American Academy of Pediatrics 

Frequently Asked Questions About H1N1 Flu (Swine Flu)

(August 18, 2009)
1. What should parents do to protect their children from the swine flu?

• 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. Alcohol-based hand cleaners also work well.
• Cough or sneeze into your elbow.
• Alternatively, cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Stay at least six feet away from people who are sick. Avoid crowds. This will limit the spread of illness.
• Stay home when sick to keep from spreading illness.
• Children and adults who are sick should stay home at least 24 hours after they are free from fever (100°F) or signs of fever without the use of fever-reducing medications.
• Seek medical care if you are severely ill, such as having trouble breathing. Antiviral medicines may help.

The CDC answers common questions about swine flu.

2. Are face masks necessary?

• Handwashing and avoiding close contact with sick people are more important than wearing face masks to prevent the spread of the virus.
• If you are caring for a child or other person who has swine flu, a face mask can be used to help reduce the chance of spreading germs.
• Follow the recommendations of local and state public health authorities.

The CDC offers guidance on face masks.

3. How do you know whether or not to be concerned about swine flu in your area?

• Know what the public health authorities in your area are saying.
• Follow their recommendations to reduce your risk of catching the virus.

4. What’s the most important thing parents should do now, just in case infections are reported in their own area?

•  Plan now what you would do if your child’s school or child care center was to be closed.
• Consider what you will need to do to arrange for child care at home for your children.
• Stock up on supplies and non-perishable food at home.
• Have your pediatrician’s contact information handy.

5. What advice do you have for parents with children in school or child care?

• Parents should not take children out of child care or school unless public health authorities have recommended such a step.
• We do not have to close schools and other gathering places to prevent infection except in those areas where the public health authorities have determined that school closings are necessary.
• If the virus is causing significant illness in a particular area, authorities may close child care programs and public events.
• If the school or child care program closes and your children are healthy, you should still keep them home and not participate in social activities. Working parents may team up with other parents to take turns staying home with children; such groups should be kept to small numbers of children (<6) to minimize the risk of spreading germs.
• Parents should remind their children about proper hygiene, including sneezing and coughing into a tissue or sleeve, and frequent handwashing.
• Parents should advise children to go to the school nurse if they start to feel sick during school. Children who are sick should stay home at least 24 hours after their fever is gone.

6. How can parents avoid overreacting?

• Be aware of what’s going on in your area and follow the recommendations of public health authorities.
• It is not necessary to withdraw your kids from school or child care, if there are no reported cases.
• Start preparing for what you would do if schools and child care centers do close.

The CDC offers advice for parents on talking to their children about H1N1.

7. What are the symptoms of swine flu in children?

• Classically, children with influenza have a sudden onset of high fever, chills and respiratory symptoms. Children will develop mild nasal congestion and cough. Older children may complain of headache, scratchy or sore throat, and muscle aches.
• Influenza is very different from the common cold. Typically, a child who has fever and no nasal symptoms likely has influenza. A child who has no fever, but significant nasal symptoms, likely has a cold, not influenza.

8. What should parents do if their child has flu-like symptoms?

• If your child has mild illness, he or she should stay home from school or child care.
• Any child younger than 3 months who has a fever should see a pediatrician. In a child older than 3 months, how high the fever is, is not as important as how he or she feels and acts.
• Any child with a chronic medical condition (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurologic disorder), who has even mild flu symptoms should see a pediatrician.
• Signs that warrant a visit to the pediatrician include lethargy, irritability, fast breathing, vomiting and inattention to the environment.
• If your children are uncomfortable because of fever, you can give them medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Do not give aspirin-containing products.
• If they are not eating well, encourage them to drink liquids.
• Call your pediatrician for advice. Your doctor can help you decide whether your child needs to be seen or if they may need to be tested and/or treated for swine influenza.

The AAP offers advice on taking a child’s temperature .

To help guide parents, the CDC has posted tips on caring for a child with flu-like symptoms:

• Keep your child at home. Don’t let him go to school or child care until he has been fever-free for 24 hours.
• Keep a sick child away from other people as much as possible.
• If your child has underlying health problems, see a doctor when symptoms start.
• If your child is otherwise healthy, call a doctor to see if an appointment is needed.
• When holding a small child who is sick, place the child’s chin on your shoulder so that he or she will not cough in your face.
• 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.
• Wash your hands with soap and water often, or use an alcohol-based hand gel if soap is not available.
• Keep surfaces (including toys and bedside table) clean – wipe them down with a household disinfectant.
• Wash bed sheets and towels with laundry detergent in hot water. Avoid “hugging” the dirty laundry on the way to the washing machine, and wash your hands right after handling dirty laundry.

9. What are the signs that my child with flu-like symptoms is getting worse?

• Trouble breathing or fast breathing
• Not drinking well
• Not urinating as much as usual
• Bluish or gray skin color
• Being irritable even after their fever goes down
• Not waking up normally or interacting normally
• Rash
• The fever goes down and flu symptoms get better, but then get worse again a day or two later

10. Are any medicines recommended to help children with swine flu?

• Children with influenza should not get any product that contains aspirin. Tylenol (acetaminophen) Advil and Motrin (ibuprofen) 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.
• Antiviral medications like Tamiflu and Relenza, which are in adequate supply, work against the H1N1 swine influenza virus. It is expected that 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. Relenza is not for young children.
• Although recommendations may change, at this time treatment may not be needed for everyone, even if you are proven to have H1N1 infection.
• Your pediatrician will decide when treatment is indicated and which drug is best to treat your child.
• Based on current recommendations, your pediatrician may prescribe Tamiflu or Relenza for members of the family who have been in close contact with a child diagnosed with H1N1 swine flu.

The CDC offers advice for taking care of a sick person with swine flu.

11. Is flu more dangerous for very young children?

• Children under age 2 have a higher risk of complications and hospitalization due to influenza than older children.
• Children of any age who have an underlying medical condition, such as asthma, diabetes, another metabolic disease, chronic kidney disease, or sickle cell disease are at greater risk of complications.

12. Is the swine flu worse than the “regular” flu?

• We don’t know the answer to this yet. As we learn more about the people who have been affected by the H1N1 virus, recommendations for prevention and treatment may change.

13. Should I use antibacterial soaps and/or alcohol-based hand rub products?

• Washing hands with warm running water and soap (antibacterial soap is fine but not necessary) for at least 20 seconds ( the time it takes to sing the “Happy Birthday” song twice) has been shown to kill the H1N1 virus.
• Alcohol-based rubs can be used when soap and water are not available, such as after hand shaking or touching objects that carry germs. Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.) Please keep these products out of the reach of children and supervise their use.

14. Can mothers who have swine flu continue to breastfeed?

• The influenza virus is not transmitted by breastmilk.
• Mothers who believe they may be infected should be sure to wash their hands before breastfeeding their baby.
• Be sure to use clean burp cloths, and consider wearing a face mask.

The CDC offers guidance on breastfeeding with swine flu.

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These tips offer great information on how to deal with Swine Flu. Another helpful tip is to purchase washable keyboards for your families and schools. Washable keyboards are durable, waterproof, silicon keyboards that are easily disinfected after using without damaging the keyboard. These healthy gadgets can be purchased at wetkeys.com.

By Jeff Nagel – Richmond Review.com

Published: August 24, 2009 2:00 PM
Updated: August 24, 2009 2:59 PM

Posted: Monday, August 24, 2009 11:42 AM by Domenico Montanaro
Filed Under: White House

From NBC’s Winston Wilde
Education Secretary Arne Duncan and Health and Human Services Secretary Kathleen Sebelius acknowledged there is a significant chance of school disruptions in the upcoming flu season, due to H1N1 “swine flu.”

At a press conference this morning in front of H.D. Cooke Elementary School, Duncan said, “Some schools may experience large absentee rates; some across the country may even need to be closed temporarily at some point during the school year. We must make sure that learning continues if the virus spreads. That is hugely important.”

He added that the goal for schools nationwide is “to keep our children safe and keep our children learning.”

The Department of Education released instructions to schools today on how to be ready for any possible disruption due to H1N1, including having homework packages ready for students while they must stay home, having online resources accessible from the home (Apple and Microsoft representatives were present at the school, according to Duncan), and maintaining close contact with parents, so they can keep their kids up to speed on curricula.

The H1N1 vaccine will be ready by mid-October. Once available, kids will be one of the “priority populations,” and both the Department of Education and HHS are reaching out to schools to make sure parents remember to make vaccinations a priority.

While the H1N1 vaccine is still in its testing phases, Sebelius emphasized mitigation strategies, like remembering to wash hands, coughing into shirtsleeves instead of coughing into a hand or worse yet, not covering a mouth, and to stay home – students and teachers alike – if they develop flu symptoms.

HHS  distributed to elementary school s its “Avoid the Flu” resource kits, and of course, has a flu Web site, with guidance for K-12, colleges and  universities, and businesses.

After the press conference, Sebelius and Duncan toured the school to see its health facilities and green initiatives  and ate a breakfast with the  children in the cafeteria.

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New Swine Flu Guidelines for Colleges, Work

Aug. 20, 2009 — Health officials want colleges, universities, and businesses to get up to speed on how to deal with swine flu this fall and winter.

The CDC today released new guidelines for colleges and universities about how to handle H1N1 swine flu, and yesterday issued guidelines for businesses that may find themselves short-staffed due to swine flu.

Swine Flu at Colleges and Universities

Apart from swine flu prevention tips that apply to everyone — such as washing your hands, coughing into a tissue or your sleeve, cleaning shared surfaces like doorknobs, and staying home when you’re sick — the CDC has specific recommendations for college students living on campus.

The key guideline is for people with flu-like illness to avoid other people until at least 24 hours after they are free of fever of 100 degrees Fahrenheit or more, or signs of fever, without use of fever-reducing medicines.

That means not going to classes, not going out to meals, not socializing in person, and avoiding close contact such as kissing, sharing eating or drinking utensils, or having other contact that would make it easy for the H1N1 virus to spread. The basic idea is to stay at least 6 feet away from people the sick person lives with.

Some students may have their own dorm rooms or temporarily move to a private home off campus. But if they have roommates, the CDC says the sick person should stay at least 6 feet away from people they live with and wear a surgical mask if close contact can’t be avoided, and that shared bathrooms be avoided or cleaned frequently.

The CDC encourages colleges and universities to plan the solutions that would work best for their own particular situation and suggests considering setting up temporary, alternate housing — such as a gym — where sick students can recover.

To make that easier, the CDC suggests enlisting a friend to help out as a swine flu “buddy” who can bring in food, class notes, and other necessities.

Young adults have been hard hit by swine flu. The CDC advises college-age students to  to find out if they’ve got high risk conditions that could make swine flu more severe.

Managing Swine Flu at Work

The CDC’s swine flu guidance for businesses and employers focuses on preparing for people to be out sick — and on reassuring staff that staying home won’t cost them their job.

As with college students, the CDC’s main point is that workers with flu-like symptoms should stay home and not come back to work until at least 24 hours after they are free of a fever, or signs of a fever, without using fever-reducing medicines.

The CDC also urges employers to come up with flexible leave policies, in case workers need to stay home and care for a child who is sick or whose school or child care program has closed due to swine flu.

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Bloomberg — Swine flu vaccines under development by drugmakers may not provide immunity until the last week of November, too late to hold off outbreaks triggered by infected students returning to schools in the U.S. and Europe.

Just 45 million of 195 million doses ordered for the U.S. will be delivered by mid-October, said health officials who lowered their estimates yesterday. The vaccine will probably require two shots given three weeks apart, and the body won’t produce antibodies for two additional weeks, according to an Aug. 7 report by the Department of Health and Human Services.

H1N1 has reached more than 170 countries and territories in the four months since being identified, the Geneva-based World Health Organization said.

Protection Priorities

Authorities want to ensure adequate supplies to protect health-care workers, pregnant women, people at risk of developing severe complications from flu and children, whose close contact in tightly packed schoolrooms and in other social settings makes them the biggest spreaders of the virus.

Part of the U.S. plan to vaccinate children is to encourage state and local health departments to set up school-based vaccine clinics. In the U.K., most shots will be given by family doctors and nurses who provide routine health care including seasonal flu shots, according to the Department of Health.

Schools that arrange in-house immunizations will face logistical hurdles, said Mel Riddile, the National Association of Secondary School Principals’ associate director for high school services in the U.S. Riddile, a former principal at a Fairfax County, Virginia, high school, said it typically took a month just for all 2,500 students to turn in their emergency medical information forms at the beginning of the school year.

Along with hand washing, washable keyboards are a great way to help stay protected against viruses, such as the flu. Since keyboards are the other thing you touch all day, being able to wash and disinfect them helps decrease harmful germ contamination. Get a washable keyboard at WETKEYS.com. 

Swine Flu Shots May Be Too Little, Too Late to Halt Outbreaks

Back-to-school Swine Flu (H1N1) precautions and treatment

August 14, 6:26 AMLA Parenting ExaminerRebecca Lacko

With summer winding down and schools preparing to reopen, another possible H1N1 virus outbreak poses a threat to the 6-24 year old age group which the Centers for Disease Control (CDC) has targeted as being at high risk for contracting the virus.

At this time, the CDC does not consider novel H1N1 “swine” flu to be more dangerous than other types of seasonal flu, but it does state that the disease burden of swine flu is greater on young people. 

Dr. Martha Howard offers parents her advice for effective ways to protect children from getting the disease.

Avoid close contact with sick people. Dr. Howard advises children carry tissues and hand sanitizer, and know how to use them: Sneeze or cough into the tissue, throw it in the wastebasket (not on the desk); Put a dime size blob of hand sanitizer on hands and rub together until dry. She also warns against children sharing drinks or food, and not to touch their eyes nose or mouth with their hands. 

Vaccination Precautions Dr. Howard says it is not wise to receive swine flu vaccination for grade school children at this time. “There are generally about 100 child deaths per year in the United States from flu. Even if that is doubled by swine flu, I do not feel it is worth the risk of exposing your child to possible long-term problems with immunity,” she reports.

• The vaccines being developed are to contain the “adjuvant”—a chemical that induces greater immune response—squalene, which is known to cause a harmful immune response in rats resembling rheumatoid arthritis.
• There are currently no other vaccines containing squalene that have been approved for use in the United States.

Natural and Homeopathic Alternatives A recent study reported in American Family Physician Journal (August 2009), showed that elderly patients taking 600 milligrams of N-acetylcysteine (NAC) twice daily over the flu season were much less likely to have clinical influenza illness (29% vs. 51% of controls), and when they did have it, episodes were much less severe. In addition, cell mediated immunity was improved in the people receiving NAC, and not in the controls.

Dr. Howard recommends giving children N-acetylcysteine in a dose that is proportional by weight to the adult dose of 600 milligrams twice a day. (A 70 pound child would be given 300 milligrams twice a day. A 35 pound child would be given 150 milligrams twice a day, and so on. For children under 2, consult a physician.)

Treatment for Children who Contract the Virus Dr. Howard recommends supportive treatment: rest, fluids, and Chinese herbs.

• The combination of two readily available formulas, Zhong Gan Ling and Yin Chiao Chieh Du Pian (both available online) is effective for treating flu.
• Keep children home if they are sick for 7 days after symptoms begin or until they have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

 Emergency warning signs that need urgent medical attention, according to the CDC:

• 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

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Center for Disease Control–May 4th 2009

Transmission

Transmission of novel influenza A (H1N1) is being studied as part of the ongoing outbreak investigation, but limited data available indicate that this virus is transmitted in ways similar to other influenza viruses. Seasonal human influenza viruses are thought to spread from person to person primarily through large-particle respiratory droplet transmission (e.g., when an infected person coughs or sneezes near a susceptible person). Transmission via large-particle droplets requires close contact between source and recipient persons because droplets do not remain suspended in the air and generally travel only a short distance (< 6 feet). Contact with contaminated surfaces is another possible source of transmission and transmission via droplet nuclei (also called “airborne” transmission). Because data on the transmission of novel H1N1 viruses are limited, the potential for ocular, conjunctival, or gastrointestinal infection is unknown. Since this is a novel influenza A virus in humans, transmission from infected persons to close contacts might be common. All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious.

Incubation period

The estimated incubation period is unknown and could range from 1-7 days, and more likely 1-4 days.

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According to Bloomberg, swine flu outbreaks shouldn’t close U.S. schools this fall unless so many students or teachers get sick that it interferes with teaching or puts the students at risk, U.S. health officials said.

The pandemic flu, also known as H1N1, can no longer be contained by closing schools, and the disruptions caused by closures outweigh the public health benefits, according to guidelines posted today on the Health and Human Services Department’s Web site. The guidelines, based on lessons learned earlier this year, cover the nation’s 55 million students and 7 million staff members at 130,000 public and private schools.

Health officials around the world are completing plans to deal with widespread outbreaks in the Northern Hemisphere beginning in September. That’s when cooler temperatures and the return to schools may fuel the biggest flu epidemic in decades.

Since US Health Officials recommend schools remain open – washing and disinfecting the computer keyboard and mouse that students and teachers share may be the most important and most overlooked safety procedure that must become standard practice. WETKEYS.com offers a vast selection of cleanable keyboards and mice. 

Schools Should Remain Open When Swine Flu Strikes

The World Health Organization reports that:

The countries and overseas territories/communities that reported their first pandemic (H1N1) 2009 confirmed case(s) since the last web update (6 July 2009) as of 22 July 2009:Afghanistan, Andorra, Belize, Bhutan, Botswana, La Réunion (French Overseas Community) , Haiti, the Marshall Islands, the Federated States of Micronesia, Namibia, Sint Eustatius (Netherlands Antilles) , Saint Kitts and Nevis, Saint Vincent and the Grenadines, Seychelles, Solomon Islands, the Sudan, Tonga, Turks and Caicos Islands (UK Overseas Territory), the United Republic of Tanzania, American Samoa (US), Guam (US)

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