Update on H1N1 and vaccines as of 11/3/09
There is no denying the H1N1 epidemic is here. Unfortunately with it, has come a lot of misinformation and the sense of panic. This update is a supplement to the previous letter, so please also read the initial H1N1 letter. We also encourage you to click on the CDC and AAP links provided in that initial letter.
Some of the specific issues that have come up are:
1. What do I do if my child has been exposed to H1N1?
Exposure is going to be unavoidable. There are many cases in the schools as well as in the general public. Unless your child is in a very high risk category, prophylaxis is not indicated. Try to keep your child's immune system strong by ensuring they are getting enough rest and proper nutrition. Encourage your child to be good about hand washing and not sharing utensils or cups with friends.
2. What are the symptoms of the H1N1?
The most common symptom being described is a sudden onset of high fever accompanied by headache, body aches, sore throat and congestion. If your child has a very low grade temperature and is otherwise playful and active it is unlikely to be the flu. Even if your child has the typical symptoms of the flu do not panic. Most healthy individuals will be able to fight it without any complications.
3. When do I worry?
The main complications of the flu are respiratory infections and dehydration. If your child who has the typical flu symptoms starts having labored breathing, very rapid breathing, wheezing or chest pain, call us immediately. Also if your child is not drinking well and is becoming lethargic, call us right away. If the fever is lasting more than 5 days and is still very high, call us. We will recommend seeing the patient in the office after 1-2 days of fever, mostly to rule out any other issues. We will also want to see them back if the fever is still very high after 4-5 days.
4. Is there a test to detect H1N1?
There is no good outpatient test to detect H1N1. There is a rapid influenza test that is done with a nasal swab. However, it does miss approximately 40% of the flu cases and it will not tell you if it is seasonal flu vs H1N1. The CDC is recommending using the history and clinical presentation in order to make the diagnosis. We will be using the rapid flu test in the office in the very near future for clinically indicated cases. There is a more specific test to isolate for H1N1, but it is only performed on patients that are admitted to the hospital with suspected flu.
5. Do you treat H1N1?
The H1N1 virus is found to be sensitive to tamiflu. Tamiflu is an antiviral medication. The CDC and the AAP (American Academy of Pediatrics) recommend only treating the patients that are high risk. These patients are:
- Patients under 4 years of age
- Patients over 4 years old with chronic medical conditions such as asthma, diabetes or heart problems
- Patients on chronic aspirin therapy
- Pregnant women
- Household contacts of high risk patients
The fear of over treating with tamiflu is the development of resistance. That means that in a few months the virus may not even respond to the medication and then there will be no treatment at all.
6. What about the H1N1 shot?
We are definitely recommending the H1N1 vaccine for all pediatric patients. Unfortunately the supply of this vaccine has been an issue. Our office has not yet received the vaccine for H1N1. We have been in contact with the Department of Health and we will be posting further information when it is available. At this point we have started a waiting list for the vaccine, but we are only putting names on the list of patients that are high risk.
The patients that are high risk are:
- Patients 6 months to 4 years of age
- Patients over 4 years old with chronic medical conditions
- Patients on aspirin therapy
- Patients that are pregnant
- Household contacts of somebody that is high risk
There are 2 kinds of vaccines for H1N1. The inactive form (shot) and the live virus (nasal spray). We will probably be getting both kinds from the State.
The live H1N1 flu vaccine (nasal spray) is contraindicated for those with asthma, those under 2 years of age and those with severe egg allergy. Patients with severe allergy to eggs should not get any form of the flu shot.
Seasonal flu shot and H1N1 shots can be given at the same time. They do not have to be separated by a specific amount of time. They can be given with the rest of the childhood immunizations on the same day
The only exception is with the MMR and varicella. Those shots can be given on the same day with the flu shots. However, if they are not given on the same day, then they have to be separated by 4 weeks.
If your child has been on steroids recently for asthma or any other condition, he or she should wait to receive the flu shot for at least 2-3 weeks.
Seasonal flu shot update
At this point we have a very limited supply of the seasonal flu shot. We still have doses for the children younger than 3 years. If your child is under 3 years old and has not yet received the shot please call to make an appointment.
We are currently out of the flu vaccine for the children over 3 years of age. We have a waiting list for the older children but we will be giving it first to the children that are high risk. You may place your child on the waiting list at any time. We will be posting an update when we get more vaccines in the office.
H1N1 Update
Dr George Skarpathiotis and his partners are deeply committed to your child's health and well being. We have been following closely the emerging and rapidly changing outbreak of the H1N1 virus. In this letter we will address some of the common questions that have come up regarding the virus. We strongly urge you though to visit the AAP (American Academy of Pediatrics) and CDC (Centers of Disease Control) websites through the links provided at the end of this letter. In these websites you will find helpful articles regarding the transmission, etiology, scope and prevention strategies for the H1N1 influenza virus.
What are the signs and symptoms of this virus in people?
The symptoms of this virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Fevers typically are in the high range, and occasionally patients will present with vomiting and diarrhea. If your child's symptoms are very mild and there is no significant fever it most likely is a viral upper respiratory infection and it is ok to treat at home.
Call us or bring your child in right away if your child displays any of the above symptoms:
- Fast breathing or trouble breathing
- Bluish or grayish skin color
- Not drinking enough fluids
- Severe or persistent vomiting
- Lethargy
- Being so irritable that your child does not even want to be held
- Flu like symptoms and fevers initially subside, but then fever comes back with worsening cough
- Has other health conditions such as diabetes, heart problems or asthma and develops flu like illness with high fever
Who is at higher risk?
Most children affected with the H1N1 virus will have a mild case and will have no complications. However, if your child is under 5years of age, or has an underlying medical condition it is considered to be in a higher risk group and will need closer monitoring. Some of the medical conditions we are concerned about are asthma, diabetes, kidney problems, cystic firbosis, chronic aspirin therapy or immune compromised states.
Can the flu be treated?
Data suggests that the H1N1 flu virus is sensitive to medications such as Tamiflu and Relenza. The CDC though recommends that these medications are used only in the patients with the more severe disease that requires hospitalization or in the individuals that are in the high risk category. Antiviral medicine is not recommended for all patients with the flu, nor is it recommended to give it as prophylaxis. Not all cases have to be confirmed with lab testing in order to treat. Many times we will recommend treatment on the basis of the clinical presentation.
How can I protect myself and my children from getting sick?
There are some simple everyday actions that can help protect the spread of the viruses that cause the flu:
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw away the tissue right after you use it
- Wash your hands often with soap and water, especially after coughing or sneezing. Alcohol based hand cleansers are also effective
- Avoid touching your eyes, nose or mouth.
- Keep surfaces like bedside tables, surfaces in the bathroom, kitchen counters and toys for kids clean by wiping them down with a household disinfectant
- Try to keep your child away from other household contacts that are sick.
Is there a vaccine for the H1N1 flu?
A vaccine for the H1N1 has been developed and is now undergoing the last clinical trials for safety and effectiveness. The CDC expects to be able to release the vaccine by the end of October. We have registered for the vaccine but we have no further control as far as the quantity and the timing of the vaccine that will be available to us. There may be additional sites where the vaccine will be available such as schools and health departments. We will post more information on the vaccine as soon as it becomes available. Because it is expected that the vaccine will be available in the beginning in limited doses, we will immunize the high risk population first such as children under 5 years of age and children over 5 years old with chronic medical conditions.
Again we urge you to visit the sites in the bottom of this letter in order to get more information on the H1N1 virus. We will do our best to accommodate all your needs this upcoming winter and to anticipate any new challenges that may come this flu season. We want to stress that it is important not to panic and to communicate with us and our staff about any concerns you have regarding this issue. We will post an update once the vaccine is in the office. We want to remind you that the seasonal flu vaccine is in the office and that we have started vaccinating all the children at risk.