FREQUENTLY ASKED QUESTIONS ABOUT H1N1

H1N1 influenza

Currently, in our practice, we have seen several hundred cases of H1N1 influenza since the summer. Most of the cases were mild to moderate with many children and teens having to stay home from camp/ school/ activities for a week or so. We have put together some answers to common questions regarding the H1N1 infuenza for the benefit of our patients and their parents. The source of most of the information on our website is from the CDC. We will be updating the information on this website as it becomes available. We are confident that we, as a community, can handle the upcoming flu season calmly and effectively by being informed, conscientious about hygiene, and proactive about immunization. During this time, Valley Pediatrics will continue to provide information, support, vaccination, diagnosis and when necessary, medication to help prevent and treat the 2009 H1N1 influenza.

What is the 2009 H1N1 (swine flu)?
2009 H1N1 (referred to as "swine flu" early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. It has been found to be quite contagious.

What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever (>100.4), cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting.

This is in contrast to the common cold, which may present with a low grade fever (<100) and significant nasal symptoms (runny nose, sneezing, congestion) rather then body aches and chills.

How do we know if we have the H1N1 flu?
If you are concerned that your child might have the flu, call and make an appointment to be seen. Currently, we have the rapid flu test which can tell us which type of influenza the child has (either A or B). Since we haven't seen any occurrences of the seasonal flu, we are assuming that all positive A's are the H1N1 for now. Once we start seeing influenza B, we will not be sure which type of influenza A is circulating (seasonal vs. H1N1).

What should parents do if their child has flu-like symptoms? / When to make an appointment?

• If your child has mild illness (low grade temperatures, little cough, runny nose), he or she should stay home from school or child care.
• For any child who has a fever (100.4 F) and cough and/or other symptoms, make an appointment to see us.
• Any child with a chronic medical condition (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurologic disorder), who has even mild flu symptoms should see us.
• Signs that warrant an emergent visit to the office include lethargy, irritability, fast breathing, vomiting and inattention to the environment.
• If your child is uncomfortable because of fever, you can give them medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Do not give aspirin-containing products.
• If they are not eating well, encourage them to drink liquids.
• Call us for advice if you continue to have further concerns or make an appointment to have your child seen. Also, we have Walk-in-Hours from 8am - 9am Monday - Friday.

Who should be treated with antivirals?
Treatment with oseltamivir or zanamivir is generally recommended for persons with suspected or confirmed influenza who are at higher risk for complications:

• Children younger than 2 years old - the risk for severe complications from seasonal influenza is highest among children younger than 2 years old.
• Adults 65 years of age or older
• Pregnant women
  
  Who should receive the 2009 H1N1 influenza vaccine?
• Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
• Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants younger than 6 months old might help protect infants by "cocooning" them from the virus;
• All people from 6 months through 24 years of age
• Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients.

When will the vaccine be available and how many doses are necessary?
The CDC states that the vaccine will be sent to health agencies, including various pediatrician offices, in late October. Please continue to check our website for updates.

Once the vaccine is available, children < 10 years of age will need 2 doses, 1 month apart while children 10 - 17 years old will need only one dose. This is because the first dose will "prime" the immune system to recognize the new virus while the second dose will activate production of antibodies to fight the H1N1 virus in the younger children.

In children, what are emergency warning signs that they need urgent medical attention?

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy. Currently, it is not yet clear if the severity of the H1N1 flu will change/ worsen during the winter season.

Among children, rates of influenza hospitalization from 2009 H1N1 have varied by age group with the highest rates of hospitalization in children younger than 2 years of age.

How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

What steps can I take to protect my health?

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Face masks are not necessary at this time
• Wash your hands often with soap and water (20 seconds with warm water - sing "Row, row, row your boat" twice). If soap and water are not available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, we recommend that you stay home for at least 24 hours after your fever (>100.4 C) is gone . (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

What advice do you have for parents with children in school or child care?

• Parents should not take children out of child care or school unless public health authorities have recommended such a step.
• We do not have to close schools and other gathering places to prevent infection except in those areas where the public health authorities have determined that school closings are necessary.
• If the virus is causing significant illness in a particular area, authorities may close child care programs and public events.
• If the school or child care program closes and your children are healthy, you should still keep them home and not 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 small numbers of children (<6) to minimize the risk of spreading germs.
• Parents should remind their children about proper hygiene, including sneezing and coughing into a tissue or sleeve, and frequent handwashing.
• Parents should advise children to go to the school nurse if they start to feel sick during school. Children who are sick should stay home at least 24 hours after their fever is gone.

How can parents avoid overreacting?

• Be aware of what's going on in your area and follow the recommendations of public health authorities.
• It is not necessary to withdraw your kids from school or child care, if there are no reported cases.
• Start preparing for what you would do if schools and child care centers do close.

For more information regarding the H1N1 influenza, check:
http://www.cdc.gov/h1n1flu
http://www.aap.org/advocacy/releases/swineflu.htm

For information for breastfeeding moms and the H1N1 influenza, check:
http://www.cdc.gov/h1n1flu/infantfeeding.htm

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