For Parents
Online H1N1 Chat Transcript from Nov. 6, 2009
H1N1 Chat with Dr. Nowalk
Transcript from November 6, 2009
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Dr_Nowalk: Welcome to the H1N1 influenza chat. I am Andy Nowalk, one of the infectious disease specialists here at Children's. I am happy to say today that (compared with our last chat two weeks ago) things seem to be improving in Pittsburgh and nationally. A good report in the PG yesterday (http://www.post-gazette.com/pg/09309/1011003-488.stm) shows that local rates may be declining. Our own ER is a little less stretched, and more vaccine is available. Since we have a lot fewer folks lined up for this chat than last time, I will try to answer all of your questions. Let's begin!blueeyes: My 6-month-old son received his first dose of the h1n1 vaccine on 11/4/09 at his CCP office. However, they advised us we couldn’t schedule a 2nd dose appointment b/c they do not plan on giving them out (for this or the seasonal flu). They said they want to get everyone 1 shot first and they don’t know that they’ll even be getting anymore in. Considering that children under 9 years old need two doses, why did I bother exposing him to the risks of one shot (both H1N1 and seasonal) if he won’t even be able to receive a second shot of them? I’ve read that one shot offers no protection, then I’ve read it offers “some” protection. Again, why would my pediatrician’s office expose him to vaccines for the flu, seasonal and H1N1, when they do not plan on fully vaccinating him against them? What, if any, immunity will he receive from the first shots of the vaccines? And in terms of a %, for example 60% immunity, what exactly does that mean? You either get sick when exposed to the flu or you don’t- how do you only get 60% or 40% sick? And how long does it take for those first shots of the vaccine to take “effect” and offer protection, and for the second? Is it an immediate response or do the vaccines take days or weeks?
Dr_Nowalk: This is a long question but let me summarize the main issue: with vaccines being short in supply right now, is there any benefit to a single dose. The answer is -- Yes!! Absolutely. This is a safe and effective vaccine, and 75% of children will respond to the first dose in recently published work. So any dose is a good one; the second dose is recommended to boost response levels above 90% in all children. The vaccine does provide protection which sometimes is not absolute -- but we know that flu vaccine reduces the severity of flu dramatically, even if you are not fully protected. So the bottom line -- safe, effective, and get a dose wherever you can.
CCN: Please advise as to extra precautions necessary to protect children who are medically fragile, are undergoing chemotherapy, have suppressed immune systems, etc. What should those in medical settings do to lower the risk for these patients? What can educators of patients do to minimize their exposure? How can medical and educational personnel work together to protect these children? Thank you.
Dr_Nowalk: We certainly know these children are high risk. Common-sense measures will work well, however. Wash your hands -- a lot! Also, if you are a household contact of such a child, get vaccinated when you can. If you are a health care worker of any type, get vaccinated and protect yourself and your patients. And if you are a teacher or educational contact, wash your hands and above all STAY HOME IF YOU GET ILL. We really recommend staying home or isolated for at least 24 hours past the end of your fever. It's the best way to prevent spreading things on.
gerdes: I know others who are getting their children vaccinated for H1N1 without a problem here in the Pgh area. Do you have any idea when the vaccine might be available in the CCP offices? Right now it only appears to be available in 3 of the 27 offices. I have heard that the spread seems to be slowing down some, but a second wave might be coming. What are your thoughts on that?
Dr_Nowalk: The vaccine supply question is our most popular. There is more coming literally every day, as Pennsylvania has now received 900,000+ doses for our state. If you go to a CCP practice, check their daily updates on www.cc-peds.net for their individual office supplies. More is coming, I promise! As to further waves -- it may not be as prominent but H1N1 will be around all winter. I would continue to try to get vaccine anytime you can until we are done with both flu seasons, this one and the one coming in January-February.
maryanne: Will this session be archived for review later?
Dr_Nowalk: Absolutely. A transcript will be posted in a few hours after we are done.
swine_dad: My daughter got very sick last week and had all the symptoms of H1N1 flu, including a very high fever. However, she was not tested. She is high-risk in that she has asthma. So not knowing whether she definitely had H1N1 but suspecting she did, should I get her vaccinated or not?
Dr_Nowalk: This remains a tough question. If she had contacts with H1N1 and had high fevers, cough, muscle aches, and was really wiped out, it was likely H1N1. If you have had the infection, you do not need the vaccine. However, if you have any doubts -- get her vaccinated. A dose of vaccine after natural infection will not hurt. We have seen a lot of sick kids with asthma nationally with this H1N1 strain, so we are worried about all of them.
UnsureMom: My son's asthma is induced by colds. The Pediatrician recommends that he get the vaccine, but I worry about that it is so new, the mercury and past vaccine links to GBS. What are the findings of the studies done so far? How much of the mercury-free injectible vaccine is being produced?
Dr_Nowalk: There is not a lot of mercury-free vaccine out there. The monitoring so far does not show any increase in GBS above the base national rate, which is 1 in a million (so about your chance of being struck by lightning). The studies so far show the vaccine is safe, and works well in producing protection. Check out the CDC site with some data on thimerosal for more info (http://www.cdc.gov/Flu/about/qa/thimerosal.htm).
swine_dad: I have heard that because H1N1 is circulating, we may not see much seasonal flu. Is that true and if so, what is thinking behind that?
Dr_Nowalk: We do expect a full flu season to follow, mostly because this one started so early. When H1N1 really tires out around December-January, we expect seasonal to pick up, and are monitoring closely for its appearance. So make sure to get both vaccines if you can.
JenH: Three weeks ago our whole family came down with the flu. My youngest son and husband were tested and the rapid result came back positive for Type A. We were told since H1N1 was the strain going around, that was most likely what we had (symptoms were all there). So now that we've had it, do we need the vaccine? I've read and heard conflicting answers on this.
Dr_Nowalk: If you all had it, you do not need vaccine. The natural infection protects you against reinfection.
12345: Why aren't doctors testing for H1N1?
Dr_Nowalk: A simple reason -- we have run out of the ability to test everyone because it is so common. We are still recommending testing the very high risk (i.e. pregnant women), and most of those who are being admitted to the hospital. But not all. There have just been so many cases we have exceeded our ability to test everyone.
Melissa: I am sure I am not the only worried mother with this question, but I have been trying for several weeks to get my daughter vaccinated (she will be 2 years old in four days). It seems impossible to find. Our pediatrician’s office is waiting on shipment with no further information. Health Dept and CDC are unable to help or tell me anything. No pharmacies have it, and every office that I find that does have it is only giving it to established patients. Do you have any thoughts or advice?? Thank you!
Dr_Nowalk: My advice is to keep trying. You can try calling the state hotline at the Pennsylvania Department of Health at 1-877-PA-HEALTH (1-877-724-3258). Otherwise, the CCP site is good as well. The only silver lining is that we are getting hundreds of thousands of new doses per week. There should be more available soon.
Cheryl_W: How can find vaccine for my two 4 year old daughters? Most of my co-workers have gotten vaccines for their kids from their pediatrician, but mine doesn’t have it. Thank you.
Dr_Nowalk: Please see my previous answer. Keep in touch with your pediatrician's office, check the website, or call the hotline. Right now we do not have quite enough to meet demand, but that will change in the near future.
mackre: My daughter just became ill yesterday with the fever, cough, vomited during the night. Called the pediatrician and they said to just treat the fever, plenty of fluids and rest. Do you have any other advice? She is 14 years old, about 100 pounds. No underlying medical conditions. Also, my 19-year old son is home from college, has history of mild asthma and has not had the H1N1 vaccine. Do you have it available, the pediatrician does not?
Dr_Nowalk: Your pediatrician's advice is good advice -- the vast majority of kids with H1N1 need not more than that. Healthy children with mild symptoms should do fine. If they change at all -- trouble breathing, difficulty staying hydrated, changes in their consciousness -- have them seen immediately. We at Children's only have vaccine for our hospitalized patients right now, not for general distribution.
Cheryl_W: Are there any proven serious complications or deaths of those who have received H1N1 vaccine now that millions of doses have been given?
Dr_Nowalk: I have not seen any reports of deaths or complications. We have distributed something like 15-20 million doses nationwide thus far. At a large infectious disease meeting last week in Philly, the CDC did not say they were seeing anything worrisome in their monitoring. However, we are all going to watch this with a very close eye -- every doctor in the US wants to be sure we are observing how the vaccine is doing.
Melissa: A second question, if you have time: If my child develops flu-like symptoms, can I be assured that whether or not it's H1N1 can be determined? I understand getting her the vaccine after she's already had the illness is pointless.
Dr_Nowalk: You can't be 100% sure of whether it was H1N1 without a test. However, this has been contagious enough that if they had a contact with H1N1, it's very likely.
maryanne: If someone has had a laboratory-verified case of H1N1 flu, is there any value in getting the vaccine? If someone has had a suspected or likely case that was not laboratory-verified, should that person get the vaccine? I'm thinking ahead to the spring when we might have another round of H1N1 flu.
Dr_Nowalk: If you had lab-verified H1N1, you don't need it. If you had a likely case, you probably don't. But I would discuss with your doctor how likely your exposure and illness was to be H1N1. We will be seeing H1N1 for a while longer, so I would err more on the side of getting vaccines in most cases.
CCN: A colleague in Ohio told me that a CDC contact in her area warned that the "worst is yet to come" for them. Do you have any reason to believe a stronger version of the virus may hit our area again?
Dr_Nowalk: I don't have any reason to think that. The "worst" they may be referring to is that we are still due for both a regular flu season as well as RSV season. Just because we had H1N1 does not mean our winter will be slow. Thus my harping on getting seasonal vaccine as well.
MCorcoran: I am a CRNA at UPMC Presbyterian. Both my husband and I are in health care and would like to receive the HINI vaccine but it is not currently being offered at UPMC Presby. Can you tell me what my best course of action to receive the vaccine may be? Is it being offered at Children's and if so am I able to receive it since I am a UPMC employee that may rotate to Children's in the near future?
Dr_Nowalk: The short answer here is that you need to check with Employee Health at your hospital -- the system is also getting more doses of vaccine all the time so availability may change rapidly for you. But you'll need to check with your home hospital.
Tomko: I have a 2 yr 10 month year old and a 10 month old, we believe they both just got over the H1N1 after five days of a high fever and today being the first day they are normal. The 2 year old is scheduled for the seasonal flu mist; the 10 year old is scheduled for the second shot of the seasonal flu. Should they get the vaccinations tomorrow?
Dr_Nowalk: Yes. There should be no interference between H1N1 and the response to the seasonal shot (if there was, we would have had an easier time because of all the seasonal vaccine we gave prior to the H1N1 surge).
mcd0505: Have you seen a decrease in cases in our area?
Dr_Nowalk: Yes, we have. Again, see this good article: http://www.post-gazette.com/pg/09309/1011003-488.stm. This matches what our ER has been seeing -- a decline in cases.
dekowal29: What is the rule about someone born in 1957 and having some immunity? I have a 2 heart defects and a bad lung, should I get the vaccine?
Dr_Nowalk: You probably have some immunity. However, we know the vaccine is hitting asthmatic and people with lung disease harder, so you should probably get the vaccine.
maryanne: The news this week had a story about H1N1 found in a cat. Does this mean anything in terms of future infections? Will future H1N1 vaccine need to be re-made every year, just like seasonal flu vaccine?
Dr_Nowalk: I would not worry too much about your cat. If your snot covered 2 year old son wants to cough on you, that's when I would worry. As for the second question -- I suspect we will be adding this to the mix of the seasonal flu shot for years to come (the seasonal flu shot is a mix of three common strains).
anjali: How many weeks/days later does the vaccine become effective?
Dr_Nowalk: It takes 10-14 days for full immunity to develop.
kjl: I work at Children's. If a parent contacts us looking for somewhere to get the H1N1 vaccine for their child who is at high-risk, what should we tell them? Her pediatrician office will not be getting the vaccine.
Dr_Nowalk: We do have vaccine for some of our outpatient clinics. If you have a high-risk patient, they should be able to come to their clinic here and get a dose.
Dr_Nowalk: Thanks once again for all the excellent questions! There is more vaccine coming, so please check all the sources I listed for continuing updates. Wash your hands, get your vaccine when you can, and rest a little easier this week -- we might just be past the worst of H1N1. Have a good weekend!
