Video scripts: H1N1, children focus of FAQs

Vaccine questions
Risks and symptoms questions
Treatment and protection questions
Miscellaneous questions

Vaccine questions

Would you recommend that children get the H1N1 vaccine?

Absolutely, I would recommend that they get either the inactivated H1N1 injection or the live attenuated H1N1 nasal spray according to their health status.

Will my child feel bad after getting vaccinated?

The H1N1 vaccine reactions are similar to what we see with seasonal influenza vaccine reaction. So, in general if you get a shot, an intramuscular injection, that reaction will be mild within the first 24 to 48 hours, and use of fever-reducing medications can help alleviate some of the mild discomfort. For children who receive the live H1N1 vaccine (nasal spray), it's very comparable to what we see with the live seasonal influenza vaccine, and that is that some children will get some mild nasal congestion for a short time period or a mild sore throat.

How far between can children get the seasonal and H1N1 injections?

Keep in mind that there are two types of vaccines, both for seasonal influenza and for the novel H1N1 pandemic virus. That is the inactivated (injection) and the live (nasal spray). For the inactivated vaccines (injections), they can be given at the same time at different sites. For the live attenuated seasonal and H1N1 influenza vaccines (nasal sprays), we do not have data at this time to support both being administered at the same time. And so for now, they should be administered about four weeks apart. For children receiving the inactivated seasonal influenza vaccine (injection), they should be able to receive the live H1N1 pandemic vaccine (nasal spray) at the same time and not have to worry about interference.

My pediatrician's office does not have the vaccine yet. Do I have any alternatives in getting it?

Yes, you do have alternatives. You'll have to do a little bit of leg work. For the city clinics as well as the county health clinics, I would advise calling ahead to see whether they have the vaccine available at that time.

I'm hearing that my pediatrician's office may not have enough doses to vaccinate my children. Are there any other ways to prevent the infection?

Vaccines are the very best way to prevent infection, number one. An alternative if you're not able to get the vaccine is, once there's mild symptoms, consider antiviral therapy in order to basically treat the disease early and still get some of benefits in terms of development of an immune response.

Risks and symptoms questions

What are examples of underlying conditions?

Underlying conditions are things that we state that really increase the risk for more severe disease. For instance, children or adults with asthma, they tend to handle less well viral infections. Individuals with underlying heart disease, individuals with diabetes, individuals who have neurologic conditions. So when they develop influenza infection, not all but many of them can develop a disease that is more severe more often than those who are healthy.

What does it mean to be at risk? Does this mean at risk of getting the flu or at risk of having complications from the flu?

Both can occur. For instance, children tend to be at greater risk of developing infection compared to older adults or the elderly adults. However, some individuals who have at-risk medical conditions, they're at greater risk from complications from flu. So it really depends on the population that we're talking about. Likewise, infants are at greater risk for complications from flu and compared to older adults would also have greater risk for infection. So each age group is a little bit different and underlying conditions raise different issues.

Are all children considered to be in a high risk group?

We know that children 2 and younger with seasonal influenza have higher risk for hospitalization. We also know that children under 5 for seasonal influenza have a higher risk of seeing their doctor, going to the emergency room or even ending up in the hospital.

For pandemic H1N1 influenza, we're seeing that older children as well have higher risk for hospitalization compared to let's say elderly adults. And so there's going to be some differences in patterns of disease presentation with regards to seasonal versus pandemic H1N1 influenza.

A child in my children's class has come down with the H1N1 flu, what is my child's risk?

Right now, there's a pandemic of H1N1 that is not unique to a school, that's not unique to a class so everywhere we go, we're going to be exposed to individuals who may be infected. And so your child will be at risk multiple times throughout the day, including at school. Being in close contact with somebody who is infected with swine flu will also increase the risk of getting infected in that environment, and that happens very well in school settings. So it's not only for pandemic H1N1 flu, it happens for seasonal flu and other viral pathogens.

What else besides regular flu symptoms are you seeing in children with H1N1? Such as vomiting and diarrhea?

The most common complaints or symptoms that we see with pandemic H1N1 influenza as well as with seasonal influenza will be the following: fever, cough, runny nose, you can get body aches, feverish feelings, just run down, and if you're a young child, irritability. Now what is somewhat more unique to pandemic H1N1 influenza compared to seasonal influenza is that a large proportion of individuals are also getting gastrointestinal complaints such as nausea, vomiting and diarrhea. We see that with seasonal influenza, but not to the same extent as we're seeing it with pandemic H1N1 flu. Those are the common complaints, you can also get uncommon things such as pneumonia, and in young infants you can get febrile seizures.

Treatment and protection questions

Is it a good idea to give my child aspirin to reduce fever?

Absolutely not. Children should not be treated with aspirin. Aspirin and flu make a bad combination. We don't see it nowadays because for many years we have educated the public of Reye's syndrome. Reye's syndrome is really a deadly syndrome in which up to 30 percent of children who develop it can die. And one of the risk factors is the use of aspirin during treatment for flu. And so absolutely not, individuals should not be treated with aspirin or aspirin-containing products to reduce fever.

If a child has a high fever, what is the best way to bring the fever down?

Keep in mind that if you're uncomfortable and the child has high fever, that you always need to seek the advice of the child's doctor. But, there are medications such as Tylenol that can be used very safely to reduce the temperature of that individual.

If my 8-month-old twins get H1N1, can they get Tamiflu or is there something else that will be given to them?

For 8-month-old children the only antiviral medication that is available is Tamiflu. And Tamiflu is approved for children 1 year of age and older, but under the Emergency Use Authorization, it is also approved now for children 3 months of age and older, so they would fit under that criteria.

I think my child might have the H1N1 flu. Can I ask my doctor to put them on antivirals?

Absolutely, having good communication with your doctor is always very important. And we know that right now there's a pandemic out there, so if your child has fever, and has cough or runny nose, sore throat or irritability, one should talk to their doctor and discuss with him the benefits or you could say the risk of using antivirals. For me, there's more benefits than risk for most people.

When should I take my child to the emergency room?

That really is a very personal question, or very personal issue. What I mean by that is that every mother has or every father has a different threshold of comfort. And there are children who are healthy and there are children who have at risk conditions. And so if you have a child who has, let's say fever and is irritable and you feel uncomfortable, by all means call your doctor and discuss what you should do next. If you have a child who has asthma and develops a flu-like illness with fever and respiratory manifestation, and is starting to have shortness of breath, then likely he has an asthma exacerbation and may need to be seen in the emergency room, or they may be able to provide medication through discussion with the doctor. And so I would say that for individuals, it is always good to have a good discussion and do not feel afraid to contact your physician for advice. And if you don't have a physician, then obviously the emergency room is there for children who are sick, but it also tells you the importance of a medical home, so that you can seek advice and have appropriate recommendations on what one ought to do.

Miscellaneous questions

How long after a fever is a child still contagious?

We don't have absolute data, but we do know that in a child who truly has the H1N1 infection, that individual is still infectious after resolution of fever. For how long that individual will remain infectious, that's a different issue that we don't know. Most fevers in children will resolve in about four days, sometimes shorter, sometimes longer. If we look at shedding pattern for seasonal influenza, it is not unusual for young children to have virus in their nasal passages for up to two weeks. For the novel H1N1 pandemic virus, we don't have precise data, but it would not surprise me that some individuals will still be infectious at seven days, at 10 days, at 14 days.

What is the rule of thumb when it comes to when a child should stay home from school?

The current recommendations are that children can return to school within 24 hours of resolution of their fever. We cannot tell you for any given child how long that child will remain infectious. And when you're in the midst of an outbreak, we know that there are going to be multiple contacts, not only from that child, but from other children either within the school setting or within the community setting that will cause or will serve as a potential source for transmission. So it's always a balance, a balance of how much social disruption am I willing to take in a family, and how much social disruption am I willing to take in a school setting. And for right now the current recommendations are to go back to school within 24 hours of resolution of fever.

What kinds of activities can my child undertake when he/she is recovering from the flu?

The child will tell you. For the most part, it takes about two or three weeks for a child to fully recover. During the first two weeks, the child's energy level is going to be somewhat down. They can go to school, they can do their school class activity and all, but they may not have the same energy level and may not be able to do things as well and that is part of having a respiratory illness. The normal duration of a respiratory illness is anywhere from 10 to 14 days. So it really lasts longer than what people think, although the febrile period may on average about four days.

How is the virus most easily transmitted among kids?

We don't have perfect data there, but if we use seasonal influenza as a model to the current pandemic H1N1 influenza, we would expect that both large droplet and small droplet transmission to occur. What large droplets transmissions indicate is that when you sneeze, those large droplets are going to fall in a space of about three to six feet, and when they fall on hard surfaces, those surfaces will be contaminated with the virus for an extended period of time. If you touch those contaminated surfaces with your hands and touch your eyes, or your nose, or your mouth, you have a good likelihood of transmitting the virus to yourself. Likewise if you're in that environment of about three to six feet when that individual coughs and that individual does not use good hygiene etiquette, then you have a good chance of coming down in contact with the infectious particles. Now, we also know that for influenza, it can be transmitted efficiently by small particle, and that means that the cough can go not only three to six feet, but it can project the small particles for many feet. And so small particles remain in the air, and if the virus is alive, and frequently it will be, then as you breathe, those infectious particles will go into your lungs and be transmitted that way

My child has asthma, what extra precautions should I take?

The best precaution is prevention, and that's to have your child vaccinated against both seasonal influenza and pandemic H1N1 influenza. Another precaution is to ensure that if he's on a prescribed medication for asthma treatment that he remains on that prescribed medication, so that his asthma is well controlled. And then the third is to ensure that if he starts getting sick and you think that it's with the pandemic H1N1 influenza virus, or with seasonal influenza virus, that there are effective antivirals for treatment.

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