H1N1 and You

1. H1N1 and You Kate Avitabile MD Morgan Stanley Children's Hospital of New York - Presbyterian October 13, 2009

2. What is H1N1? • New Influenza virus - differs from seasonal flu in the proteins of the coat  • Spread through coughing or sneezing or by touching an object with flu virus on it then touching your mouth/nose/eyes • Some parts of the virus are LIKE a virus that affects pigs, but H1N1 is NOT a pig virus • First detected people in the US in April 2009  • Most people have recovered without requiring medical treatment

3. What are the sign and symptoms of the virus? • Fever (although some people may not have fever) • Cough • Sore throat • Runny or stuffy nose • Body aches • Headache • Chills • Fatigue • Unlike seasonal flu, some people may have vomiting and diarrhea

4. How is the flu different from a cold? • Both are infections of the nose and throat caused by viruses, NOT bacteria • Both are spread via coughing/sneezing • Colds are usually milder - runny/stuffy nose, lasting only a few days • Flu may cause several days of fever, aches, cough, runny nose, vomiting/diarrhea • Neither is treated by antibiotics, rather liquids/rest/Tylenol/Motrin • Flu shot protects against Flu, NOT common colds 

5. Compared to seasonal flu • In US each year, > 200,000 people are hospitalized from seasonal flu • A little more than half of those hospitalized are > 65 yo • < 10% are children < 5 yo  • About 36,000 people die from complications • Vast majority of deaths are in patients > 65 yo • H1N1 causing more disease in patients < 25 yo rather than other people  • April to July - about 1 million confirmed cases • Now stopped counting as 99% "flu" is H1N1 • 10,000 hospitalized • 1000 deaths 

6. Who is "high risk" for H1N1? • Those at risk for complications including breathing difficulties and severe dehydration: • Children < 5 yo but especially children < 2 yo  • People 65 yo and older (but haven't seen many cases) • Pregnant women • People with cancer, blood disorders (sickle cell), asthma, COPD, diabetes, heart disease, kidney disorders, liver disorders, neurologic disorders, neuromuscular disorders (muscular dystrophy and MS), weakened immune systems (AIDS)

7. Do I need to go to the ER if I am only a little sick? • NO • Only if you have any of the warning signs OR if you are sick with flu-like symptoms and are at high risk of flu complications • Otherwise you may catch the flu if you do not have it already • Remember, you can ALWAYS call your health care provider with questions or concerns 

8. Warning signs • Children • Fast breathing or trouble breathing • Bluish skin color • Not drinking enough fluids • Not waking up or not interacting • Being so irritable that the child does not want to be held • Flu-like symptoms that improve but then improve with fever and worse cough • Fever with a rash 

9. Warning signs • Adults • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting 

10. What should I do when I am sick? • Stay home for at least 24 hours after your fever is gone, without the use of Tylenol or Motrin • Work, school, travel, shopping, social events, and public gatherings • If you need to leave home for medical care, wear a mask or cover coughs and sneezes with a tissue  • Wash your hands often with soap and water or use an alcohol-based hand run 

11. Will I get tested for H1N1 if I am sick? • 99% current flu is H1N1 so no longer testing everyone with symptoms  • Treatment should be started right away in high risk people, before flu results are received • May test those sick enough to be hospitalized, those at high risk of flu complications, and sick health care workers • Children who are low risk (> 2 yo without medical conditions) will likely not be tested OR treated  

12. Other tests your doctor may do • Throat culture - usually for fever and throat pain WITHOUT cough/runny nose • Blood or urine tests - to look for infection in infants or signs of dehydration in infants or older children • Chest Xray - for prolonged fever, cough, difficulty breathing

13. Are there medicines to treat H1N1? • Yes - Tamiflu or Relenza for 5 days • They may make you feel better faster and may also prevent serious complications  • Mainly to treat people who are very sick, for example those who are hospitalized or those at high risk of complications  • Your health care provider with decide whether anti-viral drugs are needed to treat your illness • Remember, most people with H1N1 have had mild illness, have not needed medical care or antiviral drugs 

14. Who will be treated for H1N1? • Those hospitalized • Children < 2 yo  • Those with high risk medical conditions - including children with asthma 

15. H1N1 Vaccine  • Will be available this fall • NOT an experimental vaccine  • Created and tested in the same way as seasonal flu vaccine  • Does not protect against seasonal flu, still need to get the yearly seasonal flu shot! • Should get vaccinated even if had ILI in the spring or H1N1 in 1976 

16. H1N1 Vaccine • Effectiveness • Unknown at this time but likely reduces chances of getting flu by 70-90%  • Safety/Side effects (same as seasonal flu) • Flu shot (inactivated) • Soreness, redness, swelling; low grade fever; aches • Intranasal (live - rare virus transmission to close contacts) • Children - runny nose, wheezing, HA, vomiting, aches, fever • Adults - runny nose, HA, sore throat, cough  • Length of testing  • Same procedures as seasonal flu vaccine

17. H1N1 Vaccine • Target groups  • Pregnant women • People who live with or care for children < 6 months old • Health care and emergency medical services personnel • People between 6 mos and 24 years old • People age 25-64 years old with high risk conditions 

18. H1N1 Vaccine • Shortage target groups • Pregnant women • People who live with or care for children < 6 months old • Health care and emergency medical services personnel • Children 6 mos to 4 years old • Children between 5 and 18 years of age with high risk conditions • Finally those > 65 years old will be vaccinated 

19. Doses for children • 2 doses for children < 10 years of age • **different that seasonal flu vaccine (< 9 yo) • Recommend 28 days between 2 doses, but valid if > 21 days • Intranasal (healthy, non pregnant people, age 2-49 yo) and intramuscular forms • Can give IM forms of seasonal flu vaccine and H1N1 at the same time, but cannot give flumist and intranasal H1N1 vaccine at the same time • Children with asthma likely will not be able to get the intranasal form, just like the seasonal flu vaccine

20. FAQs • How long can flu virus stay alive on objects? • 2-8 hours • How should I clean my home if someone is sick? • Clean surfaces with household disinfectant • Clean lines with laundry soap and tumble dry on hot • Wash utensils in dishwasher or with soap and hot water • Can I get H1N1 from eating pork? • No • Is there a risk from drinking water? • No cases documented, chlorine would kill virus

21. FAQs • How long is someone with flu contagious? • From 1 day before getting sick to 5-7 days afterwards • What are the side effects from the antiviral medicines? • Tamiflu - children < 7 yo • Nausea and vomiting  • Self-injury or delirium in teenagers - unclear if virus or treatment  • Relenza - children > 7yo, NOT in those with asthma • Few side effects 

22. Important things to remember • Most people with H1N1 flu will have a mild illness • Stay home while you are sick and for 24 hours after fever is gone • Give children Tylenol or Motrin for fever  • No OTC for children < 5 yo, No aspirin  • Use a cool mist-humidifier or suction bulb  • Seek medical attention if you or your child are high risk or have any of the warning signs • Get vaccinated if you are in one of the target groups (**most children will likely be vaccinated) • Wash your hands often and cover your mouth/nose when you sneeze!