1. 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

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 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!