Dr. Richard Besser knows a thing or two about the flu pandemic. This pediatrician was the acting Director of the Centers for Disease Control and Prevention (CDC) earlier this year when H1N1 first emerged. Here, he answers your flu questions and explains why you and your children need to get the H1N1 vaccination.The H1N1 Flu Virus Q. How is H1N1 different from other strains of influenza? Is it worse?
A. This illness looks like any other flu. The flu itself isn't any worse. What makes this flu different is that this particular strain hasn't been seen before, so there is no natural immunity. Older people appear to have some protection probably from exposure to similar strains before 1957, but young people are pretty much unprotected. With H1N1, we're concerned for children.
Q. It's often reported that children are at greater risk, but what does that mean? Are they at greater risk for getting H1N1 compared to seasonal influenza, or does it mean there is a greater risk for death?
A. The answer to both questions is yes. With H1N1, there is a greater risk of becoming ill, and there is also a greater risk for death for children. Each year 36,000 people die from seasonal influenza and another 20,000 are hospitalized. About 90 percent of those affected in a typical year are our elderly. This year we've already seen more than 80 H1N1-related deaths in children. That's more childhood deaths than we see in a typical flu season, and it's only mid-October. There are some estimates that say we could see between 30,000 and 90,000 H1N1-related deaths. I believe those estimates are high, but the take-away is correct. We need to have a healthy respect for this flu.
Q. If I get H1N1, when am I contagious? How long should I stay away from people?
A. You are most contagious when you have a fever. The current recommendations are that you stay home until the fever is gone for 24 hours.
Q. If my child is diagnosed with H1N1, what should I be concerned about?
A. Every parent needs to know this: If the patient seems to be recovering and then gets a high fever, you need to go to the doctor as soon as possible. It could be a sign that a bacterial infection has started. Watch for other danger signs as well. These include difficulty breathing or a blue or gray color change around the mouth. Parents know their children. If they look really sick, contact your doctor.
Q. Could I get H1N1 twice in one season?
A. If you truly had H1N1, meaning you tested positive for it with a good test, then no. You should not get it twice. If you were diagnosed with influenza but were not tested or if you didn't see a doctor and think you had H1N1, then there?s the possibility that you didn't actually contract H1N1. Anyone who falls in those categories should still get the H1N1 vaccination to protect themselves.
Q. Are infants susceptible?
A. Infants are susceptible. However, the vaccine is not for infants younger than 6 months old. I recommend having everyone who is in contact with infants under 6 months old get the H1N1 vaccination. This includes parents, day-care providers, and any others who spend time with babies.
Q. What can parents do to protect their children from H1N1, especially those children who might have underlying medical conditions?
A. People who are sick end up with germs on their hands from touching their noses. When you touch infected hands or contaminated objects you can pick up those germs. Then when you touch your eyes, nose, or mouth, germs can set up shop. Wash your hands often with soap or a hand sanitizer if you don't have access to soap and water. The temperature of the water isn't as important as the amount of time you are washing with soap. The other thing you need to do is cover your cough or cough into the crook of your elbow. Finally, stay home if you are sick. If you are in the high-risk category, talk to your physician about a treatment plan. Your doctor might write you a prescription for Tamiflu that you can have on hand. (You would only fill it if needed.) Second, you could fill the prescription and have an antiviral in the house, depending on the patient's specific issues. There is a recommendation from the CDC to do this. This response is more for a parent that has H1N1 and/or is high risk, not for how to protect your children.
Q. Who is considered high risk?
A. People 24 years of age and younger, pregnant women, healthcare workers, and people who suffer from underlying medical conditions, such as heart disease, diabetes, asthma, or neurological disorders such as cerebral palsy, are all high risk.
Q. If I have been diagnosed with H1N1 and am high risk, what kinds of symptoms should I be concerned about?
A. Difficulty breathing, bluish coloring to the skin, dehydration. Also, take it very seriously if you seem to be getting better and then get worse. See your healthcare provider immediately.
Q. Tamiflu is the most talked about antiviral treatment. Is it safe?
A. The safety profile of this drug is very good. Relenza is also effective. The benefits of using antivirals when you are sick with the flu outweigh the risk of it for people who are at risk of severe illness. I wouldn't expect a miracle from Tamiflu, though. It shortens the illness by less than a day in adults and about 36 hours in children. As with all medications, ask your doctor or pharmacist about possible drug side effects.
Q. Are there any preventive treatments?
A. Not medical treatments, but we recommend taking care of yourself and maintaining a healthy lifestyle. That means getting good rest and eating a well-balanced diet.
Q. Many parents say they are using probiotics and other supplements to boost the health of their children. The hope is that these supplements will strengthen the immune system and make them more able to fight off illnesses such as H1N1. Where do you stand on that?
A. I haven't seen good data on any of these products preventing the flu. But if a parent feels that this is good for their child and there are no risks, then it comes down to the parent's comfort level. Discuss these approaches openly with your doctor.