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Cold and Flu Guide

Cold and flu season is once again upon us. When kids get sick during this time of year, many how-to-prevent-the-flu-4parents aren’t sure how to tell the difference between a cold and the flu, and at what point they should take their child to the doctor. Cold and flu symptoms can be similar and confusing. The rapidly spreading 2009 H1N1 influenza virus is also a growing concern for parents. Using the guide below can help you determine whether your little one needs symptomatic treatment at home, or whether it is time to seek a doctor’s help.

Winter colds:

  • Cold symptoms may include: Stuffy nose, sneezing, cough/chest discomfort (mild to moderate; hacking cough), mild to moderate sore throat, mild aches and pains, mild fatigue.
  • Complications from a cold can include: Sinus infection and/or ear infection, lower respiratory infection such as bronchitis.
  • Prevention of a cold: Thorough hand-washing and avoiding contact with others who have colds as much as possible. Disinfect toys if a sick child has played with them. Disinfect household surfaces and doorknobs.
  • Treatment for a cold: Treat symptomatically with clear liquids, over-the-counter (OTC) medications, and get plenty of rest. For young children, ask your doctor’s advice before giving OTC medications. Never give more than one medication containing acetaminophen (Tylenol) See your doctor if symptoms worsen or if they are not getting better after a week.

Seasonal Flu and 2009 H1N1 Influenza

  • Flu symptoms may include: High fever (102 to 104), headache (may be severe), aches and pains (moderate to severe), extreme exhaustion (early on in the illness and prominent), fatigue and weakness (can last up to 2-3 weeks), cough/chest discomfort (can become severe). May have stuffy nose, sore throat, and/or sneezing.
  • Complications from the flu can include: Bronchitis and/or pneumonia, which may require hospitalization.
  • Prevention of the flu: Same as for colds. In addition, an annual flu shot or flu mist, upon your doctor’s recommendation. Anti-viral drugs may be prescribed if you have been exposed to the flu.
  • Treatment for the flu: If you suspect that you or a family member has the flu, contact your doctor right away. He or she can tell you whether an office visit is necessary, based on symptoms and previous health history. For any child who has an underlying health condition (especially asthma or other respiratory problem), an office visit is in order, as soon as possible, or go to the emergency room if it is after office hours. Influenza is a serious illness and requires monitoring for complications. If necessary, Amantadine or rimantadine (anti-viral drugs) should be started within the first 24-48 hours after onset of symptoms. Follow your doctor’s advice for treatment of symptoms.

If your child has any signs of respiratory distress (trouble breathing) such as:

  • Shortness of breath
  • Labored breathing (watch for retractions – chest muscles being sucked in when inhaling)
  • Paleness or grayish/blue tint in the skin, especially in the face and lips
  • Wheezing
  • Severe coughing

..call 911 or seek emergency medical help immediately.

These guidelines are of a general nature and not intended to replace the advice and supervision of your physician or pharmacist.

Copyright 2009 Tamara Walker, R.N. All Rights Reserved. May be used only with author’s permission.

November 2, 2009 | Filed Under Community | 2 Comments 

Swine Flu for Parents: Real World Answers Part II

Swine Flu for Parents

In our last post we walked you through what we hope was everything you needed to know about the virus in general:  how to recognize symptoms, avoid the virus and take care of your kids if they happened to catch it. Our goal today is to provide you with the same kind of detailed information…but on the vaccines. We’re not going to make choices or judge anyone’s decisions or tell anyone what they should believe or what actions they should take. But there is a lot of information out there, a lot of rumor and a lot of conjecture. There are polls saying that a large percent of parents are choosing not to vaccinate for the swine flu because of concerns about what is or isn’t in the vaccines…And there are numerous mixed message coming from the media. What we can do is help you sort through all the media coverage and pull together some of the best, most reliable information currently available to hopefully provide you with some much needed “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 as we did yesterday…let’s start off with a little background, but this time… about the H1N1 vaccine…

The H1N1 vaccine for kids…

Dr Ari Brown: The vaccine will be available as both a nasal spray and a shot. Currently the FDA has approved three flu shots from three manufacturers and one nasal spray from another manufacturer. Keep in mind that all of these protect against just H1N1. They will NOT protect against the other flu strains we typically see in the fall and winter season

All three vaccine shots are inactivated vaccines and like the seasonal flu vaccines are created with egg product, so people with egg allergies need to steer clear. Here are the key differences between the 2 brands that have been approved for young children:syringe w vaccines2

  • Novartis Brand: FDA approved for children four years of age and older. There are two forms of this shot: The single dose uses thimerosal in the manufacturing process but then it is extracted before the final production. The multidose vials use thimerosal as a preservative
  • Sanofi Brand: FDA approved for children six months of age and older. There are two forms of this shot—a single dose in a prefilled syringes and a multidose vial. Both products are thimerosal preservative free.

The nose spray is similar to the Flumist vaccine used for seasonal flu vaccine. It is also made with egg product and it does not have any preservative.

  • Medimmune makes the H1N1 nasal spray. It is FDA approved for healthy people two years old up to 49 years of age. Because it is a live vaccine, pregnant women, people with asthma, people with immune deficiencies, and those with underlying medical conditions should NOT get this vaccine.

If I choose to vaccinate, how many shots or doses does my child really need?

AAP: The seasonal flu vaccine is given separate from the H1N1 vaccine and is available now for all children ages 6 months through 18 years. If your child is less than 9 years old and this is his or her first time getting a flu vaccine, s/he will need two doses.

Parents and caretakers of infants under 6 months of age should also get the seasonal flu vaccine now to protect these children who are too young to be vaccinated.

Dr Brown: For H1N1 flu, kids under ten will need a series of two shots or doses, given approx. one month apart. Ten years of age and older will only need one shot or dose for protection. Infants under 6 months are too young to be vaccinated.

It is definitely a good idea to get both vaccinations, but keep in mind all live-attenuated flu vaccines (the nose sprays) must be given at least four weeks apart so you have an adequate immune response to the vaccinations. So, if your child gets Flumist over the next few weeks for seasonal flu, he has to wait a full four weeks to get the H1N1 nose spray. Consider that before getting Flumist right now.

There is not a special time interval to receive seasonal flu shot and H1N1 shot.

My kids are not great with shots – any suggestions?

Mattel Children’s Hospital UCLA: The good news is that there are several techniques that parents can use to positively impact their child’s experience when getting a needlestick – the key is to be creative and use the right combination of tactics depending on your child’s age, the particular procedure being done and the child’s fear level.child doesnt like shots3

Parents of young children can bring soap bubbles and ask them to blow bubbles during the injections, suggesting they are “blowing away the hurt.”With a crying infant, if the parent places the plastic bubble maker in front of their mouth, as they cry out, they will make bubbles. “I have seen babies stop crying mid-cry because they were distracted by the bubbles,” said Dr. Lonnie Zeltzer, director of the Pediatric Pain Program.

For older children and adolescents getting the shots, but parents can help the child to breathe out slowly to relieve the pain.

Parents can ask their kids to use their imagination and experience being somewhere else really fun during the injections, such as at the park or at the beach. Other distraction ideas include jokes, video games, stories and music.

Experts have also advised parents to ask doctor for a prescription for a numbing cream or patch and put on the areas to be injected. Or if the doctor approves, parents can give the child a dose of pain reliever, such as Tylenol, about one hour before the injection.

After returning home, put an ice bag on the injection site to reduce local swelling and pain.

Finally, do not lie to your child about getting an injection…No one likes to get poked with a needle, but if you reassure your child that there are ways to make the hurt go away, then you can help them achieve a successful, less painful experience

Am I better off with the H1N1 nose spray? What about antivirals and the nose spray?Nasal swine flu vaccine for 4 yo

Dr Brown: If someone is taking an antiviral (such as Tamiflu), he should not take the nasal vaccine until it has been at least 48 hours after completing the medication. And, if a person receives the nasal vaccine, he should not take an antiviral (such as Tamiflu) for two weeks after being vaccinated unless it’s medically necessary. That’s because the medication will reduce the ability for the vaccine to work.

What about vaccine safety concerns?

Folks, here I will depart from providing information – only because this topic could be a post unto itself. I will say that Dr Brown, The American Academy of Pediatrics, Public Health of Canada and Pediatric Safety’s own Dr Kim among others feel confident in their recommendations to immunize (please read Dr Kim’s comments at the end of this article). I will also say that other professionals – including some in the medical profession – feel differently.  What I can do is provide you with several links that should hopefully give you some useful reference points to consider… For my family, I feel safer with the H1N1 vaccination than taking a chance without one.

When will the vaccine be available?

Dr Brown: The seasonal flu vaccine (both shot and Flumist nose spray) is available now.

Wall St Journal: For the United States: The first available H1N1 vaccine will be the nasal spray for 2 years and older and started distribution as of US FlagTuesday; the first H1N1 vaccine shots for 6months and older, could start becoming available for high priority groups (pregnant women and anyone with an “at risk” medical condition) as early as later this week. 45 million doses are expected to be distributed across the US by mid-October. Approx. 250 million doses have been ordered which should cover any American who wants to be vaccinated

Public Health Agency of Canada: For Canada: The Canadian government intends to purchase 50.4Canada flag million doses of H1N1 vaccine on behalf of the provinces, territories and federal populations, which should meet the need of every citizen desiring vaccination. The government remains on target to have a safe and effective vaccine available in November 2009. However we expect the vaccine could be available as early as mid October should this be necessary.

We hope our vaccine overview has been a help. We know you have some tough decisions in the weeks ahead…and we hope we gave you some useful information that makes it a little easier for you to make some of them.  We also know it can be a bit scary…and that no matter how good the information we provide, sometimes it just helps to hear a few words of advice from someone who speaks from the heart…and while she may not be your own pediatrician, she’s really great with kids and she cares an awful lot… So here is Dr Kim, our own in-house pediatrician, to give you her thoughts on the H1N1 vaccines.  In the end…we leave it up to you and your pediatrician to decide on the best path forward for your kids…

Dr KimHere’s my take on the upcoming flu season and influenza vaccines for children this year.

First, every single year the regular seasonal influenza kills approximately 35,000 people in America. And it is responsible for severe illnesses and hospitalizations, as well as the missing of school and work days, for many more kids and families.

As much as we may wish, we cannot prevent your children from getting sick each winter. There are more than 200 cold viruses and we have no vaccines to prevent these illnesses. But influenza is among the most severe and the most miserable of the viruses, and we can prevent severe illness with vaccinations.

But is it safe doctor?

I have fielded questions from worried parents and watched the media stir up fears for the past months about the safety of the H1N1 vaccine.

Many patients and writers in the press have expressed concerns about the “new-ness” of the H1N1 vaccine. That concern is based on a lack of understanding of the way that flu vaccine is made. Every year a “new” influenza vaccine is made based on the circulating strains of virus and given to millions of people with excellent safety and efficacy. The H1N1 vaccine has been made in the same way, at the same companies and factories. We know how to do this well and safely.

Some people worry that there is not enough safety data. In my opinion, there is never “enough” safety data. But again, given the track record of similarly-made flu vaccine in the past, there is not reason to be concerned that this vaccine will be unsafe at all.

Others worry that the vaccine will not be effective, citing concerns that the virus may mutate and change. Virologists know that this is rare in a single flu year, and we have watched the virus through the spring in Mexico, the summer here and the winter in the southern hemisphere, and the virus has not changed; there is no reason to expect that it will do so this winter.

Other concerns relate to preservatives used in childhood vaccines, such as thimerisol. Please keep in mind that many studies have been done to evaluate the safety of these compounds, and no good scientific study has ever shown that the very small amounts of thimerisol used in vaccines are harmful to children. 

Finally given the recent media attention, questions have been raised about the 1976 flu vaccine and Guillain-Barre Syndrome.  What isn’t being given as much attention is that the 1976 flu vaccine was made in a completely different way than the current swine flu vaccine, with less sophisticated and safe vaccine technology.  So there’s no reason to suspect that GBS (which is typically present at a mild level in the general population), would increase at all with this year’s H1N1 vaccine.

In summary, as I mentioned in my previous post on this topic, 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. I think that these vaccines are safe, and I think that they are important. They will save lives and decrease pain and suffering this winter.  And as always I recommend to families 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

Dr Kim Newell is a pediatrician in a busy outpatient practice in San Francisco. At Princeton University she studied the history of religious thought and practice around the world. Only in modern times have healing and religion been separate fields of study. 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 at drkimmd.com

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October 12, 2009 | Filed Under Awareness | 2 Comments 

Swine Flu for Parents: Real World Answers Part I

Swine Flu for ParentsOn 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 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.

American Academy of Pediatrics (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.

How do I know if I or my child has swine flu?Swine Flu symptoms2

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)kid hand washing2
  • 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 on vaccines in our 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 child with feverhours 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…so for today, here are Dr Kim’s thoughts on the upcoming flu season for children this year:

Dr KimIn the upcoming winter, we expect that there will be both seasonal influenza and the new strain of H1N1 influenza commonly known as swine flu. There is already quite a lot of H1N1 virus circulating, and I see children daily who have swine flu.

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 

Dr. Kim Newell is a pediatrician in a busy outpatient practice in San Francisco. She 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 at drkimmd.com

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October 9, 2009 | Filed Under Awareness | 2 Comments 

What’s New with Swine Flu: Keep Your Family Safe & Have a Laugh Too

What do you do when you hear “global pandemic?” Is it time to build a bunker? Should you and your family lock yourself in with enough PB&J for weeks of sustenance? The novel H1N1 virus commonly known in the US as swine flu has officially been deemed a global pandemic. Somehow, though, the initial flutter seems to have died down. Parents now alternate between worrying about how to protect their families from this illness and wondering if they should purposefully expose their children now when the virus is “mild.”

Though the media buzz has calmed a bit and my friends are surprised to hear it, our pediatric practice in San Franciscofashion-swine-flue-mask1 is seeing huge numbers of children infected with swine flu. Since it is clear that this virus will be with us for some time, I will review what we know about the 2009 H1N1 influenza virus. A strain of flu that infects pigs has mutated so that it can make humans sick, and also be transmitted between humans. It has spread across borders and has caused human-to-human transmission in many countries. It was officially elevated to the level of a “global pandemic,” by the World Health Organization in early June.

It is now clear that this strain of flu will cause illness in tens or hundreds of thousands of people, but that most people who get sick will have a mild to moderate illness. Experts are debating the likelihood of the current virus mutating to a form that is much more virulent by the fall or winter, but the virus may well stay mild. Only time will tell the extent and severity of the 2009 H1N1 influenza.

Being on the front line of a pandemic is quite an experience, and at times I am tempted to feel a little nervous myself. At the moment, however, the best thing that all of us can do is use common sense, stay informed, and, as usual: don’t panic.

Here are some basic facts about this flu virus so far. Things continue to change: please visit a reliable source like the CDC’s website for up-to-date information.

  • The symptoms of this swine flu are the same as “regular” seasonal flu: fever, cough, runny nose, sore throat, and body aches. Some people have vomiting or diarrhea and headache along with these symptoms.
  • So far the cases in the US have been mild, but there have been deaths, mostly in people with chronic health conditions.
  • Many people do not know that seasonal influenza causes an average of 35,000 deaths yearly. These deaths are mostly in the elderly.
  • The virus spreads in the same way that seasonal flu spreads: mainly from person to person through coughing and sneezing.
  • The swine flu germ can also be spread by touching an object or surface contaminated by the virus. Some germs can live on surfaces for up to 2 hours.
  • The swine flu virus cannot be transmitted by eating pork products.
  • People with the swine flu may be contagious one day before getting symptoms and up to 7 or more days after they become ill.
  • If you are exposed to swine flu you may become ill 1 to 7 days after exposure.
  • The current flu shot does not protect against this strain of flu virus. A swine flu vaccine is being manufactured, but will not be ready for several months.
  • There are medications to treat swine flu but these medications are only effective when given within the first 24-28 hours of symptoms and only shorten the duration of the illness by one day. Most health authorities are currently recommending the selective treatment of people who are very ill or who have chronic illnesses. These recommendations are also changing: you may read the details on the CDC website or contact your health care provider.

Tips for parents:

  • As always, try to prevent your child (and you!) from getting sick.
    • Wash hands frequently with soap and water or use hand-sanitizing cleaners.
      • Having your child sing the ABC song during the hand washing may get them close to the recommended 15-20 seconds.
    • Cover little mouths and noses when sneezing or coughing.
    • Try to avoid close contact with sick people.
    • If you are sick, try to limit your contact with others as much as possible. (I know, this is all *much* easier said than done).
  • If your child has a mild illness, it may be best to stay home, give them your usual excellent care, and closely observe them for signs of serious illness.
  • If your child is moderately ill, please contact your health care provider.
  • If your child is extremely ill, please go to the local emergency department.
  • There is gobs of good and bad information about the swine flu available on TV, the radio and on the internet. Try to get your information from a trusted source.
    • Keep yourself updated about the situation by following the updates by the CDC’s website.
    • In many states, the public health department has a website that is being updated with local information and recommendations. California’s swine flu site has local recommendations.
    • A lover of maps, I like watching this attempt at mapping the number of cases as the virus races around the globe. Since I diagnosed about 12 cases (not laboratory confirmed) last Monday without telling these guys, however, I can only imagine that the real numbers are much larger.

 On the Lighter Side:fashion-swine-flue-mask2

A firm believer that humor eases our stress in times of crisis, I wrote a post on my blog about my favorite moments in the virus-formerly-known-as-the-swine-flu epidemic (now pandemic). But they just keep coming. Here are several that hit my funnybone recently.

  • Thanks to Dr. Rahul Parikh for pointing me to the variety of multimedia tools that the CDC  has pulled out for this one!
    • You can send your coworkers and friends an e-card to remind them to wash their hands, cover their sneezes, and keep their snotty little ones out of your kid’s school. But please “send all”– I’m pretty certain I would be offended if I received one of these directed just at me.
    • You can browse flikr to see electron micrograph pictures of the dastardly flu virus itself. There are also pictures of people getting immunizations, presumably part of a vaccine campaign: don’t miss the black and white photo of a woman getting an immunization from a device that looks like a nail gun. Now that’s going to make the kids rush in to get their flu shots!
  • Dr Parikh also highlighted the potential of this outbreak to start a whole new fashion movement. I’m heading in to work today with a sharpy and my favorite red lipstick to make sure that my N95 mask is tres chic.
  • Many of my patients ask me about the prudence of so-called “chicken pox parties” but the idea of a swine flu party is altogether batty. I agree with US officials who call it a “bad idea.” Though most people who get swine flu have only a mild or moderate illness, young healthy people–both children and adults–have developed very severe illness and even died. I would try to make a joke about swine flu parties about I cannot touch the British humor of Bryony Gordon.

Are you finding some humor amidst the chaos and tragedy of this pandemic? If so, please share. We can all use a laugh in these trying times.

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July 11, 2009 | Filed Under Community | Leave a Comment