For Parents
Online H1N1 Chat Transcript from Oct. 23, 2009
H1N1 Chat with Dr. Nowalk
Transcript from October 23, 2009
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Dr_Nowalk: Thanks for joining me in the chat today! We have a lot of great questions, but so many that I can't answer each individual question. I am going to try to answer most questions that seem to be recurring in what people have asked. What I can start with is that we are in a real surge of H1N1 influenza here in Pittsburgh, as well as nationwide. The last CDC weekly report, which came out around noon, showed that the whole country is suffering from widespread flu. Most cases have remained mild, but we have seen a number of children hospitalized as well. You can check out the excellent CDC website at www.cdc.gov -- there is accurate, up-to-date information for people of all ages. The Pennsylvania DOH has a good site too (www.h1n1inpa.com) for information about the Keystone State and our efforts to fight this flu. Let's take some questions!
Michele: Is the Swine Flu vaccine safe for children?
Dr_Nowalk: A very important question. Yes, it is safe, and yes, it is effective. All of the data published from thousands of children and adults who have had the new vaccine have shown no difference in safety when compared to regular flu vaccine. So this vaccine works and is safe for children of all ages (and adults, too).
Mrs_NM: When do you expect the shot version of the vaccine to be available?
Dr_Nowalk: The nasal version (an attenuated live vaccine) and the shot version (an inactivated vaccine) are both available now. The different versions are available in at some offices. Finding vaccine will be a challenge as we all are waiting on the supplies which the government is distributing as fast as they can. Pennsylvania has received 400,000+ doses so far, and is sending them out primarily to community practices. If you go to a CCP practice here in Pittsburgh, check the CCP website at www.cc-peds.net to see if your local office has vaccine currently.
bellasmommy: My daughter has a history of respiratory issues and is on maintenance so I am really nervous about the H1N1. My doctor has told me that she should get the shot which has the dead virus as opposed to the mist which has the live virus. Is there still any risk of her getting sick if she gets the injection?
Dr_Nowalk: Your daughter should be well protected by the shot or inactivated, dead virus vaccine. Both versions of the vaccine are very effective.
kellyc: How long do you have to wait between seasonal flu vaccine and H1N1 vaccine? My children already received the seasonal FluMist®. When can they receive the H1N1 FluMist®?
Dr_Nowalk: If children receive the live vaccines, we recommend that they wait a month in between, based on the CDC data. However, they can receive a live and a killed at the same time, or two killed vaccines at the same time. The only issue of waiting comes up with the live vaccines together. There is a lot of seasonal (i.e. non-H1N1) vaccine still available, so get it now!
MomOfTwo: Please comment on the safety of the H1N1 vaccine. I've heard mixed reactions and want to be 100% sure this is what we should do for our children.
Dr_Nowalk: I know I answered this already but it is worth repeating. The vaccines are safe. The vaccines work. They will protect your children.
autumnbreeze: Is the H1N1 the only flu currently going around?
Dr_Nowalk: Yes, the novel H1N1 is the only strain going around. The good news is that it will end eventually. The bad news is that seasonal flu will likely come in at its regularly scheduled time in February and March. So make sure you get vaccinated against both!
wabash747: If you have been diagnosed with H1N1 or if you were suspected of having it, should you get the vaccine and how long should you wait to get it after the illness. Also if you have taken Tamiflu® is there a length of time you should wait until getting the vaccine?
Dr_Nowalk: Great question! If you have definitely been diagnosed with H1N1 influenza, you will not need the vaccine -- your body should make a good immune response to the infection. For the most part, we recommend that folks who have had the infection not get vaccine, to make more available for people at risk. As for Tamiflu® -- it will not interfere with the shot, and you need only wait about 72 hours after finishing a course to get the live vaccine.
HNFRIES: My 2 kids were to the Dr. this morning and I was told they both have influenza and h1n1 but he did not do a h1n1 test. How do I know for sure if it is h1n1?
Dr_Nowalk: This is a very popular question. If the illness is typical (fever, cough, muscle aches, sometimes diarrhea), the CDC and Children’s Hospital both recommend that a test is not needed. Since most illness is going to be mild, this is very appropriate (similar to seasonal flu, where we do not test routine cases).
Sick_of_the_Flu: On one hand, we're told that if your kids get the flu don't rush off to the pediatrician or the ER because most cases are able to be managed at home. On the other hand, it's reported that the best defense against severe complications is starting an antiviral medication within the first day or so of symptoms. These two pieces of advice seem to contradict one another. It seems to me that if you take the "watch and wait" approach you will likely miss the effective window for the antiviral and thus the opportunity to head off any severe complications. What is your advice?
Dr_Nowalk: First off -- great log in name. I feel the same way. As a parent, I too feel the catch 22 you are describing. It is a difficult line to ask parents to walk, but the truth of the matter is that we are seeing so many cases that if everyone with a question of the flu in their child went to get seen, offices and EDs would shut down. What we are asking is that if your child is healthy, has flu-like symptoms, but does not seem too sick, keep them home and let them recover. Children with severe medical problems, children who appear very ill (difficulty breathing, poor fluid intake or urine output) -- you should have those children seen. For the most part this flu hits quickly and problems should arise early if they are coming. If you become worried about how your child is acting or doing, get some advice, as always.
laura: My son is 11 months old. Do you think its a good idea for him to get the h1n1 shot and what are the side effects? And if he gets this should he still get the flu shot also?
Dr_Nowalk: This is a good question about age. To clarify, children 6 months and older can get flu shots -- so your 11-month-old is a great candidate. The side effects are similar across all groups -- sore and/or red arms are the most common by far; low grade temperatures next. Severe allergic reactions are extremely rare, and do not seem to be any more common with these vaccines. Some folks who get live vaccine will get sniffles and low grade temperatures a few days after, or might have some wheezing if they have asthma (which is why this is not recommended for asthmatics).
grmnkb: My daughter is 3 and was born with a congenital diaphragmatic hernia that is fixed but when she gets sick it goes straight to her lungs. They say this virus attacks the lungs. What should I look for if she get the H1N1 Virus with her history?
Dr_Nowalk: I picked your question because we want to be clear that children with medical histories like CDH, asthma, cerebral palsy, or immune problems (chemotherapy, organ transplant, etc.) are at high risk and are target groups for early vaccination. Many pediatric practices are focused on these children first, very appropriately. If you have a child with a chronic medical condition noted above, keep a close eye on them if they have the flu, and get advice and help as needed.
jason: I was wondering you opinion, I have a 1-year-old boy, do you recommend a H1N1 shot for him, and should you get the regular flu shot as well?
Dr_Nowalk: I'm repeating myself ... but for a good cause: get both vaccines. Children are being hit hard by H1N1, and we know they are always at risk from seasonal flu as well. Both vaccines are highly recommended.
billiejean: My son got the flu early this morning. Headache, sore throat, cough, fever, aches, upset stomach. I don't believe right now it is anything but typical flu symptoms so I don't think I should take him to the doctor's office. He is eating soup and drinking enough. Am I right should I just keep him home as long as things stay like this?
Dr_Nowalk: You are right on target! This is the mild illness I was mentioning earlier, which we are seeing TONS of. Most cases need just the supportive care you mentioned (soup is a great antiviral!). Most cases are feeling better in a few days.
shellik: Is the H1N1 vaccination recommended for women in early pregnancy and 2- year-olds?
Dr_Nowalk: This question is important for a reason: pregnant women. Although I am a pediatrician, all docs know that H1N1 has been really severe in pregnant women. So please get the shot whenever you can. And if you're pregnant, a great way to protect your family is to vaccinate the 2-year-olds (who are not the world's most notorious hand washers...).
kris5995: Once vaccinated, what are the chances you could still get H1N1?
Dr_Nowalk: The chances are still there but most people estimate the vaccine effectiveness of seasonal flu at 80-90%. Since the H1N1 vaccine is perfectly matched to the strain (which is not normally the case for seasonal flu), I am expecting even better effectiveness. Also -- if you do get flu, the vaccine likely reduces how severe your flu will be. So get it!
LisaD0512: Are there any risks or side effects from the H1N1 vaccine? My oldest child has DS and has had 2 open heart surgeries to repair complete AVSD. I want to do what's best for her and her siblings but I don't know what that is. Thank You.
Dr_Nowalk: What's best for her siblings but especially her is to get the vaccine. We know that kids with Down syndrome have increased issues with respiratory infections, so this is a crucial vaccine for her. The flu vaccines work in children with Down syndrome and most other syndrome without immune problems, so now is the time to get the shot. The CDC is really targeting kids like your daughter, as are most practices.
Jennifer: When will the vaccine be available, and how many shots does my child need?
Dr_Nowalk: The vaccine is available now, although supplies are limited right now. Many practices are vaccinating their high risk children first. Although the manufacturers recommend two shots for children under age 11, the vaccine produces a robust response with one dose in 75% of children, so many more past that will be protected as well. Get the first dose as you can and keep in touch with your practice about boosters.
Kristy: As a mom breastfeeding my 9-month-old, is it best for: her to get the shot, me to get the shot, both or doesn't it matter? Also, will she need two rounds of it a month apart like she does the seasonal flu vaccine?
Dr_Nowalk: A follow-up to previous questions -- both of you should get it. Get the first dose for her and you, then see what availability there is for boosters.
rebecca: When does the flu become serious enough to require a trip to the doctor?
Dr_Nowalk: This is a tough question for all parents. What I would say is that most children will be miserable, have muscle aches, sleep a lot, but do fine. What I would look for are signs of breathing problems (rapid breathing or difficulty breathing), signs of dehydration (not drinking or not peeing), or changes in their consciousness (difficult to wake or not making sense). Those signs should prompt a call in any child, high risk or not.
SusieS: I have been told that the nasal vaccine is not appropriate for my family, because my son has an immune deficiency. Could he be infected by the sneeze, etc. of a healthy classmate who has had the nasal vaccine?
Dr_Nowalk: Almost certainly not. The nasal vaccine is not virulent and does not shed like regular flu, so the danger is almost nonexistent.
robin: If my child already had the swine flu is it more likely that she will be susceptible to get it again ... this season or ever?
Dr_Nowalk: If you get it once, we feel very strongly that you will not get it again.
jeanine: I have a 12-year-old son with Cerebral Palsy. I have heard different things about H1N1 and special needs kids. Should he receive this?
Dr_Nowalk: Your son should absolutely receive vaccine and so should you. Children with CP are at special risk from data we have so far, so he really needs it.
parent: How long is someone contagious who has H1N1? And what is the best way to protect family members living in the same household as someone who has tested positive?
Dr_Nowalk: We believe that someone who has H1N1 sheds virus for several days during and then after the illness. The CDC recommends (and we agree) that having your family member who is sick stay away from other family is reasonable. Hand-washing is key, but covering your coughs and sneezes is just as important. These simple measures work, but as you all know it's often hard with children to limit spread completely.
MB: Do you expect "waves" of flu or just one long sustained outbreak. When do you anticipate the tide to end?
Dr_Nowalk: That's a great question! In truth we are all guessing ... but we can base this on what we know from the Southern Hemisphere. We think that the big surge (which we are in now) lasts for a couple of months, so I will guess we are about ½-way through (underline that as a guess). We will likely see cases sustained through the next few months until vaccinated and previously infected people become so common that we can't transmit through the community any longer. We have a while to go, I am afraid, but the vaccines will likely be the solution (something Australia and South America never had access to).
Jan: Will the seasonal flu shot help protect you at all from H1N1, or possibly make it a milder case?
Dr_Nowalk: We don't at this time think it helps very much. Most researchers think the only good protection was being exposed to influenza strains in the 1920s and 1930s -- so older folks for once are spared much problem with the flu!
MomOfTwo: Do you recommend Tamiflu® for treating young children? I've heard about nasty side effects.
Dr_Nowalk: We do recommend Tamiflu®, mostly for children who are pretty sick with H1N1. Again, routine flu cases that are doing well probably do not need much help (besides soup, as we noted before). However, we think that Tamiflu® (and the related drug Relenza®) have a role for very ill children in reducing the severity of illness. The side effects in children in general are less than in adults or teens.
mzeh2: How do I know if I had the H1N1 if my doctor's office is not testing?
Dr_Nowalk: Well ... you don't absolutely know, you're right. I won't dress that up for you. However, if your kids get a respiratory illness with cough, fever, some diarrhea, and then you get severe muscle aches which make you reach for Motrin®, as well as fevers to 102-103, and want to stay in bed all day ... it's probably influenza. There are not many viruses that act like that, and nothing else is epidemic right now like H1N1.
bpmom: Is it possible that one family member can have H1N1 without a fever while other members have fevers and more severe symptoms, or is it likely that they have two different viruses?
Dr_Nowalk: Another great question (that's why I can't stop this chat!). Flu like all illnesses is a spectrum, with mild, moderate and severe. We know well from the Southern Hemisphere that many cases did not have the totally typical flu. So your scenario makes me think that a) you had the H1N1 like they did, b) it was all the same virus, and c) you are very lucky. They will probably have you make the soup.
adamm: I have heard from other members of the medical community that the H1N1 vaccine can cause neurological problems. I'm sure any vaccine has some risks but can you please give some more info. I have also read the government has released any of the drug makers for this vaccine from liability should something happen.
Dr_Nowalk: The vaccine has not caused neurological problems that I have seen reported. With the intense media focus on the vaccine, I think it's unlikely this is happening without being reported (the media has hyped every other aspect of this). The flu vaccine is covered as are all vaccines by the National Vaccine Injury Compensation fund, so it is no different from other vaccines in that sense.
rd: Dr. Nowalk answered part of wabash747 question, but not the part of the question I had asked also which is regarding H1N1 vaccine for kids suspected of having H1N1 without confirmation. If H1N1 infection is confirmed I understand vaccine is not recommended.
Dr_Nowalk: Fair point. If H1N1 is suspected strongly my recommendation would be to not vaccinate.
christine_snyder: I am trying to get my son vaccinated, but the pediatrician said it is not available. I want to get him vaccinated -- how do I do this?
Dr_Nowalk: Keep a close eye on websites like www.cc-peds.net, where some practices are reporting their supplies. The state will continue to release vaccine constantly over the next few months. Just because they are out now, does not mean they will not get more supplies very soon (by soon I mean days and not weeks).
Mrs_NM: Another question please. My son, who is 6, had open heart surgery 18 months ago to repair a VSD. I was told he should not get the live vaccine. Do you agree?
Dr_Nowalk: He could get live vaccine, yes.
e1234: Why aren't peds testing to confirm H1N1? Aren't there benefits in knowing whether it is H1N1 versus seasonal flu?
Dr_Nowalk: I mentioned this before but boy is it a popular and tough question. Simply put, all the flu right now is H1N1. Simple cases which need only supportive care are not recommended for testing at this time. Patients who are sicker (especially when we see them here) are more frequently tested, but even here at Children’s Hospital we are not testing everyone we see with likely flu. I know it's frustrating, but mild illness likely does not benefit from testing.
jen: In response to rd question -- What if it's too late and your kids did have h1n1, but were vaccinated w/o knowing?
Dr_Nowalk: Great question! Vaccinating someone who had H1N1 already will have no bad effects, it will only boost their immunity.
Cyril1921: Is it true that the H1N1 is expected to cycle back again in January/February of 2010 and that it will be more virulent?
Dr_Nowalk: We don't think that H1N1 will cycle back as much as the regular seasonal flu will cycle up. Again -- get vaccines for both.
Mom3: There are many misinformed parents that I've spoken to out there. I've heard comments like increase your vitamin intake and you'll be fine. Does this concern you?
Dr_Nowalk: What a great question. I tend to think there are tons of very worried parents out there who are anxious to protect their children and do what's right. Regular nutrition and health only helps children's immune system. But for this virus, clearly vaccine is a huge help. Protecting your family from transmission through hand-washing and common sense avoidance is right. Checking out good information from CDC (www.cdc.gov) and Children’s (www.chp.edu) is a way to find out what's true and what's not. We are all worried and want to keep our kids safe, and we at Children's want to provide the information to help you.
marawink68: My 8 yr old daughter has iga nephoritis (a kidney disease). With every infection that she gets she gets more blood and protein in her urine which then damages her kidneys. I am trying to keep her safe from any illness because of this disease. So what I am asking is it better to take the chance that she gets this or any flu or take the chance with the vaccine?
Dr_Nowalk: Last answer from me -- any child with a chronic health condition should get vaccinated. Taking your chances with the flu when vaccine is available is like not using a seat belt for your child -- an unnecessary risk.
Dr_Nowalk: Thanks so much for all the great questions! Please keep checking our site and the states for information, and follow-up on your practice's website for their vaccine supply. More will be coming, and for the most part if you need vaccine you should be able to get it in the coming weeks. Thanks!
