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That lingering cough

Don't think I don't see you glaring at me. Yes, those are my kids, coughing up a storm. And, yes, if they were your kids, I'd be glaring at you.

I wish I could hang big signs around my son's and daughter's necks saying "No longer contagious -- we think." As I wrote last week, both kids have been vaccinated against both seasonal flu and H1N1. They got the latter shots, though, only after they'd both had a bout of what the pediatrician's office figured was likely H1N1. A cough came with each of their illnesses. When the other symptoms faded away, the cough remained.

I followed the rules: I kept them home for 24 hours after fever subsided. I've kept an eye on them to make sure some secondary infection has not set in, looking for new symptoms such as difficulty breathing. And, while you might not have noticed with all that hacking going on, I have reminded them frequently -- and they have obeyed -- to cough into their elbow rather than in the open air.

Still, I feel awkward taking them out in public. If I were a stranger, I'd back away if I saw/heard one of them coming. That's where those signs-around-the-neck would come in handy.

To reassure myself that I've not committed a public disservice by releasing my coughing children into the world, I spoke with Henry Bernstein, professor of pediatrics at Dartmouth Medical School and a member of the American Academy of Pediatrics Committee on Infectious Diseases. He said that as long as I'd kept them home until their temperature had been back to normal, without help from Tylenol, for 24 hours, it was fine to let them loose without fear that they'd infect others.

That lingering cough, he added, is characteristic of many respiratory-tract infections, not just H1N1. "Any virus that invades the upper respiratory tract can cause persistent cough," Bernstein said. Having the cough linger longer than a week or 10 days, as my kids' have, isn't all that common, though, so I still should be on the lookout for those secondary infections.

But in general, Bernstein explained, a cough is a protective mechanism designed to keep foreign stuff out of the airway during illness and afterward. "The virus disrupts the epithelium lining the airway, and that takes a while to heal," he said, which explains why a cough might last a while, too.

As for me and my multiple sclerosis, which places me at risk of complications should I get influenza, I've still not been able to get an H1N1 vaccination because my risk category isn't as high a priority as others such as pregnant women and health-care workers. I've got a packet of Tamiflu in my purse, just in case symptoms show up.

How about you? How is this flu-and-cold season treating you and your family?

By Jennifer LaRue Huget  |  November 19, 2009; 7:00 AM ET
Categories:  Family Health , General Health , Influenza  
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Next: Is That Right? Onions and garlic fight swine flu?

Comments

Had the whole fever, congestion, cough, sinus thing. Went to one nighttime doctor who swabbed my nose and declared "no flu." Still felt terrible so went to my GP who gave me a Z-pack and am now just starting to feel better although the cough lingers. People, please do not become hysterical when others cough. We're not always contagious and are trying to be responsible.

Posted by: bluestilton | November 19, 2009 11:27 AM | Report abuse

I am the cougher. I had the flu three weeks ago, but haven't been contagious for two. I am asthmatic, and find myself in this situation fairly often. I can't remove myself from society, but I can cover my mouth.

Please don't glare.

Posted by: MzFitz | November 19, 2009 12:17 PM | Report abuse

MzFits -- As a fellow asthmatic, I can so relate. My family had what we think was the swine flu, and I coughed for 3 weeks. I cough for weeks after bad colds and during allergy season even though I take daily asthma medicine and see my allergist regularly. I never understood what the term "head cold" meant until I was an adult because for me every virus was accompanied by coughing. After getting over a cold, I once had a co-worker rudely exclaim, "Why don't you take your damn medicine!" even though I was taking the cough medicine my PCP had prescribed. When I told her I had asthma and had been sick, she smirked and was completely unsympathetic. A couple of years after leaving that job, I was surprised to learn that the my former co-worker had contracted and died from a debilitating disease. I guess she found out in the worst way what it's like to suffer from something your body has that you cannot control.

Posted by: 1950snoopy | November 19, 2009 1:06 PM | Report abuse

"As for me and my multiple sclerosis, which places me at risk of complications should I get influenza, I've still not been able to get an H1N1 vaccination because my risk category isn't as high a priority as others such as pregnant women and health-care workers. I've got a packet of Tamiflu in my purse, just in case symptoms show up."
=========================

Do people not realize that the vaccine DOES NOT PREVENT INFECTION, only reduces the chance.

I have meet 5 people now that got the shot and still got H1N1. The funny thing is they all took longer to recover than those people who got it without having the shot and simply used Tamiflu....

About the only thing they have been successfully manufacturing in quantity is fake pandemic spin and BS to shove down our throats while they draft legislation to regulate every aspect of our lives...

Posted by: ProveMeWrong | November 19, 2009 1:10 PM | Report abuse

I received my H1N1 vaccination last night. Only question I had was when does the imunization take effect. I was told two weeks. So, yes getting the shot doesn't prevent Swine Flu until your body builds anti-bodies to flu virus. But then it is the absolute only effective method to prevent infection if exposed to the virus. People who believe this is some sort of Big Government scheme should look at the old fluoride in the water crazy opposition.

Posted by: MitchinADK | November 19, 2009 1:36 PM | Report abuse

CDC is now recommending you remain home 48-72 hours after fever subsides and not 24 hours.

My daughter had the cough for 30 days after she no longer exhibited symptoms.

H1N1 is trasmitted through coughing and sneezing, so if you had H1N1, my guess is if you are coughing 2 days later you are still contagious and why it continues to spread- because there is so much misinformation out there.

Posted by: jhkh | November 19, 2009 1:40 PM | Report abuse

I caught H1N1 in October. I was just released from the hospital 2 days ago. I was unconscious and on a ventilator for almost 2 weeks, so I don't recall much. But I did wake up mute from the tracheotomy and practically paralyzed from muscle atrophy. Spent the next two weeks building muscles to be able to walk with a walker. It hit suddenly and I have no idea how I caught H1N1. If you can get the vaccine, I strongly suggest you do so. I have to rebuild every muscle. Learning to walk again, and eat has been so hard.

Posted by: AnnsThought | November 19, 2009 2:32 PM | Report abuse

I have amazing, year-round allergies. For those who can relate, my IgE test runs over 3,200. That leaves me sneezing and coughing a lot. A whole lot. I see it as a blessing.

When I am in public people avoid me, most likely assuming that I have H1N1, TB, or anthrax. That leaves me with a wide berth, good access to clothes racks and book displays, and also moves away those who may actually be sick so they don't infect me.

One day I may even start a rap group. I will call it Tenacious Snot and the Mucous Membranes. We'll have to play only very small clubs, though, since a larger venue will overwhelm our nine groupies.

Posted by: crisp11 | November 20, 2009 4:38 AM | Report abuse

I've had a cough for about 2 months. About 1 in 4 people I come across appear to have the same condition. Even while watching the World Series, I think I saw some of the players coughing as well. At least in the northeast, it looks like there is a low-grade coughing condition going around.

Posted by: randomray | November 20, 2009 9:36 AM | Report abuse

I'm not in a high risk category, but I understand the efficacy of inoculations in general, and against Influenza in particular, so I'll get the shot when it's available to the general public.

However, there is another preventive whose efficacy rivals that of immunizations- Vitamin D. There is a growing body of professional medical literature demonstrating that Vitamin D deficiency is rampant in the general population, and is responsible for many illnesses and conditions. In particular, there is strong evidence that Vitamin D deficiency may be the long-sought seasonal variant that explains the phenomenon of Influenza infections drastically increasing during each hemisphere's respective Winter.

Numerous studies show that we need far more Vitamin D than we can get without significant supplementation during Winter months, especially at latitudes above 35 degrees or so. While Vitamin D is toxic at very high levels, those levels are far above even the most aggressive recommendations, although there are specific things that can decrease your Vitamin D tolerance (e.g. certain cancers). But in general, aggressive supplementation with Vitamin D is cheap, uncomplicated, and very low-risk.

I'm not a medical professional; just summarizing what I read at http://www.vitamindcouncil.org/. This is mainstream medicine, albeit somewhat leading edge, and they give lots more info than I mentioned here. Check it out for yourself, and add to your arsenal against H1N1 and seasonal Influenza, and see the host of other problems being linked to Vitamin D deficiency.

Posted by: mark51 | November 20, 2009 9:59 AM | Report abuse

I believe I saw the swine flu the other day. A college-aged, well-fed (not fat, not skinny) girl sat in the doctor's office wearing a mask, a baseball cap over her eyes to shield them from the dim ceiling light. Her chest was heaving noticeably as she tried to breathe. That did not look good. I can see where those symptoms -would kill older folks and babies.

Posted by: HookedOnThePost | November 20, 2009 10:16 AM | Report abuse

I've found an interesting article, well documented, which will reflect more than one person. It's in Spanish-can be translated into network, via Google, for example -:

http://www.dsalud.com/cabecera.htm

The article starts going down the headline, with the title "Demoledor informe sobre la gripe A"("Devastating report on the swine flu").

Posted by: vilo3000 | November 20, 2009 7:40 PM | Report abuse

Hooked-- H1N1 is killing young people, children and pregnant women. If you are old, you may already have some resistance, particularly if you were infected in 1976. Younger people have more robust immune systems and their bodies respond more aggressively to fight off the virus-- so aggressively that lungs inflame, fill up with fluids, etc... precisely the things you saw in the doctor's office.

I thought this was going to be about that lingering cough associated with nothing more than a lingering cough and some sniffles. Both of my kids have had one-- no fever, no aches, no nothing. Just a cough and sniffles that have persisted for the past four weeks.

Posted by: mdreader01 | November 23, 2009 1:11 PM | Report abuse

I would not be so sanguine about your children's coughs, from a public health point of view. First of all, the CDC recommendation that at 24 hours after fever the patient is no longer a threat to public health was based on an attempt "to balance the risks of severe illness ... with the goal of minimizing social disruption". In other words, the recommendation is NOT based on science alone. In addition, it is known that some children will shed virus for up to two weeks after onset of seasonal flu.
Second, a recent study in the American Journal of Preventive Medicine studied an outbreak of H1N1 at the U.S. Air Force Academy. They noted that virus was collected for up to nine days after onset from some cadets. The problem is that the influenza virus doesn't always read the script that was written for it.
If you are coughing you owe it to those around you to wear a surgical mask. Surgical masks protect others from your aerosols. Just to hang a sign around your neck that you are not contagious isn't enough. If you are coughing and you get on an elevator it is only courteous to wear a mask. Coughing into your sleeve just doesn't do it for me.

Posted by: henjobo | November 24, 2009 4:19 PM | Report abuse

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