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How are you approaching the swine flu epidemic?

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All around the health care web, it's swine flu, swine flu, swine flu.
(Visit HemOncToday.com's sister site, InfectiousDiseaseNews.com, for daily news and breaking updates on the swine flu.)

I have had a few patients call or e-mail me about the risk for this disease, but largely the response from patients has been pretty restrained (here's one breast cancer patient's question about her risk for swine flu while on chemotherapy. My compliments to the website for very calm, reasoned responses). The media, though, has gone bonkers over this (and, uh, the vice president, too). I understand it has the potential to be bad, really bad, devastating. But it hasn't yet (this article is a nice reality check on your real risk so far).

I think all the coverage may lead to increased personal sense of risk and stockpiling of antibiotics (and then potentially inappropriate use of these antibiotics and then resistance). The plus side may be that all this coverage may also lead to more hand washing or more people not coming to work sick and infecting coworkers, which would be a good thing.

I haven't seen anything that specifically speaks to cancer patients' risk of H1N1 influenza virus, though it would stand to reason that patients on chemotherapy or especially those with a status of post-bone marrow transplant would be at a higher risk of getting the flu if they were exposed. Certainly if they had a known H1N1 positive exposure, I would give the recommended 10 days of chemoprophylaxis, but I have not taken to routinely giving all my chemo patients prophylaxis regardless of exposure, however.

Of course, if a chemotherapy patient displayed symptoms of possible H1N1 infection, I would also empirically treat them, especially if their counts were low. Additionally, I have had some patients choose not to travel to Mexico given the CDC's recommendation not to, which seems reasonable. How are you approaching this swine flu epidemic? Are your cancer patients and their families asking about it?