H1N1 Flu

Parents’ Top Five Questions Answered

by Kathy Sena

You can hear the concern in parents’ voices as they drop off their kids at school, dance class, daycare… “Should I have my daughter get the flu vaccine?” “What is the school doing to help prevent an outbreak?” “What if my baby gets the flu?”

Whether you call it swine flu or H1N1 flu, this virus has become a (very) well-publicized public-health concern. Watch the news and you’ll hear frightening predictions galore. It’s enough to make even the calmest parent a bit uneasy.

So we asked parents what questions concern them most. Then we sought the best advice from the American Academy of Pediatrics (AAP), the U.S. Centers for Disease Control and Prevention (CDC) the U.S. Department of Health and Human Services (HHS) and the World Health Organization (WHO).

What’s the big deal with H1N1?

How is it different from seasonal flu?

Seasonal flu occurs yearly. The viruses change somewhat each year, but many people have some immunity to seasonal flu viruses. Flu vaccine also helps reduce the number of cases. But H1N1 is a new virus and one to which most people have little or no immunity. This virus could cause more infections than are seen with seasonal flu.

The H1N1 flu appears to be as contagious as seasonal flu, and it can spread quickly. The severity ranges from very mild symptoms to severe illnesses that can result in death. Most people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. More than half of all people hospitalized with the flu have underlying health conditions or weak immune systems.

Children under age 2 have a higher risk of complications and hospitalization due to influenza than do older children. Kids of any age who have an underlying medical condition, such as asthma, diabetes, another metabolic disease, chronic kidney disease or sickle-cell disease are at greater risk of complications.

People age 60 and older seem to have stronger immunity to the H1N1 virus than do younger people. Researchers suspect that older people have been exposed to past flu strains in which viruses were more similar to the present H1N1 flu strain, compared with the newer seasonal flu strains that younger people have been exposed to. However, health officials aren’t sure about the exact amount of protection afforded older people.

When will an H1N1 vaccine be ready?

The U.S. Food and Drug Administration (FDA) has

approved the H1N1 flu vaccine and expects it to be ready for distribution beginning in October. Clinical data has shown that the vaccine produces a good immune response within 8 to 10 days.

The most common side effect of the H1N1 shot is soreness at the injection site. Other side effects may include mild fever, body aches and fatigue. Anyone who has severe or life-threatening allergies to chicken eggs should not be vaccinated, according to the FDA.

Who should get the H1N1 vaccine?

The CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended the H1N1 vaccination for five key groups:

° Pregnant women

° People who live with or care for children younger

than 6 months

° Healthcare and emergency-medical-services personnel

° Persons between the ages of 6 months and 24 years

° People ages 25 through 64 who are at higher risk

because of chronic health disorders or

compromised immune systems

These groups total some 159 million people in the U.S. The committee doesn’t expect there to be a shortage of H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this case, the committee recommended that the following groups receive the vaccine before others:

° Pregnant women

° People who live with or care for children younger

than 6 months

° Healthcare and emergency-medical-services personnel with direct patient contact

° Children ages 6 months through 4 years

° Children ages 5 through 18 years who have chronic medical conditions

The committee further recommends that once the demand for vaccine for these prioritized groups has been met at the local level, providers should begin vaccinating everyone ages 25 through 64. As demand for vaccine among younger age groups is met, providers should offer vaccination to people over age 65.

The H1N1 vaccine is not intended to replace the seasonal flu vaccine. Seasonal flu and H1N1 vaccines may be administered on the same day.

What should I do if my child has flu symptoms?

Seasonal flu and H1N1 have similar symptoms: Sudden onset of high fever, chills and respiratory symptoms. The child usually develops mild nasal congestion and a cough. Older children and adults also may complain of headache, scratchy or sore throat and muscle aches.

Influenza is very different from the common cold. Typically, a child who has fever and either no nasal symptoms or mild nasal symptoms likely has influenza. A child who has no fever, but significant nasal symptoms, likely has a cold.

If your child has a mild illness, he should stay home from school or child care. Any child younger than 3 months who has a fever should see a doctor. In a child older than 3 months, how high the fever is not as important as how he feels and acts. Signs that warrant a visit to the pediatrician:

° Lethargy

° Vomiting

° Trouble breathing or fast breathing

° Not drinking well

° Not urinating as much as usual

° Bluish or gray skin color

° Being irritable even after the fever goes down

° Not waking up normally or interacting normally;

inattention to the environment

° Rash

° The fever goes down and flu symptoms

get better, but then get worse again

a day or two later

If your child has severe symptoms, has been to an area where there have been cases of H1N1 or has been directly exposed to a flu patient, call your doctor for advice. Any child with a chronic medical condition who has even mild flu symptoms should see a doctor.

Children with influenza should not take any product that contains aspirin. Tylenol (acetaminophen) Advil and Motrin (ibuprofen) are fine to treat fever and body aches in children. Cough and cold medications do not help, and should not be used, especially in children under age 4.

Antiviral medications such as Tamiflu and Relenza, which are in adequate supply, work against the H1N1 virus. It is expected that Tamiflu will be more effective if taken soon after the onset of symptoms, rather than later in the course of the illness. Based on a recent study, Tamiflu may have more side effects in children than in adults. Your pediatrician can help you decide if this medication is right for your child. Relenza is not for young children.

Based on current recommendations, your doctor also may prescribe Tamiflu or Relenza for family members who have been in close contact with a child diagnosed with H1N1 flu.

Treatment may not be needed for everyone, even those proven to have H1N1 infection. Your doctor will decide when treatment is indicated and which drug is best.

If your child is ill, try to protect yourself and other family members from the virus. When holding a small child who is sick, place the child’s chin on your shoulder so that he or she will not cough in your face. Clean household surfaces and toys with a household disinfectant. Wash linens in hot water. Avoid “hugging” the dirty laundry on the way to the washing machine, and wash your hands right after handling dirty laundry.

How can I protect my family from catching the flu?

People infected with seasonal and H1N1 flu shed virus and may be able to infect others beginning one day before getting visibly sick and continuing up to five to seven days afterward.

° Plan now what you would do if your child’s school or childcare center was to be closed. Consider how you will arrange for childcare at home.

° Stock up on healthcare supplies and non-perishable food at home.

° Keep your doctor’s contact information handy.

° Don’t take children out of childcare or school unless public-health authorities in your area have recommended such a step.

° If your school or childcare program closes and your children are healthy, you should still keep them home and should not allow them to participate in social activities. Working parents may team up with other parents to take turns staying home with children. Such groups should be kept to less than six children to minimize the risk of spreading germs.

° Advise children to go to the school nurse if they start to feel sick during school. Children and adults who are sick should stay home at least 24 hours after they are free from fever (100°F) or signs of fever without the use of fever-reducing medications.

° Cough or sneeze into your elbow. Or cover your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue immediately.

° Wash hands often with soap and water. Wash for 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice. Alcohol-based hand cleaners also work well. But keep in mind that these products are toxic if ingested by children. (The amount left on hands after use is not a concern.) Keep these products out of the reach of children and supervise their use.

° Avoid touching your eyes, nose or mouth.

° Stay at least six feet away from people who are sick. Avoid crowds.

° If you are caring for a child or other person who has H1N1 flu, a face mask can be used to help reduce

the chance of spreading germs.

Finally, stay informed, our experts advise. But don’t let the media coverage of H1N1 flu cause you — or your kids – sleepless nights. Following these common-sense precautions, and knowing when to see a doctor, will go a long way toward keeping your family safe this flu season. For more information, visit these websites:

U.S. Centers for Disease Control and Prevention: www.cdc.gov/flu

American Academy of Pediatrics: www.aap.org


Kathy Sena is a freelance journalist who frequently covers health issues. Visit her parenting blog, Parent Talk Today, at www.parenttalktoday.com.

Sources: U.S. Centers for Disease Control and Prevention; The Lancet; U.S. Department of Health and Human Services

pregnancy and H1N1

Pregnant women infected with H1N1 flu have a higher rate of hospitalization, and a greater risk of death, than the general population has due to the flu, according to a study in the British medical journal Lancet.

“If a pregnant woman feels like she may have influenza, she needs to call her healthcare provider right away,” says the study’s lead author, Denise Jamieson, M.D., of the U.S. Centers for Disease Control and Prevention.

Six deaths of pregnant women with H1N1 were reported to the CDC between April 15 and June 16, 2009, representing 13 percent of the 45 deaths reported to the CDC during that time period. All were healthy prior to infection with H1N1 and all subsequently developed primary viral pneumonia leading to acute respiratory distress requiring mechanical ventilation. None of the pregnant women who died received antivirals soon enough to benefit from their treatment, the researchers say.

Despite recommendations from the American College of Obstetricians and Gynecologists that all pregnant women receive the inactivated seasonal flu vaccine, the percentage of pregnant women in the U.S. who get the seasonal flu vaccine each year has been very low — less than 14 percent. Health officials are hoping that pregnant women will roll up their sleeves for both seasonal and H1N1 vaccines this year.

breastfeeding and H1N1

Mothers with flu symptoms can express breast milk for bottle feedings, which can be given to the baby by someone who is not sick. (It’s safe for women to take antiviral medication to treat or prevent H1N1 flu while breastfeeding.)

Women who are breastfeeding and are well, but who are taking antiviral medications to prevent the flu because they have been exposed to the virus, should continue to breastfeed as long as they do not have symptoms of the flu such as fever, cough or sore throat.

Don’t stop breastfeeding if your baby becomes sick with H1N1 flu. Give your baby additional opportunities to nurse throughout the course of the illness. Babies who are sick need more fluids than when they are well. The fluid babies get from breast milk is better than water, juice or Pedialyte because it also helps protect the baby’s immune system.

If your baby is too sick to breastfeed, he or she can drink expressed breast milk from a cup, bottle, syringe or eye-dropper.

If you, your infant or someone else in your family becomes ill with flu symptoms, contact your doctor for further instructions.