by Stefanie Zucker and Dr Kim
Part I: On Tuesday October 6th, the very first doses of swine flu vaccine started to arrive in doctor’s offices around the United States. These doses however will arrive in extremely limited quantities and initially are targeted for those considered to be “in high risk”. Soon however, as supply becomes more readily available, there will be some very important decisions to be made by every individual – and more important to us here at Pediatric Safety – by every parent. Not surprising, there are some difficult questions that need to be answered for each parent to feel comfortable making these decisions. That’s what our goal is…over the course of this post and the one following. There’s an incredible amount of information out there about the swine flu…along with a lot of mixed messages. What we hope to do is pull together some of the best, most reliable information currently available from some of our best sources and provide you with some “real world” answers to some very important questions. AND THEN…we will let you make your own decision about what’s right for you and your child. So to start us off…a little background…
What exactly is the “swine flu” and how is it different from the regular or “seasonal” flu?
CDC: Swine flu is a new influenza virus causing illness in people. This new flu was first detected in people in the United States in April 2009. It was originally referred to as “swine flu” because laboratory testing showed that many of the genes were very similar to flu viruses that normally occur in pigs in North America (note: that theory didn’t actually pan out – but the name stuck).
Swine flu spreads the same way that seasonal flu spreads -mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
AAP: At this point the 2009 H1N1 virus does not appear to be any more severe than seasonal flu. However there are some small differences. Unlike seasonal flu, which tends to cause more significant illness in elderly people and very young children, H1N1 flu (swine flu) is most common in people 5 to 24 years old. Also, while seasonal flu usually peaks in January or February, the 2009 H1N1 virus has caused illness during the summer months and remains active as we head into the fall and early winter.
AAP: Children with influenza have a sudden onset of fever, chills, sore throat, cough, and runny nose. It may also cause headache, muscle aches, tiredness, nausea, vomiting and belly ache. The flu is different from the common cold, but it can be hard to tell which one your child has because typically a child with a cold can have a stuffy nose, sneezing, scratchy throat, hoarse voice, dry cough (usually from mucous dripping down the throat), and slight fever. One additional comment from the CDC: most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs, and the same is true of seasonal flu. Most people with flu symptoms do not need a test for 2009 H1N1 because the test results usually do not change how you are treated.
Are there actual tests for the flu and are they accurate?
CDC: A number of flu tests are available to detect influenza viruses. The most common are called “rapid influenza diagnostic tests” that can be used in outpatient settings and they provide results in 30 minutes or less. Unfortunately a rapid test’s ability to detect the 2009 H1N1 flu varies, therefore you could still have the flu, even though your test result is negative. Rapid tests do however appear to be better at detecting the flu in children than adults. There are other more sensitive flu tests that require specialized laboratories, but these tests are typically only recommended for cases with serious health risks. In most cases, if a healthcare provider suspects you have the flu – whether seasonal or swine flu – having test results that confirm it will not change how they will treat you.
What is the best way I can protect my child (and myself) from getting sick?
AAP: There are some everyday actions that you and your child can do to help prevent the spread of germs that cause respiratory illnesses like influenza. Most of these are common sense recommendations, but it doesn’t hurt to have a reminder…plus we threw in a little fun with kids in mind:
Cough or sneeze into your elbow or upper sleeve. If you use a tissue instead, cover your nose and mouth with it when you cough or sneeze. Throw the tissue in the trash right after you use it. (See who has the best aim – extra points for making sure it gets in the trash) - Wash hands often with soap and water, especially after you cough or sneeze. Wash hands for 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice. You can use alcohol-based hand cleaners but keep in mind that alcohol-based products are toxic if ingested by children. (Don’t worry about the small amount left on hands after use.)
- Avoid touching your eyes, nose or mouth. Germs spread this way. (Kind of like that old game of “operation” – see who avoid touching for the longest period of time)
- Make sure your kids know to go to the school nurse if they start to feel sick during school. Children who are sick should stay home until 24 hours after their temperature has fallen below at least 100.4°F without the use of fever-reducing medications. Note: Normal body temperature is different for each child. In general, 100.4°F (38°C) or higher is a sign of fever.
- On a serious note – make sure to seek medical care if you or your child is severely ill, such as having trouble breathing. Antiviral medicines may help.
- The H1N1 vaccine is currently in production, but supply will be limited for the next couple of weeks. The U.S. plans to have 195 million doses of vaccine, but it will be distributed in several batches on a weekly basis. Once it is available, this is a decision you as a parent will need to make for yourself and your child. More detail on vaccines in Part II of Swine Flu for Parents.
Finally, make a plan in case you or your child get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public. Also, keep your child’s pediatrician’s number handy, just in case.
What should I do if my child gets sick?
AAP: Any child younger than 3 months who has a fever (rectal temperature of 100.4°F or higher) should see a pediatrician.
In a child older than 3 months has mild illness, he should stay home from school or child care until he has been fever-free for 24 hours without the use of fever-reducing medications. Encourage them to drink liquids, especially if they are not eating well. Chicken soup can provide liquids and has been found to alleviate symptoms. If your child is otherwise healthy, call your pediatrician to see if an appointment is needed.
If your child has underlying health problems (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurological disorder not including ADHD or autism), see a pediatrician as soon as mild flu symptoms start.
If your child has severe symptoms, has been to an area where there have been cases of swine flu, or been directly exposed to a swine flu patient, call your doctor for advice. Your doctor can help you decide whether your child needs to be seen or if they may need to be treated with an antiviral medicine.
If on the other hand, your child experiences any of the following warning signs, seek urgent medical care.
- 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
Are any medicines recommended to help children with swine flu?
AAP: Children with influenza should never receive any product that contains aspirin. Acetaminophen (Tylenol) and ibuprofen (Advil and Motrin) are fine to treat fever and body aches in children. Cough and cold medications do not help, and should not be used, especially in young children under 4 years of age.
Most adolescents, adults and children do not need antiviral medicines. Overuse of these medications could be counter-productive and lead to resistance. Parents with children who are at high risk of complications from flu (such as those with chronic disease or cancer, or very young children) should talk with their doctor in advance about what to do if they notice flu-like symptoms.
It is expected that oseltamivir (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. Zanamivir (Relenza) is not for young children under 7 years of age.
Your pediatrician will decide when treatment is indicated and which drug is best to treat your child.
We hope our swine flu overview has been a help. And we promise to provide just as detailed a review of vaccines in Part II. We also know that no matter how good the information, sometimes you just need a few words of advice from someone that makes you feel confident…that’s your doctor, not a government doctor…and while we can’t ask each of your pediatricians to comment, we can leave you with some words from our own in-house pediatrician, Dr Kim…so for today, here are her thoughts on the upcoming flu season for children this year:
When we first discovered the new H1N1 flu virus, the world watched and worried to see how severe it would be, and there was a great deal of anxiety and even panic. We now know a great deal about this virus, and luckily, there is no reason to panic. We have seen many many cases in my own office, and throughout the US. And public health officials watched it evolve in the winter of the southern hemisphere.
The good news is that the new H1N1 illness is generally no more severe than the usual seasonal flu strains. There are several differences, however. Since none of us has any innate immunity to this strain, H1N1 has been incredibly contagious: in my practice when one family member gets sick, it usually wipes out the whole family for a few days.
Another difference is that we have seen more severe illness and even deaths in pregnant women, which is why the current recommendations for vaccination have pregnant women on the list of high-risk groups who should receive priority for the vaccine.
What does it feel like to get the swine flu? The symptoms are similar to the usual seasonal flu, except many patients with swine flu get not only rapid onset fever, cough, body aches and headaches, but also have the pleasure of some vomiting and diarrhea. Fun.
The illness can be mild but is usually miserable and can be severe, especially in younger children without a fully developed immune system or in those children with chronic illnesses like asthma or compromised immune systems. And it does cause deaths in children. We would like to prevent childhood deaths if at all possible.
I am strongly recommending both the regular seasonal flu vaccine and the H1N1 vaccine to my most vulnerable patients this winter: young children, those with chronic illnesses like asthma, pregnant women, and the parents and caregivers of babies younger than 6 months old who cannot yet be vaccinated. They will save lives and decrease pain and suffering this winter.
I am also recommending, as I always do, that families focus on their overall health, especially in the winter cold and flu season. That means getting enough rest (sleep-deprived bodies are much more vulnerable to illness), staying well hydrated, practicing extra-vigilant hand hygiene, and reducing stress and increasing joy (both of which have measurable impacts on the immune system)!
I hope that you all have a fun and safe fall and winter! -Dr Kim
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Relevant Links
- Influenza Diagnostic Testing During the 2009-2010 Flu Season by CDC.gov Sept 29, 2009 http://www.cdc.gov/h1n1flu/diagnostic_testing_public_qa.htm
- 2009 H1N1 Flu (Swine Flu) and You by CDC Sept 24, 2009 http://www.cdc.gov/h1n1flu/qa.htm
- Frequently Asked Questions About H1N1 Flu (Swine Flu) http://www.aap.org/advocacy/releases/may09swinefluqanda.htm
- Each week the CDC publishes an update on flu statistics including location of flu activitiy, type of flu, hospitalization and mortality stats. For those interested, the data can be found here: 2009 H1N1 Flu: Situation Update by CDC October 2, 2009 http://www.cdc.gov/h1n1flu/update.htm
- At Pediatric Safety, we have an active link to the latest flu news from flu.gov. Visit us here for updates or sign up for email updates http://www.pediatricsafety.net/awareness/
About the Author
Stefanie Zucker is President and co-founder of Pediatric Medical Devices and Managing Director and co-founder of Axios Partners, a consulting firm dedicated to developing highly focused, creative strategies for clients. After a number of years spent researching the child safety issues associated with transporting children on ambulances she became a child health safety advocate and formed Pediatric Safety with a goal of creating a world-wide movement of parents and caregivers inspired to protect the health and safety of kids. Stefanie is a member of the PedSafe Team
Dr Kim is a pediatrician in a busy outpatient practice in San Francisco. Dr. Kim was raised in western North Carolina but lost her southern accent intermittently during summers spent in Colorado and finally when she went to college at in New Jersey. At Princeton University she studied the history of religious thought and practice around the world. She attended medical school at the University of Pennsylvania to learn the practice of medicine in a busy urban teaching hospital. Along the way she lived in India for a year and worked at hospitals in Guatemala, Uganda, and on the Navajo reservation in New Mexico, where she learned to be grateful for the luxury that allows her patients to fret over the small things. She completed her pediatric residency at the University of California at San Francisco (UCSF). Dr. Kim would like to help parents build healthy families by arming them with knowledge and tools, as well as a bit of lightness and laughter. She believes that the joys of parenting should outweigh the worries. Dr. Kim blogs about child health, parenting, and doctoring children at: www.drkimmd.com
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