Q& A about H1N1 (swine flu) and My Child
(Excerpts of this Q&A were published in the September , 2009 issue of Parent and Child Magazine)
When will you get the H1N1 vaccine?
As of Dec 28, Anchor Pediatrics has an excellent supply of H1N1 injectable vaccine. Anyone interested in having their child vaccinated against H1N1 should call one of our 3 offices to schedule a vaccination appointment. We no longer carry the nasal "mist" version of the H1N1 vaccine.
The Collier County Health Dept will be administering 2nd doses of the H1N1 vaccine to a couple remaining elementary schools. Click here to view the Collier County Public Elementary Schools second dose H1N1 schedule. We encourage families to have their children receive their H1N1 vaccinations at their school if feasible.
To see the Collier County Public Schools first dose H1N1 vaccination schedule go to http://www.collierschools.com/parents/docs/health/H1N1%20Vaccine%20Schedule.pdf .
The Collier County Health Department is also hosting H1N1 clinics. Please visit www.collierprepares.org to find out more about these clinics.
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What symptoms does the H1N1 virus cause in children?
Similar to seasonal influenza, the H1N1 (swine flu) can cause high fevers, chills, cough, scratchy throat, headache and body aches. Nasal congestion, vomiting and diarrhea can also occur. In some cases, fever is not a prominent symptom. The severity of the illness can vary from mild to severe. Mild to moderate cases tend to run their course in 3-7 days.
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Why has the media made such a big deal about the novel H1N1 flu?
In a matter of 2 months, the novel H1N1 influenza virus went from a localized outbreak in Mexico to a global pandemic. This was newsworthy since the world has not seen a true influenza pandemic since 1968. It is also newsworthy because we are not accustomed to talking about influenza in the middle of the summer or beginning of the school year! The initial reports out of Mexico made the novel H1N1 sound extremely dangerous. Subsequent reports appear to show that this influenza strain is no more deadly than the regular seasonal flu strains that have been circulating in the US over the last couple years. And although most of the deaths and hospitalizations from novel H1N1 have occurred in individuals with underlying medical conditions, there have certainly been some well publicized cases of otherwise healthy individuals who have succumbed to swine flu. Bottomline: influenza should be respected just like a lightning storm. If you take a chance, most people would just get wet to varying degrees (catch a cold of various severities) but because of the unpredictable and potentially lethal nature of the storm, you are better off getting vaccinated than playing outside.
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Why won’t the regular seasonal flu vaccine protect my child against H1N1?
Each influenza virus is armed with two weapons to get inside our bodies. They use something called Neuroaminadase (the “N” portion of the H1N1) to cleave thru the mucous barrier (aka snot) that protects the lining of our airways. They then use something called Hemagglutinin (the “H” portion of the H1N1) to grab and fuse with the cells lining our airways. The flu vaccine primes our body to recognize the presence of these H and N weapons and if they do appear, our body can churn out antibodies to neutralize the invaders. Unfortunately, the influenza virus can periodically change the appearance of the H and N weapons so our immune system won’t recognize the intruder until it is too late. The influenza virus essentially forces doctors and scientists to play an annual game of cat and mouse. At the beginning of each year, scientists try to predict which strains of influenza virus will be circulating at the end of the year. Sometimes the scientists guess right, other times wrong. So the vaccine manufacturers have already taken the scientists’ predictions for 2009-10 and have been testing and making seasonal flu vaccine for the last few months. Now throw H1N1 (swine flu) into the mix. This particular strain has H and N weapons just like the other influenza strains however some of the weapon parts are derived from influenza viruses that typically only infect pigs and birds. When animal strains mix with human strains it creates H and N weapons that have never been exposed to a human immune system anywhere on the planet. This vulnerability leads to a pandemic. This is why we need a separate vaccine to fight it.
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Who should get the H1N1 flu vaccine?
When H1N1 flu vaccine first becomes available, it should be given to the following groups:
- Pregnant women appear to be at particularly high risk for complications from swine flu
- People who live with or care for children younger than 6 months of age
- Health care and emergency services personnel
- Persons between the ages of 6 months through 24 years of age since many in this age range go to daycares, schools and colleges where outbreaks are more likely to occur
- People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
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If the illness is usually mild, why should my child get the vaccine?
Here are 5 good reasons your child should be vaccinated:
- Influenza can kill you. The CDC has reported over 230 childhood deaths in the US due to the H1N1 virus since April 2009. Since August 30, 2009, CDC has received 189 reports of influenza-associated pediatric deaths that occurred during the current influenza season (34 deaths in children less than 2 years old, 20 deaths in children 2-4 years old, 71 deaths in children 5-11 years old, and 64 deaths in children 12-17 years old). One hundred fifty-two (80%) of the189 deaths were due to 2009 influenza A (H1N1) virus infections, and the remaining 37 were associated with influenza A virus for which the subtype is undetermined.
Prior to the arrival of vaccines, most children who caught measles, mumps, whooping cough, or polio also suffered only mild symptoms. Until we can accurately predict how a germ is going to interact with the person it infects, vaccination remains our best defense. Visit familiesfightingflu.org if you would like to read more about the devastating effects of the influenza virus.
- Influenza can make your child miss school for over a week. Many high school and college students cannot afford to miss this much class time, nor can many families afford missing a week of work to stay home with younger children.
- Build the shield! The more people who are vaccinated, the better able we can protect those who are too young (infants < 6 months old) or too infirm (chemo patients) to receive the flu vaccine. This herd immunity is what has prevented outbreaks of other vaccine preventable illness. An excellent example of this is the rubella vaccine (currently found in the MMR or Measles, Mumps, Rubella vaccine). Rubella is a virus that causes only mild symptoms in children such as low grade fever and rash. However, if a healthy child with rubella came into contact with a pregnant woman who lacked immunity to the rubella virus, the unborn fetus could become infected with the virus causing miscarriage or potentially devastating defects to the unborn baby's brain, eyes and other organs. In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. By vaccinating ALL children against the seemingly harmless rubella virus, we protected unborn babies (who are too young to receive vaccinations) from something that can be utterly disasterous for them. The same concept applies to the H1N1 virus. The best way to protect people with high risk conditions against the H1N1 virus is to vaccinate the healthy children (siblings, classmates, teammates) who come into contact with them on a regular basis.
- Stop the swine flu paranoia. It is now very difficult for physicians to get swine flu out of their heads whenever they see a child with a fever or cold. This has resulted in many children getting tests and medications to treat possible swine flu when, in reality, they have a completely different illness. Because of the effectiveness of vaccinations, doctors no longer need to think about measles or polio as a possible diagnosis for a sick child.
- Unlike the seasonal flu which relies on educated guess work to predict what strains might be coming to our community, H1N1 is in our community NOW. No guessing required.
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Is the vaccine safe?
The 2009 H1N1 vaccine is not a "new" vaccine but rather is a change in the strains (just as is done each influenza season). Here is a short explanation from the FDA's website: "The four manufacturers will make the Influenza A (H1N1) 2009 Monovalent vaccines using the established manufacturing processes for their seasonal influenza vaccines. FDA approved these vaccines as a strain change to each manufacturer's seasonal influenza vaccine. There is considerable experience with seasonal influenza vaccine development and production and influenza vaccines produced by this technology have a long and successful track record of safety and effectiveness in the United States. The Influenza A (H1N1) 2009 Monovalent vaccines will undergo the usual testing and lot release procedures that are in place for seasonal influenza vaccines." Had the H1N1 influenza virus respected manufacturer deadlines and came on the world stage a few months earlier it very likely would have been included in this year's SEASONAL flu vaccine, however, viruses do not respect holidays, birthday parties or manufacturer deadlines. This necessitated development of another flu vaccine using the same process employed in seasonal flu vaccine development. The seasonal flu vaccine has strain changes made almost every year. Unlike the educated guesswork that scientists use to determine which flu strains should go into the seasonal flu vaccine, we know for certain that H1N1 is here now.
To find the most accurate and up to date information about the H1N1 vaccine, please visit the Vaccine Adverse Event Reporting System Website http://vaers.hhs.gov/resources/h1n1update#top
Some people are concerned about that the H1N1 vaccine is "too new." Just remember that auto manucturers produce limited editons of their car models every year. The limited edition models use the same engine, body and safety features as the regular model. Consider the H1N1 vaccine as a limited edition flu vaccine. The vaccine is being manufactured exactly the same way, its just using a single different strain. Remember that the seasonal flu vaccine incorporates 3 strains and these strains are changed nearly every year.
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Who should NOT get the H1N1 vaccine?
- Infants under 6 months
- Previous history of severe allergic reaction to any type of flu vaccine
- History of severe allergy to egg4.
- Fever > 100 degrees within the previous 24 hours. If you do not have a fever but are moderately to severely sick from another illness, it is advisable you postpone H1N1 vaccination until you recuperate.
The nasal "mist" version of the H1N1 vaccine contains a weakened form of the novel H1N1 influenza vaccine. The following groups should not receive the nasal version:
- children younger than 2 years
- pregnant women
- anyone with a weakened immune system
- anyone with a long-term health problem such as heart disease, kidney or liver disease, lung disease, metabolic disease such as diabetes, asthma, anemia and other blood disorders.
- children younger than 5 years with one or more episodes of wheezing during the past year
- anyone with certain muscle or nerve disorders (such as cerebral palsy) that can lead to breathing or swallowing problems.
It is OK to receive the nasal or shot version of H1N1 if breastfeeding.
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Can you receive the H1N1 vaccine on the same day?
The H1N1 Swine flu SHOT can be administered before, after or on the same day as the seasonal flu vaccine (either nasal or shot version). Both H1N1 nasal spray flu vaccine can be given on the same day as any other injectable vaccine, but SHOULD NOT be given on the same day as the seasonal flu nasal spray vaccine. At least 14 days should separate administration of these two (H1N1 and seasonal) nasal spray vaccines. If your child received an MMR, varicella or yellow fever vaccine recently, they should not receive any nasal flu vaccine (H1N1 or seasonal flu) until 28 days have passed since administration of the MMR, varicella and yellow fever vaccines.
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Will my child need one H1N1 vaccine or two?
If your child has not reached their 10th birthday, they will need to get 2 H1N1 vaccines given at least 21 days apart. If your child needs 2 doses, they do NOT have to be the same formulation. For instance, if your child received the H1N1 nasal spray vaccine, they can receive the injectable H1N1 version 3-4 weeks later. We encourage your child to receive their H1N1 vaccine either at school, daycare or doctors office. Just keep a written record of the administration date.
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Will the H1N1 vaccine cost anything?
The vaccine is free, but our office will charge an administration fee (not more than $24). If you have no insurance you will be expected to pay the administration fee at the time of service.
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Can’t I just take Tamiflu to fight off the infection as soon as I show symptoms?
Tamiflu blocks the N weapon on the flu virus rendering it ineffective. When used early in the course of the illness, it has been shown effective against H1N1. But just as bacteria developed resistance to penicillin when it was overprescribed in the 20th century, so too has the influenza virus started to mutate into strains that are resistant to tamiflu in the 21st. Tamiflu was ineffective against the predominant strain of seasonal influenza circulating last year. So in a few months it will be difficult to know if a child with flu-like symptoms has a resistant seasonal influenza strain or a susceptible swine flu strain. Routine office tests still can’t tell us the difference. To avoid overuse, we need to try and reserve tamiflu for those children who are most susceptible to the ill effects of the virus.
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What else can I do to protect myself and my family against the flu?
- Stay informed. Visit the aap.org and cdc.gov websites periodically to get the most up to date information available.
- Stay calm – your child is very in tune with your emotions. If you exude stress, they will sense this and become stressed as well. Stress lowers are immune defenses and increases susceptibility to illness. Try not to overreact in front of your child if she has been exposed to someone with the swine flu or starts to exhibit symptoms. Children rely on routines even when they are sick.
- Wash your hands! Twenty seconds of washing with soap and water (amount of time it takes to sing twinkle twinkle little star twice) or alcohol based hand sanitizers will kill influenza viruses.
- Be a good public health citizen – don’t send your child to school if they have flu-like symptoms.
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Will the 2009 H1N1 vaccine be recommended for patients who had influenza-like illness since spring 2009?
People who had an illness confirmed by rRT-PCR (real-time reverse transcriptase-polymerase chain reaction) to be 2009 H1N1 virus earlier in 2009 can be considered to be immune and do not need to be vaccinated this year. However, most people with respiratory illnesses since this spring have not had testing with the rRT-PCR test, which is the only test that can confirm infection specifically with the 2009 H1N1 virus. Tests such as rapid antigen detection assays (which we use at Anchor Pediatrics) and diagnoses based on symptoms alone without rRT-PCR testing, cannot determine with 100% accuracy if a person has 2009 H1N1 influenza. Although people who were not tested, but who became ill within 1-4 days after close contact with a person with lab confirmed 2009 H1N1 influenza might have been infected with 2009 H1N1, they cannot be certain since many pathogens can cause respiratory illness. These people should get the 2009 H1N1 vaccine as recommended for their age and risk group.
The rapid antigen detection influenza test we use at Anchor Pediatrics has a sensitivity of 94% to influenza A. Sensitivity measures the proportion of actual positives which are correctly identified as such (e.g. the percentage of sick people who are identified as having the condition). This means there will be a small number of false positive tests where a person is incorrectly diagnosed with influenza A when in fact they do not have it. Currently, the CDC is reporting that 99% of subtyped circulating influenza strains are H1N1. Subtyping is now only done in severe cases (hospitalization, death or suspected tamiflu resistance) of suspected influenza so it is possible that the proportion of H1N1 in milder cases of suspected influenza is lower. Thus, if your child tests positive to influenza A with our rapid influenza antigen detection test, it is very likely the strain is H1N1 but there is definitely a degree of uncertainty that may warrant vaccinating your child against 2009 H1N1 "just in case."
According to the CDC, vaccination against H1N1 in a person previously infected with 2009 H1N1 virus will not be harmful, and patients who are uncertain about how they were diagnosed should get the 2009 H1N1 vaccine. In addition, people recommended for seasonal vaccine should get a seasonal vaccine because infection with the 2009 H1N1 virus does not provide protection against seasonal influenza viruses. Although H1N1 may be the dominant influenza A strain this season, the seasonal influenza vaccine will be the only flu vaccine this year to confer protection against influenza B.
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