Here, we answer some of her and her readers' most pressing questions:
Are babies and toddlers more or less susceptible to Swine Flu (H1N1)?
Babies and toddlers who are below school aged, are less likely to be exposed to social situations, which would then expose them to swine flu. However, if infants and toddlers do become infected with Influenza, they are more likely to have a more severe or prolonged illness which can be associated with more complications.
Are there special considerations for pregnant women?
Pregnant women are deemed to be in the high-risk group, if again, we take our experiences from past influenza pandemics. They should take precautions to reduce their risks of contracting swine flu. These actions include frequent hand washing, covering coughs, avoiding contact with ill people and reducing unnecessary social activities in crowded settings. If a pregnant woman has swine flu, she can be treated with antiviral therapy, though these drugs have not been formally tested for use in pregnancy. Past experiences with Tamiflu and Relenza have shown them to be safe and effective in pregnancy with no observed ill effects seen in their newborns.
When should you call your pediatrician?
If your child has a sudden onset of fever along with a sore throat, cough, headache or body aches, call your pediatrician. Reports seem to indicate that the swine flu presents with an acute onset of high fever, and a rapid progression of the other symptoms. If you bring your child within a day or two of fever onset, anti-viral therapy is more likely to be effective. Most health care providers are equipped to diagnose flu in their offices. If your doctor suspects your child has influenza, he/she may perform a wash of your child's nasal secretions and submit it to your local public health department for analysis by the CDC.
When should you NOT call your pediatrician?
If you basically feel like you have the common cold or stomach flu virus -- both are common at this time of year. Do not call your doctor to obtain anti-viral therapy "just in case". This important therapy is reserved for those truly in need. Do not call your doctor if your child has NO symptoms and you have NOT travelled to a high risk area or had contact with a person suspected of having H1N1 (swine) flu.
What are Tamiflu and Relenza?
Tamiflu (oseltamivir) and Relenza (Zanmivir) are both FDA approved anti-flu antivirals that have been used to treat Influenza in the past and are deemed to be effective against the current swine influenza A virus (H1N1). They work best if started within 48 hours from the onset of flu symptoms.
What's the difference between the two?
Tamiflu is approved for treatment in patients 1 year of age or older. It is available in liquid or pill form and should be taken twice a day for 5 days for active flu. During pandemic conditions, there are dosage recommendations extending down to 3 months of age.
Relenza is for treatment of patients who are 7 years or older. It is also for preventative treatment for patients 5 years or older. It is taken twice a day for 5 days and inhaled directly into the lungs.
Are Tamiful and Relenza "okay" for babies/toddlers? Nursing moms? Pregnant women?
FDA approval of these antivirals are as per the ages described above. However during epidemics, Tamiflu can be used for children down to 3 months of age under the Emergency Use Authorization clause (EUA). Nursing moms and pregnant women can be treated with both Tamiflu and Relenza.
Is there a shortage of either one?
The U.S. Government has a stockpile of these antivirals, but judicious use of these medications is recommended, and we don't want to risk developing viral resistance to the drugs. That means that these medications should not be used daily "just in case" for prevention. They are to be used only in the vent of H1N1 illness and for household contacts of flu victims.
What are the downsides of taking Tamiflu or Relenza as a preventative?
Taking either drug in a preventative regimen is indicated only under certain specific circumstances. Essentially, these medications are recommended for the very young, or very old or those with chronic underlying illnesses who have been exposed to suspected or confirmed swine flu. These include household contacts, school contact or travel contacts to high-risk areas.
Tamiflu has side effects that may include nausea, vomiting, abdominal pain, seizures or behavior changes.
Relenza may cause breathing problems, especially in patients with underlying lung disease or asthma. It may also cause seizures, confusion or abnormal behavior.
Are there any other preventative measures worth considering?
Definitely. Here are some practical tips (mentioned in our previous swine flu post, but worth reiterating):
- Avoid who are ill and thrive with those who are well
- STAY HOME IF SICK and don't return to work, school or daycare until well and fever free for at least 24 hours
- WASH HANDS WASH HANDS WASH HANDS when coming in from school, outside or work and before putting anything in your mouth
- If you are coughing, cough into your sleeve or tissue. Wash hands frequently throughout the day.
- Don't share food or drinks with others. Secretion exchange is a common route of infection.
- Don't ask for trouble by traveling to high risk areas
- Call your pediatrician if your child has true flu symptoms so that they can diagnose and treat early (within 24-36 hours of onset of fever). True flu symptoms include fever (usually over 101-103), chills, headache, sore throat, runny eyes and nose, cough and aches. Influenza A symptoms tend to hit a bit harder, so symptoms recognition is usually obvious
- When new strains of flu emerge, such as H1N1, it takes 4-6 months to develop an appropriate vaccine to cover that strain. Already efforts are in place to develop a vaccine against H1N1, in addition to other new strains of influenza that have attacked worldwide.
Should I keep my baby/toddler under any sort of quarantine if I live in a city where swine flu has been confirmed?
It's always easier to prevent illness than to diagnose and treat it, however, it is reasonable to move about your community and do the things you need to do if you have reasonable control over whom you come in contact with. For example, a day long jaunt to a large indoor play place may not be advised if you have H1N1 in your community. But a birthday party in your home attended by healthy, asymptomatic children is reasonable. This is the time when communities need to work together to preserve public health, so keep attuned to the advisories delivered by your local health departments.
While we would advise against unnecessary crowded or social contacts, obviously if you live in a densely populated urban area like New York City, staying locked in your home and not using public transportation is not always practical.
The most critical advice we can offer as pediatricians is that we all do our part to stay healthy and prevent unnecessary spread of germs. This means STAY HOME if you feel sick and wash your hands (and your children's' hands)...A LOT...especially after you come in from the outdoors or a social situation.
We must remember that the total number of cases of confirmed swine flu in the US really amounts to a relative handful (as of 5/6, 642 cases nationwide), and that with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in perspective that the case described in the US have been mild to moderate in severity (aside from the tragic exceptions in the case of 2 recent deaths in Texas), and that local communities affected are reacting appropriately and outcomes have been good so far.
Any thoughts or insight you can provide to help explain the 2 recent deaths (and help calm any panic)?
Very young children and the elderly are more at risk for dying to getting really sick from the flu. Approximately 36,000 Americans die every year form the influenza virus. Of this number, in 2007-2008, 83 were children. So deaths in this age group represent a minority, albeit a tragic one. While we would never ever want to minimize the grief that the families of these families are experiencing, 2 deaths from swine flu, relative to the total average number of deaths from flu every year, is not a cause for public panic.
Our recommendation is that we use this tragedy as an opportunity to reemphasize to parents the critical importance of vaccinating your kids from influenza every year* (hence this year's recommendation from the AAP that ALL children between the ages of 6mo and 18yrs be vaccinated with the flu vaccine!).
*Important note: this vaccine does not protect against this particular strain, however the medical community is working quickly on developing a specific swine flu vaccine.
Like we said, remember that flu from Influenza claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter -- and the great majority survive and thrive.
We said it in our last post (so forgive the redundancy) but we'll say it again: It is still too early to tell how severe this now prolonged flu season will be, but remember that summer is coming, and the flu virus tends to want with warm weather. Keeping this in mind, we anticipate a short outbreak, with the help of Mother Nature. Some of the hysteria thankfully seems to have waned a bit, but we still want to emphasize that we all use common sense, be sensible, stay calm, and WASH your hands!
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