(This is a basic Q&A diary. For a more complete diary on swine flu, please check out Swine Flu Basics)
Swine flu hasn’t been in the headlines as much as it was in the spring, but that doesn’t mean that it’s gone away. To date, there have likely 2 million cases in the United States, many thousands of hospitalizations, and around 500 known deaths as a result of swine flu, more accurately known as Influenza A/H1N1/09.
Here’s where we stand: it’s a race. The pandemic, while widespread across the globe, thankfully hasn’t been terribly severe thus far. That could change. Even if it doesn’t, a lot of people will get sick this fall and winter, perhaps as many as 1 in 3 Americans. And a small percentage of these will get very sick. Some will die.
Fewer will die if a safe, effective vaccine gets here first. Meanwhile, schools are opening soon, and flu bugs love to infect sick kids. And they love crisp, cool weather, which is just around the corner – autumn starts in just about one month.
We should brace ourselves against H1N1 as if it were an invading army. The likelihood is that the first vaccines will not be available until mid- to late-October. Even with the swine flu shot, it’ll be two to three weeks before it starts to work, and it won’t be until after a second shot is received that most will be fully protected against swine flu.
In other words, there will be two months or more between the time children return to the classroom until when they start becoming immune to the virus as a result of immunization. It could be a long two months.
What follows are common questions about swine flu, and the best answers we presently have.
- What should parents do to protect their children against swine flu? Pay attention to updates provided by health professionals and the media. If swine flu cases are on the rise, consider avoiding large crowds. Avoid direct contact with anyone with a fever above 100.0 degrees F. Call ahead before visiting friends and relatives. And, as always, good hand washing is essential to reducing the spread of illness.
- When should my child or I stay home from school or work? Parents should follow the usual age-old recommendation that children with fever should be kept home, and adults with fever should stay home from work. Fever is defined as above 100.0 degrees Farenheit. Medications that decrease fever, like acetaminophen and ibuprofen, do NOT prevent the spread of flu virus, so it’s important to stay home when sick with fever even if taking medicine.
- What should I do to protect myself and my child when out in public? If you are out in public, and someone has a cough, you should stay away from that individual. Wearing a mask unfortunately does not reduce your risk of catching the flu virus. Again, good hand washing is crucial. Bring hand sanitizer with you everywhere, and use it regularly, especially after contact with public doors, grocery carts, public restroom faucets, etc. And people should cover their mouth and nose with their sleeve when they cough or sneeze.
- Should I send my child to school if the number of swine flu cases are rising in our community? Yes. If schools do their job well, schools can be made relatively safe places to be during flu outbreaks. To see that this happens, the biggest responsibility belongs to parents. Do NOT send your child to school if (s)he has a fever above 100.0 degrees F. If your child awakens with a cough or sore throat, take his/her temperature before anything else. Reducing a fever with medication so that a child can attend school will NOT reduce the child’s ability to spread the virus to others.
- What should I do now to start planning? Start thinking about what you would do if your child’s school or day care center is shut down. If this happens, the closure could last as long as several weeks. Think about what arrangements you would make for your child. That may mean making calls now to plan alternative child care or work coverage, stocking up on activities for the homebound child, and stocking up on tissues, Gatorade, and medications if your child is kept home for fever. It is also a good idea to stock up on hand sanitizer (which must contain greater than 60% alcohol in order to be effective), and on canned goods and freezer foods.
- What if my child has to stay home because of possible swine flu? Most children will not require medical attention or treatment for symptoms of swine flu, but they will need to stay home until they have been free of fever for more than 24 hours. And this means staying at home – taking your ill child to the mall, to the movies, to friends’ homes, and to church will only increase the chance (s)he will spread swine flu to other children and adults.
- If my child gets a fever, should (s)he see a doctor? Not necessarily. Bringing every child with a fever to the doctor’s office, urgent care, or the emergency department will only increase the spread of swine flu within a community. The first thing parents should do if their child awakens with a new fever is to CALL their doctor’s office during regular business hours. A fever is NOT an emergency, unless your child is an infant under the age of 2 months. If your child is under the age of 5 years, has asthma, or has some other chronic medical condition, the doctor will likely want the child to be seen in the office to test for swine flu and begin treatment ASAP. The treatment is only effective if started in the first 48 hours of the illness. Children older than age 5 years who are otherwise healthy do NOT need to be seen by a doctor, or treated with anti-viral medication, unless they are experiencing distressed breathing, severe or persistent vomiting, seizure, extreme irritability in the absence of fever, or failure to urinate for more than 8-12 hours.
- What are the symptoms of swine flu? Remember, influenza is NOT the "stomach flu", or a "24-hour bug". Influenza is primarily a respiratory illness, and causes a sudden onset of fever, cough and/or sore throat, often with headaches, body aches, congestion, chills, and fatigue. Some people get vomiting and diarrhea with influenza, but most do not. With influenza, the fever usually lasts 2-4 days, and the illness lasts up to one week. Again, people with swine flu may return to school or work once fever free for more than 24 hours.
- What are the reasons my child might be at risk for becoming very sick with swine flu? Children under age 2 years have a higher risk of complications from flu, and a higher risk of hospitalization. Children who have an underlying disorder – such as asthma, diabetes or other metabolic disease, chronic kidney disease, sickle cell disease, chronic immune system disease, neuromuscular disease, and others – are also more at risk of getting very sick.
- What are the primary treatments for flu? Fluids, rest, more fluids and more rest. Tylenol™ and Motrin™ are fine to give, but children with influenza should NOT get any product that contains aspirin (including PeptoBismol™). Cough suppressants are best avoided for children under age 5 years. Benadryl™ is acceptable if given at bedtime to assist with sleep. But the key treatments are rest and fluids – your child will need more of both than usual.
- Should my child receive a flu shot this fall? With all the attention being given to swine flu, it will be undoubtedly overlooked that strains of regular seasonal influenza will still be circulating at the same time, peaking between December and March. Regular seasonal flu shots will be available very soon, by late August to early September, but the seasonal flu vaccine does NOT protect against swine flu. As every year, this year it is still advisable that children under age 2 years, and children with chronic medical conditions, receive the regular seasonal flu shot, IN ADDITION to the swine flu vaccine.
- When will the swine flu vaccine be available? The first 120 million doses should be available by mid- to late-October. Those eligible to be first to receive the vaccine are everyone age 6 months to 24 years, pregnant women, health care workers, and adults with chronic medical conditions such as asthma and diabetes. If by mid-September, the number of cases of swine flu is rapidly rising, there will be an early release of 40 million doses of vaccine targeting children 6 months to 4 years, health care workers, and pregnant women.
- How many shots will be needed? The vaccine is currently in mass production, and testing started several weeks ago. We will know much more by early to mid-September, but the expectation is that 2 doses will be required to achieve full protection in most people. The doses will likely need to be separated by a minimum of 3 weeks.
- How can we be sure the vaccine will be safe? We can’t be fully sure. H1N1 came on to the global scene a mere 5 months ago...it is amazing that we already have a vaccine in mass production. Testing that is ongoing will give us good information about the effectiveness of the vaccine, and whether there are any unexpected widespread problems with the vaccine, but we won’t know for certain its possible side effects until it is given to large numbers of people. However, the swine flu vaccine is being produced in the same manner as flu vaccine is produced every year; therefore, there is no reason to expect side effects any more or different than regular seasonal flu shots. And since we know precisely the characteristics of the swine flu virus, it is reasonable to expect that the vaccine produced against it will be very effective in preventing swine flu in most who receive it.
- Should I hold a swine flu party? Already, it has been that some parents are hosting a swine flu party, with the guest of honor someone who’s got swine flu. The point is for other guests to catch the virus in the hopes that they’ll have a mild illness and gain immunity early so that they won’t get sick if the H1N1 virus mutates or strengthens. This is a bad idea, because there is no way to know whether swine flu will be severe or fatal in swine flu party guests – or anyone else that they, in turn, infect.
- Could swine flu mutate or strengthen? Yes, it could. So far, it has not, despite causing widespread illness this summer not only in the United States and Europe, but especially in the Southern Hemisphere, where it is currently winter. Public health officials are monitoring swine flu very closely in countries around the world, especially in countries in which avian ("bird") flu is still present, but thus far the virus has not mutated, and the overwhelming numbers of people sickened by swine flu are recovering without need for medication or hospitalization.
- What should I tell my children about swine flu? Tell them that there’s a germ that people are getting, and most of them get sick but get better on their own within a week. Tell them that if they start feeling sick at school, they should tell the teacher ASAP. If they cough or sneeze, have them do so into a tissue or into their sleeve or elbow. Have them throw used tissues away, and then wash their hands, ASAP. Teach them to wash with soap and water on both sides of their hands. Teach them to sing the ABC song twice while washing, and before drying. Tell them that if they get a fever, they’ll need to stay home, and away from friends until their fever is all gone for more than a day.
With 55 million U.S. children heading back to school in the next 3-4 weeks, parents and caregivers would do well to begin actively planning for swine flu outbreaks this fall and winter. What worries health professionals most is that we don’t normally see cases of influenza at all during the summer, and yet swine flu has stuck around, and has caused illness in every corner of this country. While the number of cases nationwide has dropped somewhat in the past two weeks, it can be expected to rise sharply once children are returned to the classroom.
What also worries health professionals is that, unlike regular seasonal flu, young people are getting the sickest, while the elderly, who normally account for most serious illness and annual death from flu, have largely been spared. The median age at hospitalization for swine flu thus far has been age 19 years; the median age of death 37 years.
Public health officials and physicians around the globe are monitoring swine flu closely. A massive public service announcement (PSA) campaign is set to begin in September, to educate the public as to the signs of flu, and the need for vaccination.
There are a few reasons to be hopeful. The virus has not mutated, or strengthened, despite rapidly circling the globe for the past 4 months. The overwhelming numbers of people infected with swine flu are recovering without need for medication or hospitalization. And there have only been a handful of reported cases of swine flu in which the virus has been resistant to medication.
This article by no means contains all the available information about swine flu – for more detailed information, check out the CDC website, at: http://www.cdc.gov/...
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