From one of our readers: I have chronic obstructive pulmonary disease (COPD). Is the H1N1 vaccine recommended for me?

Yes, especially if you’re under the age of 65. COPD is a chronic lung disease that makes it hard to breathe. Someone with COPD who catches the flu is more likely to suffer complications than a person with healthy lungs. If you’re between the ages of 25 and 64, having COPD places you in a top-priority category to receive the H1N1 vaccine while it’s in short supply.

Those 65 and older, who are much less likely than younger people to catch the H1N1 flu, are in the last priority group for the shot, with no distinction made for chronic medical conditions like COPD. The U.S. Centers for Disease Control and Prevention (CDC) has recommended that health care providers offer the vaccine to people 65 and up after local demand among priority groups, including healthy younger people, has been met. (For more on this, see the CDC’s Q&A on the vaccine and people 65 and older).

Whatever their age, says M. Bradley Drummond, M.D., a fellow in pulmonary and critical-care medicine at Johns Hopkins University, those with COPD are advised to seek medical consultation if they develop flu-like symptoms. “Any change in respiratory status from their baseline—increasing shortness of breath, increasing cough or phlegm”—should prompt a call to the doctor, he says.

Q. If I’m not in a priority group, can I still get the H1N1 vaccine?

Yes, just as soon as local demand among priority groups is met, a determination will be made by providers in consultation with local health authorities. The shot is free, although private doctors and pharmacies may charge a modest fee to administer it. More good news: Only one dose is required for adults, conferring immunity within eight to 10 days.

Q. When the time comes for me to get the H1N1 vaccine, should I get the nasal spray or the shot?

A. Some people shouldn't get the nasal vaccine, which contains a live, weakened virus. This group includes all those 50 and older, pregnant women, children under two and those with a medical condition that puts them at higher risk for flu-related complications.

Q. If I haven’t been able to get an H1N1 vaccine, how can I avoid getting the flu?

Experts agree that getting vaccinated is the single best way to protect yourself. But if you can’t get or are not on the priority list for an H1N1 flu shot, you can still practice a powerful prevention method—hand washing. Washing your hands well is the single most important thing you can do to protect yourself against flu viruses and any number of other bugs. And yes, a soap-and-water scrub is the best option because it actually washes the organisms down the drain. If soap and water are not available and your hands aren’t visibly dirty, the second-best choice is an alcohol-based hand sanitizer like Purell, which kills the virus. The Association for Professionals in Infection Control and Epidemiology recommends a product of at least 60 percent alcohol.

Q. Can I get seasonal and H1N1 flu vaccines at the same time?

A. Yes, with one exception. If you receive both vaccines in nasal-spray form—which contains live, weakened virus—then they need to be administered at least four weeks apart. However people 50 and older are advised to get both vaccines as shots, which can be given on the same day, one in each arm.

The pneumococcal vaccine shot also can be given the same day as any flu vaccine. The Centers for Disease Control and Prevention recommends this shot as well to prevent pneumonia, which can be triggered by the H1N1 flu virus.

Q. Has the flu season begun?

A. Yes, most states were reporting significant influenza activity as of September, and that’s unusual for so early in the fall. Presently, most of the viruses circulating are the so-called swine flu, more properly known as the 2009 H1N1 virus.

Q. Can getting vaccinated against pneumonia protect me from H1N1 flu?

A. No, it won’t prevent infection, but it could help ward off a serious and sometimes fatal complication of flu, bacterial pneumonia. A study by the U.S. Centers for Disease Control and Prevention recently found that in 77 deaths from H1N1 flu, 22 involved this bacterial lung infection. And while people age 65 and older are low on the priority list to receive the H1N1 vaccine, everyone in this age group is urged to get the pneumococcal vaccine, along with the seasonal flu shot. This also goes for younger people with conditions like chronic lung or heart disease, which predisposes them to flu-related complications.

Q. What are the symptoms of H1N1 flu?

A. H1N1 symptoms are very much like those of seasonal flu and can include a fever, cough, sore throat, runny nose, body aches, chills, fatigue and weakness. But many with H1N1 also have vomiting and diarrhea. Those with either seasonal or H1N1 flu will exhibit at least two of these symptoms. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.

Q. Should older Americans get the new swine flu vaccine, a regular seasonal flu shot or both?

A. People age 50 and older have long been a top priority for seasonal flu vaccination, with those 65 and older especially at risk, and that still holds true. This group should get a seasonal flu shot as soon as the vaccinations are offered.

With the H1N1 vaccine, it’s a different story.  In the next few weeks, only limited quantities of the new vaccine will be available. And when the Centers for Disease Control advisory committee met recently to come up with a list of priority groups for that vaccination, it placed men and women age 65 and older dead last. But the priority group for H1N1 shots did include people ages 25 to 64 who have an underlying condition like heart disease, asthma or diabetes.

As H1N1 spreads across the globe, experts monitoring the cases say that older people appear to have some immunity to it. The worst cases have been seen in those under age 55. The new flu has struck hard at teenagers and young adults, causing a spate of outbreaks at schools, while all but entirely sparing those in the older age group, who are most likely to develop dangerous and even lethal complications from seasonal flu.

Q. Do antibacterial wipes and lotions kill the virus? Are they as effective as soap and water?

A. The experts agree: Washing your hands well and often is the single most important thing you can do to protect yourself against the swine flu virus and any number of other bugs. And yes, a soap-and-water scrub is the best option because it actually washes the organisms down the drain.

If soap and water are not available and your hands aren’t visibly dirty, the second-best choice is an alcohol-based hand rub like Purell, which kills the virus. The Association for Professionals in Infection Control and Epidemiology (APIC) recommends a product of at least 60 percent alcohol. Check the label. Soaps containing antibacterial agents like triclosan haven’t been proven better than regular soaps at preventing infection in general.

Q. Are some individuals exploiting fear of contagion to make a buck?

A. Don’t they always? The scammers and spammers are already busy pitching “cures” for the swine flu, as well as products claiming to prevent it. The U.S. Food and Drug Administration has begun issuing warnings to offending websites. Don’t buy flu meds without a prescription. Report suspected swine flu fraud to the FDA.

Q. Should I buy face masks from the drugstore?

A. Lots of people are doing just that, but the masks’ usefulness for protecting you from the swine flu while you’re out and about is questionable. For one thing, the droplets from a cough or sneeze “drop out of the air at about six feet,” says Kevin High, M.D., who heads the infectious diseases department at Wake Forest University. Hand-contact transmission is much more likely than breathing airborne virus. Another thing: The masks many are buying are designed to keep people from breathing soot or being exposed to large-particle splashes. “It’s not clear that they really keep out viral particles,” says High. So-called N95 masks have smaller pores that do filter viruses, but are more expensive. They also may be uncomfortable for some older people, especially those with breathing problems, says Patricia Rosenbaum, R.N., an infection prevention expert and APIC spokesperson. Remember—the masks cannot be shared or reused and can themselves become contaminated. If the swine flu became widespread in your community, donning a mask might be part of a larger strategy to prevent transmission, say experts at the CDC. They may also be useful for health care workers in close contact with coughing, sneezing patients.

Q. Do I need to wash clothing, jewelry and other personal items? What about household surfaces?

A. It’s always a good idea to keep surfaces like telephones, doorknobs and computer keyboards wiped clean, says APIC’s Rosenbaum. But are you prepared to clean all the money in your wallet and spray down every drawer pull in the office? “We can’t sanitize everything in the world,” says Rosenbaum. That’s why hand cleaning is the key strategy. Take special care to wash around jewelry worn on the hands, she says.

The CDC does suggest special hygiene precautions for households in which a swine flu patient is convalescing.

Q. If I have flu symptoms, when should I go to the doctor?

A. Though U.S. cases of swine flu have been described as “mild,” that’s a relative term, says Louise Dembry, M.D., director of hospital epidemiology at Yale-New Haven Hospital. Like some cases of seasonal flu, she says, the illness is no bout of the sniffles, but tends to come on strong with sudden chills and aches, sore throat and coughing. “You know, you kind of feel like you’ve been hit by a truck,” she says. Symptoms like that, especially when coupled with recent travel to Mexico or known exposure to the swine flu, definitely warrant a call to the doctor. If you’re short of breath, have a very high fever, show signs of dehydration like dizziness—no matter what the cause—get seen promptly.

Q. Is there a test for swine flu my doctor can give me?

A. Yes. Your doctor may conduct various tests to identify influenza generally or rule out other infections. There’s only one that can identify the novel swine flu strain specifically. Newly developed by the CDC, the test kit is being delivered to authorized state laboratories. Your doctor takes a swab from your nose or throat and sends it to the lab for evaluation. Unfortunately, labs swamped with samples may be unable to turn them around quickly.

For patients who seem highly likely to have the swine flu—say, someone with flulike symptoms and recent travel to Mexico—doctors may begin treating with recommended antiviral medicines right away, says High of Wake Forest. The antiviral drugs need to be started within 48 hours of symptom onset to be fully effective. “It’s important to figure out specifically what you have,” says High.

Q. Are antiviral medicines safe for people 50 and older? What about people with heart problems and other chronic conditions?

A. Generally speaking, yes. The two medicines approved for use against the swine flu, Tamiflu and Relenza, are quite safe and carry little risk for drug interactions, says High. The most common side effect is mild gastrointestinal upset.

However, the difference in the drugs’ dosage form—Tamiflu is a pill; Relenza, an inhalant—does affect some older people. Especially for those with dementia, using the inhaler can be tricky because you have to time your breath, then hold it in. Two studies found that Relenza was not effective in preventing flu in nursing home populations, and the CDC does not recommend its use there. People with chronic lung disease like asthma also should contact their doctor before taking Relenza.

Q. Are there special precautions being taken for people in nursing homes and assisted living?

A. At this stage, the critical point is keeping the virus out of nursing homes, where it could spread quickly among patients who are vulnerable to complications, says Kenneth Schmader, M.D., chief of geriatrics at Duke University Medical Center. “Almost always, it’s a health care worker or family member who brings the virus into the nursing home,” he says. No one with respiratory illness should be making a visit now. Check out APIC’s “Be a good visitor” brochure for more information.

Long-term care facilities should have plans in place for coping with pandemic flu—and should be reviewing them now, says Schmader. The CDC recommends that such plans should include assigning a point person to monitor developments, protocols for tracking flulike symptoms among residents, and policies for isolating infected residents—in a single unit, for example. Adherence to the CDC guidance varies widely, judging from a study of Michigan and Nebraska nursing homes coauthored by the University of Michigan’s Lona Mody, M.D., and published last summer in the Journal of the American Medical Association. It found that while three-quarters of facilities had assigned a staff member to handle pandemic preparedness, half did not have a plan in place. About half had stockpiled commonly needed supplies like gloves and hand sanitizer, but less than half had conducted staff education on pandemic readiness.

Katharine Greider writes about medical issues and health policy.