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

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

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

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 

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 

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)

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 

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 

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

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 

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  

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

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 

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

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 

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

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 

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 

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

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

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 

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!