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The Facts About 2009 H1N1 Flu (Swine Flu)
With the outbreak of the new strain of flu this year—known as 2009 H1N1 Flu, novel influenza A H1N1, or swine flu—you have probably felt barraged by the daily reports and updated recommendations on television, radio, newspapers and Internet. It's easy to get confused and worried. Is this something that will affect our family? What precautions do we need to take? What symptoms should we look for? When is treatment needed?

Health experts have agreed that the 2009 H1N1 flu outbreak is cause for concern, but not panic. Here is a summary of the most up-to-date information provided by the U.S. Centers for Disease Control and Prevention (CDC) as of November, 2009.

What is 2009 H1N1 Flu?
2009 H1N1 flu, first referred to as swine flu, is a new strain of Influenza A virus that causes respiratory disease in people. This flu outbreak started in spring 2009 and has currently spread all around the world.

How does the H1N1 virus spread?
Like the yearly seasonal influenza, this new flu virus is spread from person to person. When someone with the flu coughs or sneezes, the virus is sprayed into the air through droplets of fluid. Other people can catch the virus by breathing in the droplets. They may also catch it by touching a surface that the droplets landed on, like a tissue or a faucet, and then touching their own eyes, mouth or nose.

Is anyone at increased risk?
As with the yearly seasonal flu, young children, pregnant women, people with chronic medical conditions (such as diabetes, asthma, heart disease, and immune problems), and people 65 and older are at risk for more serious illness.

What should I do to protect my children and myself from getting the H1N1 flu?
Follow the same general recommendations as for seasonal flu:
  • Avoid close contact with sick people. If you're sick, keep your distance from others. Generally, 6 feet is a safe distance. When you're sick, stay home from work, child care, school and errands until at least 24 hours after the fever is gone.
  • Teach your children to cover their nose and mouth when they cough or sneeze. If you cover your mouth with your hand or a tissue, be sure to wash your hands immediately afterwards. It's best to cough or sneeze into your elbow to avoid getting germs on your hands.
  • Try to avoid touching your eyes, nose and mouth.
  • Wash your hands frequently with soap and running water, scrubbing for 20 seconds. When a sink isn't available, use alcohol-based hand sanitizers.
  • Practice good health habits. Get plenty of sleep, be physically active, eat nutritious food, drink plenty of fluids and try to manage your stress.
  • Talk with your doctor about getting the 2009 H1N1 flu vaccine for you and your children. Priority is given to pregnant women; family members and caregivers of babies under 6 months of age; young children 6 months to 5 years of age; and children and adults with chronic medical conditions such as diabetes, asthma, heart disease, or immune problems. The vaccine is made is a similar way as the yearly seasonal flu vaccine. There are two types of vaccine—an injected vaccine and a nasal spray—ask your doctor which is right for you and your children, based on your age and medical conditions. In addition to the 2009 H1N1 vaccine, the seasonal flu vaccine is also recommended.
  • What are the symptoms of H1N1 flu?
    Symptoms are similar to those of the seasonal flu:
  • Fever
  • Cough
  • Sore throat
  • Body aches
  • Headache
  • Chills and fatigue
  • Occasionally, vomiting and diarrhea
Infants may show fever symptoms such as low activity level and difficulty breathing. Sometimes bacterial infections may occur at the same time as or after infection with flu, leading to ear infection, sinus infection or pneumonia. The flu can be more severe in children with chronic medical conditions such as asthma, heart disease or immune problems.

To date, most of the children and adults in the United States who've had the flu have had mild symptoms. Although rare, severe pneumonia, respiratory failure and death can occur.

What should you do if you have symptoms of H1N1 flu?
Here are some general recommendations:
  • Stay home. Don't go to work and don't send your child to childcare or school. This will help you get the rest you need to recover and also prevent the spread of the illness to others. Stay home for seven to 10 days after the symptoms begin or until symptom-free for 24 hours.
  • Drink plenty of liquids: breast-milk or formula for babies and water, juice and soup broth for children and adults.
  • Get lots of rest.
  • Keep tissues and a trash bag for disposing used tissues within reach.
  • For fever, sore throat and muscle aches, you can use fever-reducing medicines, such as acetaminophen or ibuprofen. Follow your doctor's recommendation for the proper dose for your child's age. Do not give children aspirin—it can cause Reye's syndrome, a life-threatening illness.

Try to keep the healthy people at home away from the sick person. The sick person should wear a surgical mask around the house or when going to the doctor.

  • Are there special precautions for caring for someone with the flu at home?
  • Avoid having a pregnant woman care for the sick person. She may be at increased risk for flu complications.
  • Avoid visitors. A phone call is safer.
  • Try to keep healthy people at least 6 feet away from the sick person.
  • Try to avoid being face-to-face with the sick person. Hold a sick child with her chin on your shoulder so she doesn't cough in your face. The caregiver may gain some protection from wearing a surgical mask.
  • Wash your hands with soap and water and/or use an alcohol-based hand rub after every contact with the sick person, used tissues and his room and bathroom.
  • Make sure the sick person uses his own towel.
  • Clean toys and household surfaces frequently, including bathroom faucets, kitchen counters and dining tables. You can wash laundry and eating utensils, cups and dishes as usual.
  • Watch yourself and household members for flu symptoms, and contact your doctor if symptoms occur.

When does someone with the flu need medical attention?
Usually, someone with the flu will start feeling better after several days. However, if the ill person is not getting better, is getting worse or showing any of the following symptoms, get medical attention right away:

  • Difficulty breathing, fast breathing, continual cough, or chest pain
  • Bluish color of the lips or skin
  • Bluish color of the lips or skin
  • Severe or persistent vomiting
  • Signs of severe dehydration such as absence of urination or lack of tears when crying
  • Extreme irritability or seizures
  • Not waking up or not interacting
Also, if the sick person is in a group considered at risk for severe illness—a child younger than 5, a pregnant woman, someone with a chronic medical condition or someone age 65 and older—contact your doctor for advice.

What is the medical treatment?
The doctor will examine the sick person and determine whether H1N1 flu is likely. Nasal swabs to test for H1N1 flu may be taken. If the illness is severe and/or the patient is at risk for severe illness, antiviral medication may be given as pills, liquid or an inhaler. In case of severe illness, hospitalization, close monitoring and antibiotic treatment for additional bacterial infection may be needed. In some cases, the antiviral medication may be given to close contacts of the sick person to prevent illness.

How long can an infected person spread this virus to others?
Currently, health experts believe that the contagious period with H1N1 flu is similar to the seasonal flu: until approximately seven to 10 days after the start of symptoms.

Is it necessary to close childcare centers and schools for a case of H1N1 flu?
Since illness with H1N1 flu has generally not been as severe as originally feared, health authorities currently recommend closing childcare or school only if there has been widespread illness with H1N1 flu, not just a single case.

The CDC updates its website daily, so for current updates, visit cdc.gov/h1n1flu. In addition, your local county health department will provide you with up-to-date local reports of cases of flu and any local recommendations, such as closings of childcare centers or schools.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician