Swine flu vaccines are rolling out this month—finally. Health-care workers in Indiana and Tennessee were the first to get the nose-spray version, while New Yorkers clamoring for the H1N1 vaccine finally had their chance too.

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.

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.

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.”

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.

MONDAY, Oct. 12, 2009 (Health.com) — An analysis of the sickest swine flu patients in Australia, Canada, Mexico, and New Zealand suggests that relatively healthy adolescents and young adults are among the most likely to get very sick after an H1N1 infection, a pattern similar to that seen in the 1918 influenza pandemic.

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.

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.