day lapse between hospital admission to intensive care unit (ICU) admission. As in the Mexico City study, younger patients with low blood oxygen and multisystem organ failure were hardest hit. What’s more, the critically ill tended to require mechanical ventilation and rescue therapies to aid in breathing.

In both countries, the H1N1 outbreak lasted about three months.

“It is not clear of hospitals’ need to invest in this ECMO technology because this has not proven very successful in other respiratory illnesses,” says Dr. Schachter. “We do know that treating H1N1 with antivirals such as Tamiflu (oseltamivir) and Relenza (zanamivir) did help improve mortality.”

The most important message is that children should get the H1N1 vaccination, which is safe, he says.

“The technology for making swine flu vaccine is no different than that used to make the regular flu vaccine, so in principle, there should be no differences in terms of safety,” he explains. “Recent surveys have shown that Americans are iffy about whether they will let their children receive this novel vaccine.”

James B. McAuley, MD, the director of Pediatric Infectious Diseases at the Rush University Medical Center, in Chicago, notes that the studies focused on the sickest of the sick patients.

“The mortality rate can be high for a small subset of people, but the overall death rate is closer to seasonal flu than the severe acute respiratory syndrome (SARS) outbreak of 2003,” he says. “This is a serious flu and there is mortality, but it is about the same as with the seasonal flu—maybe a little worse.”

As to why younger people seem to be hit hardest, the current school of thought is that perhaps a similar virus circulated 50 or 60 years ago, so older people could have immunity to H1N1.

Dr. McAuley’s advice? “Definitely get the vaccine,” he says. (He says his own children have already received the H1N1 vaccination.)

The editorialists write that the burden is on the public health system to heed the warnings in the new studies and prepare for the coming flu season: “Any deaths from 2009 influenza A(H1N1) will be regrettable, but those that result from insufficient planning and inadequate preparation will be especially tragic.” Such planning should include widespread availability of antivirals, antibiotics, and mechanical ventilation systems.
]]> Getty Images <![CDATA[Swine Flu To-Do (and Don’t Do) List]]>

However, the onslaught of information about H1N1—be it playground rumors, employer signs telling you to cover your cough, memos from your kids’ school, or scary-sounding news reports—is making it pretty hard to figure out what you should be doing right now.

Although some people have already been vaccinated, it could be weeks—depending on your age and risk factors—before you even get a chance at the shot (or spray). So now what?

Sometimes it feels like you have two choices. A: Wring your hands endlessly about something over which you have no control. Or, B: Tune out the static and pretend this is all just a horrible dream. (Call it the ignore-the-whole-sorry-mess-until-my-neighbor-is-sick approach.)

Well, guess what? There are a few things you should—and should not—be doing at the moment. Here’s your guide.

Look up local flu outbreaks. If you’re getting most of your news from the Internet—and about 40% of people say they do—you may not be up on H1N1 activity in your community. Take the time to check local flu activity on the online version of your local newspaper (remember those?) or health department, or check out websites like Google Flu Trends (though keep in mind that this map is based on search trends and could be skewed if lots of healthy people are searching for information). There’s also FluTrends, which is produced by Rhiza Labs, and includes past cases and current activity , or the Centers for Disease Control and Prevention’s (CDC) weekly flu update.

If your city or state is a bit of a hot spot, you may need to focus on some of these to-do points sooner than others. The good news is that some of the hardest hit areas in spring—like New York—don’t seem to have that many H1N1 cases at the moment. (Experts estimate that up to 1 million New Yorkers may have had H1N1 in the spring, which would protect against subsequent infections.)

Don’t panic. For most people, an H1N1 infection is generally mild and can be cured with time, bed rest, and fluids. The virus is serious, though—particularly for those in high-risk groups. So far this year, 28 pregnant women have died of H1N1, as have 76 children. “At least two-thirds of [the children] had underlying conditions, which we recognize as putting them at increased risk for complications,” says Nathan Litman, MD, the chief of pediatric infectious diseases at the Children’s Hospital at Montefiore, in New York City. High-risk people, whether adults or children, tend to have chronic heart or lung conditions (including asthma), weakened immune systems due to disease or chemotherapy treatment, or diabetes.

That said, H1N1 will feel like seasonal flu for most people. “I’d say at the present time the swine flu looks no more serious than the routine seasonal influenza,” says Dr. Litman.


Next Page: Stay home
Stay home. Are you sick right now? Say, with flu-like symptoms such as fever, aches, stuffy nose, and chills? Sorry, but it’s quite possible you already have swine flu. Experts say that flu activity is higher-than-normal for this time of year and almost all of it is due to H1N1. If you (or your child) are not in a high-risk group, it’s best to stay put.

If a child is 2 or older "and has no risk factors for complications and has fever, runny nose, or cough, the best thing to do is to stay home,” says Dr. Litman. “Plenty of fluids, Tylenol, Motrin, or Advil for fever, and it should run its course on its own.”

If a child has difficulty breathing, is unable to take fluids, or starts to be less responsive, or after appearing to recover from the influenza develops a fever and starts coughing again, then see a doctor.

If you are pregnant and have flu symptoms, it might be best to call your doctor before going in to see him or her, says Dr. Litman.

“They may want to set up a separate location to be seen or separate times to see sick patients,” he says. “You don’t want the pregnant woman with influenza who is coughing and sneezing to go into the room with pregnant women who are well and just there to get routine prenatal care.”

Understand the risks. While the symptoms of H1N1 may be no different from seasonal flu, there are some key differences. H1NI may be easier to catch than regular flu, and younger people may be more likely to come down with it than older people. “From what I’ve seen, I actually believe it to be more contagious,” says Dr. Litman. Often with the seasonal flu that’s circulating, a percentage of the population has some immunity to it. With H1N1, it looks like most people—other than the elderly—have no immunity to it, and that may be why it appears more contagious, he says.

People who are older than 60 may have been exposed to a swine-flu-like virus in the distant past, which is giving them an edge with this pandemic. That’s not to say they can’t get sick, but “many of them appear to have immunity from a prior infection with a similar virus or cross reactions with a similar virus that help protect them against the swine flu,” says Dr. Litman.

Get a seasonal flu shot. The regular seasonal flu shots are available now, and it makes sense to “get the jab” (as the Brits say). While most flu cases happening right now are caused by H1N1, “in two months or three months it may be the regular seasonal flu and we should be prepared for that,” says Dr. Litman. “Since that vaccine is currently available, I recommend that everyone considered a risk group receive the seasonal flu vaccine.” Seasonal flu can be just as dangerous as H1N1; about 36,000 people die, including about 80 children, of seasonal flu every year.


Next Page: Get a pneumonia vaccine
Get a pneumonia vaccine. What, another shot? For the vaccine wary, this might just feel like one too many pinpricks. However, the pneumonia vaccine, a shot that can help prevent any illness caused by certain types of pneumococcus bacteria, including meningitis and ear infections, may be a good idea too.

The CDC has analyzed H1N1-related deaths and found many people who died had dual infections, including some with pneumococcus. The good news is that if you’re up-to-date on your child’s vaccines, they probably already have it. Approved in 2001 and called Prevnar, it’s routinely given to children.

Another vaccine, Pneumovax, is available for adults, and is recommended for the elderly and those at high risk of infections.

Wash your hands. Just about every expert is chanting a “wash your hands” mantra. And, in fact, washing your hands with soap and water or using an alcohol rub can help. However, when it comes to flu, just keep in mind that hand-washing may fall into the “can’t hurt and may help” category. Because flu virus can hitch a ride on airborne water droplets, you can inhale the virus and get sick even if you wear gloves 24-7 or scrub-in like a brain surgeon. But again, flu viruses can live on surfaces for up to 48 hours. So, yes, wash up. Plus, good hygiene can protect you from other germs, like pneumococcus, which could make a simple case of flu much worse when added into the mix.

Don’t stock up on face masks or Tamiflu. If you’re the type of person who hoarded cans of soup and bottled water in 1999 just in case the world ended in 2000, it can be tempting to grab a box of surgical masks “just in case.” The CDC and most experts say that’s not a recommended—or a proven way—to prevent infection, although some studies suggest that they can be helpful in homes with a flu-infected family member or when used by hospital workers in place of a N95 respirator.

And while it may seem perfectly harmless to stockpile antiviral drugs, it isn’t. If Tamiflu is gathering dust in your medicine cabinet, then people who truly need it may find the pharmacies are fresh out. And the surest route to a drug-resistant flu virus is having people taking it “just in case” or for symptoms that would go away on their own.

Get a swine flu vaccine—really. Or at least seriously consider it. Lots of people are not crazy about vaccines in general, and fully one-third of parents say they’re going to skip them for their child, according to an AP poll. Understandable. Taking something that could cause side effects, when you feel (or your child feels) perfectly healthy is tough. But keep in mind that if you’re thinking about waiting until swine flu is in full force in your community, it may be too late. It can take several weeks after vaccination before your immune system ramps up to full-protection mode.

If you or your child is perfectly healthy, you can get the nose-spray version, which contains a weakened, but not killed, virus. Unfortunately, if you’re in a high-risk group, you may have to wait a bit for the version with killed virus, which is given in shot form. Those should be available in mid- to late-October.

While mulling over your options, try not to think of large federal agencies as faceless giants trying to impose vaccines on you. In fact, such agencies are staffed by scientists and doctors who are trying to protect the public.

“Each year approximately 30% to 40% of children between 5 and 19 years of age get influenza, that not only keeps them out of school for a few days, but they are also the epicenter of the epidemic—they spread it to household contacts, other school contacts, and high-risk people in the community, like the elderly—their grandparents,” says Dr. Litman. “For their benefit and for the benefit of others, it’s wise to get both the seasonal flu vaccine and swine flu vaccine.”


Next Page: Don’t let the past haunt you
Don’t let the past haunt you. Although the 2009 virus has been tagged with the unfortunate moniker swine flu (just like the 1976 version), there is a world of difference between the two. For one, they are different viruses. And if you were alive in 1976, you were probably digging the bicentennial, groovy pants, and platform shoes, but your chances of getting swine flu were pretty much nil. (There were roughly 200 cases in Fort Dix, N.J., and the virus never spread.)

Fast forward to 2009, which is truly a pandemic—there have been more than 340,000 confirmed cases worldwide and nearly 44,000 confirmed and probable cases in the U.S. alone. (The CDC estimates that more than 1 million people have contracted swine flu, but that their cases weren’t recorded because they didn’t seek treatment.) And the ’76 version did have a problem with side effects, including Guillain-Barré syndrome (GBS), a rare condition in which the immune system attacks nerves, resulting in weakness and even paralysis (although most people eventually recover).

However, the vaccine production used in the 1970s now looks as outdated as your striped bell-bottoms and rockin’ sideburns.

“Over the years there have been several improvements in vaccine manufacturing,” says Claudia Vellozzi, MD, the assistant director of the CDC’s Immunization Safety Office. “That certainly plays a role in improved vaccine safety now, compared to 1976.”

Of the 30 to 40 million people vaccinated for swine flu in 1976, about 1 in 100,000 did develop GBS. However, current research suggests there is little to no GBS risk associated with seasonal flu vaccine.

"There have been one or two studies that showed that if there is a risk, it’s very small, or about one in 1,000,000 additional cases of GBS would be attributable to the flu vaccine—but most studies have not supported any association,” she says. (There are 2,000 to 3,000 GBS cases in the U.S. every year, unrelated to vaccines, says Dr. Vellozzi. The cause is unknown, but it can be triggered by infections.)

“In terms of our current vaccine, we expect to have a similar safety profile as our seasonal flu vaccine, which has a good track record,” she says.

Be prepared. If you do want to get an H1N1 flu shot, it’s best to be patient. It may take weeks before everyone who wants one can get it. In the meantime, think about what you will do if you or a family member does get sick.

“Get immunized, wash your hands, cover your mouth and nose if you’re sneezing or coughing, stay home if you’re sick, and if any warning signs come up—difficulty breathing, not responsive as usual, unable to take fluids, or after a day or two of the fever coming down and having more fever and cough again—see the doctor,” says Dr. Litman.
]]> Istockphoto <![CDATA[Flu Shots, Swine Flu, and Fibromyalgia: Should Pain Patients Get Vaccinated?]]>
fibromyalgia patients who already deal with chronic pain and discomfort on a daily basis. But is a shot the best option for people with potentially compromised immune systems?

Jessica Capelle, a 35-year-old part-time lawyer from Houston, wants to get a flu shot this year. But as her fibromyalgia has worsened over time, she says she's become more sensitive to vaccines—a side effect often reported by people with chronic pain.

Based on anecdotal evidence, it does seem that vaccines, for influenza or otherwise, could temporarily increase or trigger fibromyalgia symptoms. Seasonal flu shots are made from inactivated (dead) viruses, which could theoretically trigger flu-like symptoms or allergic reactions. (Another type of flu vaccine, administered through a nasal spray, is made from live, weakened influenza viruses and is not recommended for people with underlying medical conditions.)

Since there is little formal research backing these experiences, however, doctors' recommendations vary almost as much as patients' opinions. While the Centers for Disease Control and Prevention states that you cannot catch the flu from a vaccine, it does note that minor side effects from the shot can include soreness at the injection site, aches, and a low-grade fever—and that's in perfectly healthy people.

Added swine flu concern
There are even more questions to be answered this year, thanks to the outbreak of the H1N1 influenza virus, commonly referred to as swine flu. Two vaccines for swine flu—a nasal spray that contains weakened virus and a shot that contains inactivated virus—were approved in September, but skepticism and worry about such new vaccines may prevent people from taking advantage of them.

Despite potential complications, fibromyalgia patients should consider getting both vaccinations, says Jacob Teitelbaum, MD, the medical director of the Fibromyalgia and Fatigue Centers, which are located throughout the United States. "People with severe chronic illnesses that put them more at risk [for dangerous complications of the flu] are more likely to get benefit than harm from the vaccine," he says.

But that doesn't mean fibromyalgia patients must get either vaccine. The decision for many, like Capelle, to vaccinate or not to vaccinate can be a frustrating toss-up. "The last three times I've gotten a flu shot, I ended up in bed for three weeks just from the shot," she says. "Last year I didn't get one and got the flu."


Next Page: Who should get vaccinated?
Who should get vaccinated?
It's hard to say, even for experts. "If you feel like getting the shot, if you're the type who catches everything, or if you find vaccines have been well-tolerated in the past, it's not a big deal; go get it," Dr. Teitelbaum says. "If past vaccines have knocked you for a loop, or your gut feeling is you don't feel comfortable, don't feel like you have to get it."

Indeed, some fibromyalgia patients tolerate shots just fine. Lavila Weckwerth, of Watervliet, Mich., has gotten a seasonal flu shot for the past seven years—despite being diagnosed with fibromyalgia three years ago—and has never noticed any side effects. Weckwerth works in a hospital and knows she's at increased risk of getting sick; however, when it comes to H1N1, she's uncomfortable with the new vaccine's lack of testing and doesn't plan on getting it unless it's required by her job.

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Andrea Nixon, of Pahrump, Nev., on the other hand, has never received a flu shot (and luckily has never gotten the flu) and does not plan on getting one.

"Earlier this year I was given a B-12 shot [to help with fibromyalgia and chronic fatigue symptoms]; it nearly paralyzed my left arm for six months," says Nixon, who was diagnosed with fibromyalgia in 2006. "Before being diagnosed, I was taking the Depo-Provera injection when numerous debilitating symptoms began occurring. So needless to say, I'm not much into receiving injections of any type!"

Capelle, who says she had the flu, three colds, and five sinus infections just this past summer, may simply be more susceptible to viruses, and therefore a better candidate for vaccination. In addition to evaluating your susceptibility to the flu, also consider your risk of exposure to the virus as you make your decision to get vaccinated. If you don't spend much time around other people, you may not come into contact with the virus. But if you are in frequent contact with children or sick individuals, like nurses or teachers are, you are probably at increased risk.

What's worse, flu or fibro?
Many patients are hesitant to get the vaccine in fear of bad fibro flare-ups. When deciding whether to get vaccinated, consider past flare-ups in comparison to past bouts with the flu, advises Dr. Teitelbaum.

"How your body has reacted in the past is the best predictor of how it'll react in the future," he explains. If a past vaccine triggered severe symptoms, maybe you'd be better off with a mild case of the flu.

In fact, Dr. Teitelbaum has observed that some patients actually feel a lessening of their fibromyalgia symptoms when they have the flu. "I've had people come to me and say, 'The only days that I've felt half-decent in the last eight years are when I've had the flu or some other virus,'" he says.

Although the flu's effects on fibro are nearly impossible to quantify, Dr. Teitelbaum says, doctors believe that when the virus stimulates the immune system, it naturally improves other immune-system conditions, including fibromyalgia.

Others, however, would take a vaccine's side effects over the flu any day. "I decided to get a flu vaccination this year, and I also plan to get the H1N1 vaccination, despite the side effects," says Deborah J. Norris, of Glendale, Ariz. "With [fibromyalgia], my immune system is impaired, and illness hits harder and takes longer to recover from."

If you've never had a flu shot before, or never even had the flu, you won't have any measure for comparison. For these rare cases, Dr. Teitelbaum says he would question why you want to start with vaccinations now. If it's because of the panic surrounding the swine flu, he recommends looking at the facts: In the United States, seasonal flu kills tens of thousands more people every year than swine flu has so far in 2009.

Instead of putting your faith in the new H1N1 vaccine, he recommends getting a regular seasonal vaccine—at least at first. Although the swine-flu shot has successfully made it through clinical trials, has been approved by the Food and Drug Administration, and has been deemed safe for people with weakened immune systems, its large-scale distribution hasn't yet been evaluated. "This is a whole new strain, and no one knows what the reactions are," Dr. Teitelbaum says. "Why not wait and start with something a little more proven?"

Protect yourself, shot or not
In the meantime, be sure to take the necessary precautions against the flu—and fibro. Common stressors that trigger fibromyalgia flare-ups—including cold or damp weather, poor sleep, fatigue, physical or emotional stress, and overexertion—can also leave you more susceptible to the flu.

Fibromyalgia doctors recommend avoiding these triggers whenever possible and reducing their effects by lowering stress and improving sleep habits. Dr. Teitelbaum also recommends washing your hands, staying hydrated, and adding extra vitamin C and zinc to your diet to help boost immunity.
]]> A shot may trigger fibro flare-ups, but offers protection from more serious flu complications. Getty Images <![CDATA[8 Ways Swine Flu Is Changing Society]]>

The World Health Organization (WHO) officially declared the virus a pandemic in June, and it announced in early September that at least 3,205 people have died from the virus. And while more than 60% of Americans say they are "not too" or "not at all" worried about swine flu affecting them or their families, according to a Washington Post–ABC News poll, the scare has left its mark on many parts of society, both in the United States and abroad. Here, eight ways swine flu is changing the world.

1. People may finally get flu shots.
In the 2005–2006 season, so many people did not get the vaccine that 18 million doses had to be thrown away. If this pandemic has a silver lining, it's that more people are making the decision to actively protect themselves against germs in general—and that's good news, since every year even the "regular" seasonal flu (and complications from the flu) kill about 36,000 Americans, and anywhere from 250,000 to 500,000 people worldwide.

An August Gallup poll found that 55% of respondents see themselves getting a swine-flu vaccine if one becomes available, up from 46% in May. And while the H1N1 vaccine won't be available until at least mid-October, seasonal flu shots this year are being administered earlier than usual—and recommended more strongly by health officials—in anticipation for increased interest.

Many drug stores, employers, and schools are already offering the seasonal flu vaccine, and some counties are administering the shots at no charge. On September 22, for example, CVS pharmacy will give free flu shots in New York City on the plaza of CBS's The Early Show.

Still, many people are skeptical of either shot's effectiveness, and probably won't get vaccinated or give the vaccine to their children. Pregnant women are especially at risk, but typically have very low rates of vaccination due to worries that the shots won't be healthy for their babies.

2. People are reconsidering cultural greetings.
The French are well known for offering la bise, a quick peck on each cheek, as a way of saying hello and good-bye. But with the fear of transmitting the H1N1 virus, some schools and companies—and even the health ministry's swine-flu hotline—recommend avoiding this practice. One mayor in a small French town has actually banned the kisses, telling National Public Radio, "What's the point in the preventative hand-washing when people are still kissing each other all the time?"

Spanish, Mexican, and Lebanese government officials have also discouraged kissing greetings, and school officials in New York have even discouraged students from exchanging high fives. John M. Barry, the author of The Great Influenza, warns that handshaking too could come under fire if the spread of the virus gets worse. "Any specialist would say that shaking hands is not a great habit if you're interested in controlling an infectious disease."


Next Page: It's scarier than religion
3. It's scarier than religion.
Swine flu is even changing some long-held religious practices: The Archdiocese of New York told Catholic New Yorkers they may refrain from the traditional handshaking at mass. One rabbi in Brookline, Mass., told National Public Radio that he suggested congregants at his temple greet each other with a "Buddhist bow" or an "Obama fist bump" during September's High Holy Days.

Muslims celebrating Ramadan in Kuwait and Lebanon have been advised not to hug, and, if the flu outbreak worsens, mosques could consider asking people to bring their own prayer mats to services. In Spain, Roman Catholics are being asked to refrain from kissing a statue of the country's patron saint, and Italy has banned the kissing of two vials thought to contain the blood of a saint.

4. Schools, workplaces, and day-care centers are changing policies.
Telling an entire country or religious congregation to stop shaking hands or kissing may prove tricky to control, however. "It's easier to implement when a school or an institution or a company collectively decides, 'We're not going to do this for the duration of this epidemic,'" says Pascal James Imperato, MD, a dean and distinguished professor of public health at SUNY Downstate Medical Center, in Brooklyn. And many are doing just that.

Colleges have updated handbooks to urge students and professors to stay home with even the slightest feeling of illness and to frequently clean often-touched objects in their dorms, such as remote controls and doorknobs. Offices are creating policies allowing employees to work staggered shifts or providing them with the materials needed to work from home. And day-care organizations have urged parents to consider making back-up plans should the centers need to cut their services with short notice.

5. People are scared to eat pork.
China, Russia, and Ukraine were quick to ban pork produced in the United States when the virus was first detected, and soon a total of 27 countries had followed suit. The boycotts have wreaked havoc on the pork industry, causing the government to actually bail out farmers who have been forced to sell their pork at lower costs, Time magazine reports.

The irony, of course, is that it's not at all possible for H1N1 to spread through eating infected bacon or hot dogs—and even so, there have been zero cases of infected pigs in the United States. The H1N1 virus actually has avian, swine, and human genes, and it may not even make pigs sick, scientists say. Unfortunately for pork producers, "swine flu" is a much more sensational and media-friendly name.

6. Tourism to Mexico has suffered.
When the first cases of swine flu were thought to have originated in Mexico, the Centers for Disease Control and Prevention initially recommended canceling all travel plans south of the border unless the trip was absolutely essential. Three weeks later, the warning was lifted.

The WHO now insists that international travel does not need to be restricted. Barry agrees: "At this point, the virus is everywhere," he says. "Where are you not going to go to avoid it? But that doesn't mean that there aren't people who wouldn't be a little panicked."

Those panicked travelers delivered quite a hit to Mexico's tourism industry, which was already in trouble due to violence- and drug-related publicity. Travel website TripAdvisor.com reported a 50% decrease in searches for Mexican destinations by May, according to SmartMoney.com. Hotels and airports sat empty in May, and airlines flying to Mexico have also reported millions of dollars in losses that they claim are flu-related.

The good news? If you still want to go, you can get flights and hotel rooms on the cheap.


Next Page: Precautionary (and bizarre) merchandise is flying off shelves
7. Precautionary (and bizarre) merchandise is flying off shelves.
Quickly after the virus first surfaced, consumers became caught up in the hype about the pandemic, says Dr. Imperato; they turned to whatever precautionary merchandise they could get over-the-counter. Logical purchases included face masks and antibacterial soaps, but plenty of other companies have cashed in on the marketing craze in over-the-top and even unrelated ways, as well.

There are flu kits (complete with full-body suits), swine-flu-spam computer-virus protection, a viral stop-the-spread online game, and, of course, all sorts of pig paraphernalia.

8. Coughing and sneezing are practically federal crimes.
Symptoms of sickness may not be against the law quite yet, but there does seem to be an abundance of dirty looks going around in response to simple public throat clearing. It seems that everyone is more aggressively cautious of coughing and sneezing in public, and perhaps rightly so.

A simple sneeze sends as many as 100,000 droplets of germs from your mouth and nose into the air within 3 to 5 feet at about 100 miles an hour, according to CNN's AC360°. The germs can then hang in the air for up to a minute, so even if the droplets don't land on a nearby person, he or she could still walk through the germy cloud and catch a virus. Even worse, coughing or sneezing into a hand and then touching a public space, like a subway pole, a door handle, or a shared computer keyboard, spreads the range of the germs.

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But even if you've seen dirty looks exchanged on the train or in the grocery store, it's probably a mild reaction compared to what Asian countries—which suffered through a deadly SARS epidemic in 2002 and 2003—are now experiencing. Jane Parry, a science journalist and researcher living in Hong Kong, notes that the emergence of H1N1 has strongly reinforced flu prevention techniques and attitudes about germ transmission.

"Handshaking fell out of favor during SARS, and it's totally acceptable now to not shake hands, especially if you are wearing a face mask," Parry says. "It's considered common courtesy now to wear a mask when you have a cold to protect others. Once swine flu came along, that expectation that you wouldn't cough near anyone else became even more pronounced. People would visibly reel away from you if you coughed."

In schools in Hong Kong, children with runny noses or coughs are required to wear masks, and any child with a fever is automatically sent home, Parry adds. Staff members working in food stores are also required to wear masks at all times, and Asian people are much more likely to wear face masks on airplanes, where air is filtered and recirculated through the cabin.

These measures may seem over-the-top to Americans, but is it possible they could become commonplace throughout the world? Only time will tell. For now, remember traditional cold and flu etiquette: Cough or sneeze into a tissue, or at least use your elbow and sleeve (instead of your hands) to cover your mouth.
]]> (GETTYIMAGES) <![CDATA[What You Should Know About Pseudoephedrine]]>
Pseudoephedrine

(SOO-doh-eff-ed-rin)

What is it? Commonly found in nonprescription cold and allergy medications like Sudafed and Advil Cold & Sinus, pseudoephedrine eases stuffy noses by shrinking swollen blood vessels in your nasal passages, says John Sundy, MD, an asthma and allergy specialist at Duke University Medical Center.

The buzz: Meds with pseudoephedrine were moved behind the pharmacy counter in 2006, and limits were imposed on how much you can buy. Why? The stuff can be used to make methamphetamine, an illegal drug.

You need to know: If you buy a cold or allergy medication and don’t get your usual relief, it may be because the product contains phenylephrine (available over the counter), not pseudoephedrine, Dr. Sundy says. New research shows that some people with stuffy noses get more relief from pseudoephedrine than phenylephrine.

The bottom line: Read labels so you know your phenyl from your pseudo, and ask your pharmacist for a pseudoephedrine product if you think you need it. Know that the drug slightly raises your risk for high blood pressure and might make you jumpy, Dr. Sundy says.

This article was first published in Health magazine, October 2009.
]]> <![CDATA[Study: Humidifiers May Help Fight Flu]]>
influenza virus is more likely survive, possibly giving it a better shot at spreading from person to person and making its way to you.

The finding also suggests that using a humidifier may be a good idea in places where the spread of influenza poses a serious threat, like intensive care units or even a home with a sick child—as long as sensitivity to moisture-loving mold and spores isn’t a problem, according to Jeffrey Shaman, PhD, of Oregon State University in Corvallis, a coauthor of the new study.

“It seems that [the influenza virus’s] ability to survive and be transmitted person-to-person is greatly affected by how dry or wet the air is,” says Shaman, whose study is published in this week’s Proceedings of the National Academy of Sciences.

The name for this potentially deadly respiratory infection comes from the Italian word for influence; centuries ago, people believed that the influence of the planets made people sick with the disease. Our science is a little more solid today, but researchers still aren’t 100% sure how and why the virus spreads, and they remain stumped about why some parts of the world have such a pronounced winter flu season with almost no flu activity in warmer months.

Shaman believes he’s found the answer: It’s all about humidity. Absolute humidity, that is, which is particularly low in cold weather.

Shaman and his colleague Melvin Kohn of the Oregon Department of Health Services in Portland revisited a 2007 study that found higher humidity slowed the spread of the flu among guinea pigs. The researchers had measured air dampness using relative humidity, or how saturated the air is with water vapor.

For example, 75% relative humidity would mean the air is holding 75% of its total capacity of water vapor. Relative humidity is strongly influenced by temperature; the warmer the air, the more water vapor it can hold, while colder air can’t hold as much water vapor.

Absolute humidity, on the other hand, refers to the actual amount of water vapor in the air regardless of saturation. Relative humidity is like a car’s gas gauge, Shaman notes. It tells you how full your tank is. Absolute humidity represents how many gallons you have in your tank, regardless of the tank’s size.

Shaman converted the guinea pig data from relative humidity to absolute humidity and found the link between air moisture and flu spread got much stronger. “Absolute humidity, for reasons that remain undetermined, is affecting how long the virus remains viable,” he says. “It really explains why you have this pronounced seasonality in temperate regions.”

The researcher also looked at studies dating back to the 1940s of airborne flu virus survival. Some included information on relative humidity, which he converted to absolute humidity. Again, the relationship between survival and air moisture got stronger.


Next Page: Wetter air causes flu viruses to die
For example, in the wettest possible absolute humidity, less than 20% of the virus was still viable after an hour, while at the driest conditions 80% of the virus was still capable of making someone sick. After 23 hours, the viruses in the dampest conditions were all dead, while 60% of those under the most arid conditions were still alive.

“The idea that humidity affects the life of virus has been known for decades,” says Michael Gardam, MD, PhD, an infectious disease specialist with the University Health Network in Toronto and Ontario’s public health agency. While Shaman’s findings are “important,” according to Dr. Gardam, the challenge will now be to see if air humidity affects the spread of the disease among humans in the real world. “Based on the papers that have been done thus far, I wouldn’t run out and buy humidifiers, but I would definitely buy humidifiers to study humidifiers.”

“This is sort of nibbling around the edges,” he added. “It’s useful, but it’s not sufficient to say, ‘We now have the answer to change the world.’”

It’s “frustrating,” Dr. Gardam says, that we still don’t know if the virus is spread mainly by physical contact or through the air or both. For this reason, he adds, there remains no scientific evidence that widely promoted protective measures such as hand washing and mask wearing will actually stop people from getting sick. “We’ve just sort of taken for granted we know how it transmits, and we really don’t know,” he says.

“I think they’ve done a good job. I agree with their work,” says Anice Lowen, PhD, a researcher at the Mt. Sinai School of Medicine in New York and one of the authors of the guinea pig study. “I’m not an expert in the methods that they used, but it seems to make sense.”

The reasons why the flu virus might survive and spread more easily in dry conditions—and why absolute humidity might be a better gauge of these conditions than relative humidity—are still not clear, Lowen notes. It could have something to do with moisture evaporating from surfaces more speedily when humidity is low, she says.

Lowen agrees that keeping indoor air more humid might help slow down the spread of the flu. But, she adds, “the best way to protect yourself against influenza is to get vaccinated.”
]]> (GETTY IMAGES) <![CDATA[Cold or Flu? How to Know if You’re Too Sick to Work Out]]>
cold or flu. But those who persevere when they're sick and don’t break their exercise routine may be on to something. Some experts argue that moderate exercise can actually have a beneficial effect on cold symptoms, according to the American College of Sports Medicine.

Exercisers in general tend to catch fewer colds than their sedentary counterparts, research suggests. If done regularly, moderate exercise can halve the number of days you spend with cold symptoms, according to a series of studies conducted in the 1990s. While working out may help fend off viruses, even the most dedicated gymgoer will come down with a cold at some point.

Not everyone who feels under the weather should exercise, however.

What’s the neck rule?
Experts like to cite a rule of thumb known as the “neck rule.” If your symptoms are all located above your neck (stuffy nose, scratchy throat, headache), you almost certainly have a head cold and can hit the road or treadmill safely. If, on the other hand, you have a fever, congestion in your chest and lungs, or feel achy, it is probably a sign of flu, bronchitis, or another more serious ailment, and you should rest up. (Exercising with a fever will make you more vulnerable to dehydration, among other ill effects.)

But the neck rule isn’t foolproof, and a little common sense is always a good idea. “The above-the-neck rule is a good one, but I’d say severe above-the-neck symptoms warrant cessation from regular exercise until the symptoms abate,” says Jeffrey Woods, PhD, professor of kinesiology at the University of Illinois at Urbana-Champaign. “ Even Olympic athletes need a day or two off every once in a while.”


Next Page: Don’t give 110%
Even if you pass the neck test and are determined to get a workout in, you should take it easy at first. “To be prudent, I’d recommend cutting exercise duration and intensity when symptoms are present,” says Woods.

Daryl Rosenbaum, MD, director of the Sports Medicine Fellowship at the Wake Forest University School of Medicine, recommends that people with colds begin working out at 50% intensity. If symptoms improve after the first 5 to 10 minutes (as they often do), you can gradually increase the length and effort of your workout up to about 80% to 90% of your usual routine.

“Moderation is the key,” says Dr. Rosenbaum. “Studies have shown that people suffering from the common cold who get up and get moving actually feel better. If you go too far, however—either with extreme short-term activity or long-term overtraining—the immune system weakens. A viral cold that is allowed to linger for longer than normal could create sinus conditions that are ripe for a bacterial sinusitis to take over.”

There are some other precautions to keep in mind. Staying hydrated during exercise is always important; it is especially so if you’re planning to exercise with a cold. The nasal drainage associated with colds can hasten dehydration, and some over-the-counter cold remedies containing antihistamines (many cough syrups, for instance) can dry you out further, Dr. Rosenbaum points out.

Don’t spread—or catch—more germs at the gym
If you work out in a public gym, be extra vigilant when exercising with a cold. Germs can be transmitted through the air and through any person-to-person contact, so if you use a treadmill, gym mat, or barbells, be sure to be extra careful when it comes to wiping down the equipment. And avoid touching your face after handling equipment; you can pick up germs that will be more likely to infiltrate your body that way.

Your vulnerability to upper respiratory tract infections spikes for several hours starting just after a strenuous workout, studies suggest. So if you’ve just stepped off the treadmill after a 10-mile run, give that sweating, coughing, and sniffling stranger in the locker room a wide berth.

“Regardless of whether you’re exercising moderately or intensely, you want to take precautions against infection,” says Woods. “Clean your exercise equipment before and after, use a clean cup to get water from the fountain, and try to pick a machine away from other people.”
]]> If your symptoms are above the neck (stuffy nose, scratchy throat, headache), it’s probably safe to work out. (GETTY IMAGES) <![CDATA[Stuffy Nose? 5 Ways to Tell if You Need an Antibiotic]]>
cold symptoms, saying everything from "The last time it helped me completely" to "I have to go to my daughter's wedding" and "There's this terrible green guck coming out of my nose."

There's just one problem. While antibiotics are excellent at killing bacteria (as long as you match the right drug to the right germ), they're useless at killing viruses. And viruses, including the flu, cause 90% of respiratory infections. "Most upper respiratory infections are caused by viruses; a minority are caused by bacteria," says Lauri Hicks, MD, medical director of the Centers for Disease Control and Prevention's "Get Smart: Know When Antibiotics Work" program. For example, Dr. Hicks notes, only 2% of sinus infections are caused by bacteria and require an antibiotic.

So what, you say? Antibiotics might help and they certainly can't hurt, right? Wrong. The evidence is piling up that using antibiotics indiscriminately is dangerous from a public health standpoint (it can breed drug-resistant bacteria) and even personally (they kill off healthy bacteria in your body and may let toxic germs gain a foothold).

However, there are times when the icky green goo in your nose or the hideous rattling cough in your chest might benefit from the antibiotic superhero treatment. So how do you know if you need one?


Next Page: How to know if you need an antibiotic
How to know if you need an antibiotic
Doctors consider some guidelines when mulling this question, although it's still a gray area. "It's an inexact science," says Frank Esper, MD, a pediatric infectious diseases expert at Rainbow Babies & Children's Hospital, in Cleveland. It’s difficult to distinguish a severe viral infection from a mild-to-moderate bacterial infection based on symptoms alone.

So physicians often use their spider senses—a combination of experience and science—when deciding to dole out an antibiotic. Here are five things most doctors take into consideration when making that decision:

  • Fever. If you have fever, shakes, and chills, you could have a bacterial infection, but those are also common with a viral illness such as the flu, Dr. Esper says. Physicians will weigh your likelihood of having the flu—Is it circulating in your area at the moment? How many patients has he or she seen with the flu that day?—against the possibility of a bacterial infection. If you have a fever, and flu is circulating in your community, you'll probably leave the doctor's office without an antibiotic. Next year, get a flu shot.
  • Length of time you've been sick. Viral infections that hang around for a while can sometimes morph into a bigger problem, such as a sinus infection, and bacteria may join the party. So if your symptoms have been lingering for weeks, your likelihood of getting an antibiotic goes up. However, most of the time, long-standing symptoms are due to a virus, not bacteria, says Dr. Campbell. Final verdict? It’s still not the best way to determine your need for antibiotics.
  • The color of your goo. Nasal secretions tend to be thin and clear during a viral infection, while green or yellow mucus can be a sign of bacteria. This one is tricky, though; most greenish discharges are viral. Overall, mucous color is considered an unreliable indicator of the need for an antibiotic.
  • Your sore throat. Although it's red and looks terrible to you, your doctor may also look for white spots, which can be signs of bacteria, before considering an antibiotic. Most colds start with a sore throat, but a sore throat without other cold symptoms (such as a runny nose) can be strep throat, which does require antibiotics to halt the dangerous bacteria. To know for sure, you need a culture or rapid antigen test, which takes less than 20 minutes and can be done while you wait.
  • Testing. A lab test is the only ironclad way to determine if you truly need an antibiotic. A physician can collect a sample of bodily gunk (whatever you can cough up or blow out of your nose), or take a throat swab. In general, a culture, in which bacteria are grown in the lab and tested, can take a day or two. Doctors often forgo the expense and time of a lab test if they think they can make a best-guess decision based on the above symptoms.
]]> It can be hard to tell if you need an antibiotic. (ISTOCKPHOTO) <![CDATA[How to Fight Colds, Flus, and Infections at Any Age]]>
cold-and-flu season. Here, an age-specific plan for optimum protection.


Next Page: Your 30s
Your 30s

Limit sugar and alcohol
Life in your 30s often means fast-tracking a career, starting a family, and keeping up with an active social life—all at the same time. That can mean meals on the fly, sugary snacks for energy, and some social drinking on the weekends. As a result, your immunity can suffer, says Mark Moyad, MD, director of preventive and alternative medicine at the University of Michigan Medical Center. “The sugar in just one can of soda can compromise immune system function by 30% for up to three hours,” he explains. How? By immobilizing some immunity cells and hurting their ability to surround and ultimately destroy bacteria. In addition, anything more than a few alcoholic drinks per week reduces the number of immunity-providing cells your body produces.

Dr. Moyad recommends that you not only limit drinking but also replace sweets with high-fiber snacks like oatmeal, whole-wheat muffins, or apples. Fiber is actually a prebiotic—a food source for probiotics, the friendly bacteria in yogurt and other products that help keep your gut strong enough to fend off invading bacteria and viruses. Also, try starting your day with cereals containing buckwheat (try Arrowhead Mills Organic Maple Buckwheat Flakes) or wheat germ (Kretschmer Wheat Germ); both are high in polyphenols, natural compounds linked to longer life and increased immunity.

Work out smarter, not harder
Robo-routines that get you a hard body in a few weeks may boost your physical confidence, but they actually slow down your immune system, says Len Horovitz, MD, a pulmonary specialist and flu expert at Lenox Hill Hospital in New York City. Studies show that moderate exercise, however, helps immune cells circulate through the bloodstream at a more rapid pace, making it less likely that bacteria or viruses will slip through unnoticed. And the effect is cumulative over time. Aim for about 20 minutes of aerobic exercise (walking or running, for instance) plus 15 to 20 minutes of strength training three times a week. Then try some yoga for an extra boost: A Washington State University study suggests that doing yoga three times weekly—the equivalent of a moderate-intensity exercise program—reduces a key marker for stress inside the body, helping to increase immunity.


Next Page: Your 40s
Your 40s

Go to bed earlier
You may relish your downtime before bed—who doesn’t want an hour to read or watch TV after the evening rigors of helping with homework, doing the dishes or laundry, and whipping the household budget into shape? But if you relax at the expense of getting real sleep, fighting off colds gets harder. As little as 30 to 60 minutes of additional sack time per night is enough to up your immunity, Dr. Moyad says. “Sleep is a restorative process, and it’s necessary for the immune system to function properly,” he explains. Even a nap can help. “When you feel tired don’t fight it,” Dr. Moyad adds. “It’s your body’s way of telling you that you need to recharge.”

Learn new ways to relax
Chronic stress—whether it’s from a frustrating daily commute or problems on the job—slows down your immune system, making it react less efficiently to a threat like the flu virus, for instance. To fight back, try new forms of heavy-duty relaxation, says Jacob Teitelbaum, MD, medical director of the nationwide Fibromyalgia and Fatigue Centers; he recommends transcendental meditation.


Next Page: Your 50s and beyond
Your 50s and beyond

Amp up antioxidants
In your 50s, your risk of disease rises fast. To pump up your immunity, add more antioxidant-rich fruits and veggies to your diet. Research from the University of California, Berkeley, suggests that broccoli, cabbage, and kale offer the biggest immune system boost because they contain an important cancer-fighting compound. You hated kale the last time you tried it 10 years ago? Some evidence suggests that taste buds can “mature” in a way that can turn foods you’ve never liked into pleasurable adventures.

Another smart choice, according to pharmacist Suzy Cohen, RPh, author of Drug Muggers: How to Keep Your Medicine From Stealing the Life Out of You, is a cup of tea—but not just any cup. Her favorite is matcha, a powdered form of ground-up green tea leaves sold under many brand names and found in most health-food stores as well as online. One cup of matcha will net you the antioxidant protection found in 10 cups of brewed green tea and up to 100 times the antioxidant power of vitamins C and E, she says. Dr. Moyad suggests adding a spoonful of honey to your tea for extra protection: “It has incredible antibacterial powers.”

Follow your dreams
Pay a little more attention to those long-lost goals that help define the meaning of life—and your immune system’s natural killer cells may multiply, according to a University of California, Los Angeles, study. While researchers aren’t sure why, one theory suggests that focusing on what you really want to do reduces the immunity-robbing impact of everyday stress. Dr. Moyad says volunteering in your community can pump up your germ-fighting powers even more. Studies show that those who volunteer not only are healthier but actually live longer than folks who don’t. Stress reduction may be the hidden link.

Get your groove back
Now that the kids may be out of the house for long periods, make more time for sex. A study from Wilkes University in Wilkes-Barre, Pa., found that men and women who had one to two sexual encounters per week had a 30% increase in IgA, antibodies found in saliva and mucous membranes that are considered the first line of defense against cold and flu viruses. Exactly how or why sex causes the increase is not well understood—but sometimes science is just there to enjoy!

This article was first published in Health magazine, December 2008.
]]> High-fiber snacks give friendly bacteria a boost, and help keep your gut strong enough to fend off invading bacteria and viruses. (ISTOCKPHOTO)