PARENT QUESTION: H1N1 Flu Virus and Twins

By Khanh-Van Le-Bucklin, MD, FAAP, MOM
Created on Oct 16, 2009
Reviewed on Nov 07, 2009

I was recently interviewed by Lani, the mother of triplets and co-founder of the Multiples and More Blog Network. The following questions were from our interview.


PARENT QUESTION:

With flu season here, a lot of parents are really concerned with the H1N1 virus. Can you explain why this virus is such a serious concern when so many more people get terminally ill each year from the regular flu?

DR. LE-BUCKLIN'S ANSWER:

The new H1N1 virus (swine flu) is different from the regular (seasonal) flu in that it appears to affect younger people more severely. This fact is particularly important for families of young children or those expecting the birth of newborns this flu season.

Just today, the CDC (Center for Disease Control) reported that there have been 76 deaths in children attributable to H1N1 flu infection so far this year, with 19 of them reported during this past week. The seasonal flu typically kills about 46 to 88 children a year. At the current rate, H1N1 flu is likely to outpace the seasonal flu in its death rate among children.

It’s true that the majority of people infected with H1N1 flu will have a relatively mild course and will not require medical treatment. However, parents should know that H1N1 flu can be particularly serious in young children and this fact should be considered when deciding on flu vaccination.

PARENT QUESTION:

If a child gets sick, at what point should we start to suspect H1N1 versus just a regular cold virus?

DR. LE-BUCKLIN'S ANSWER:

In general, the symptoms of the common cold are milder than the flu (seasonal and H1N1). Children with colds are more likely to exhibit nasal symptoms such as a stuffy or runny nose. They may have low grade fevers and cough. The flu typically presents with high fevers, cough, and muscle aches. Nasal symptoms are usually less pronounced with the flu. Vomiting or diarrhea may be seen with H1N1 flu. That being said, it’s often difficult to tell if a child has a cold or the H1N1 flu because the symptoms may appear very similar especially with mild H1N1 flu.

Signs of a severe infection that may be attributable to H1N1 flu (or a secondary bacterial infection) include high fevers, trouble breathing, severe headache, excessive sleepiness or inability to be easily awakened, inconsolable irritability, rash with fever, inability to drink well, or a period of recovery followed by a recurrence of fevers and/or worsening cough. Children with these symptoms should be seen by a medical professional urgently.

PARENT QUESTION:

Do you recommend that parents and children consider getting immunized with the H1N1 vaccine? Exactly what level of protection can we expect when we get these vaccines? If we get an H1N1 vaccine, does that mean a regular flu shot is not necessary?

DR. LE-BUCKLIN'S ANSWER:

The regular and swine flu vaccines are two different vaccines. A person needs both vaccines to be maximally protected from both viruses. Early testing of the H1N1 flu vaccine shows that over 90% of recipients who received two doses of the H1N1 flu vaccine developed a protective level of antibodies against the H1N1 virus. The CDC recommends the flu vaccine (H1N1 and seasonal) for anyone who wants it. In addition, they consider the following groups at the highest priority level for getting vaccinated for H1N1 flu: pregnant women, caretakers of infants less than 6 months of age, children less than 5 years of age, health care workers, and children/adolescents 5 to 18 years old with chronic medical conditions (including asthma, diabetes, heart conditions, and immunodeficiency). Those in the high risk category for H1N1 flu are also at high risk for seasonal flu.

PARENT QUESTION:

Is the H1N1 vaccine safe for pregnant women?

DR. LE-BUCKLIN'S ANSWER:

The H1N1 vaccine is made in the same way as the regular flu vaccine. The CDC considers the H1N1 flu vaccine to be safe for pregnant women. In a recent report by the CDC, 7% of patients hospitalized for H1N1 flu were pregnant women. This is a significant level of risk considering that pregnant women only make up 1% of the general population. Because pregnant women and babies are considered at high risk for serious infection, the CDC recommends that pregnant women be vaccinated against both seasonal and H1N1 flu to protect themselves and to afford protection to their newborns who can’t be vaccinated (the minimum age for flu vaccination is 6 months).

PARENT QUESTION:

What precautions should parents take if there is an outbreak of H1N1 in their child’s school?

DR. LE-BUCKLIN'S ANSWER:

If an outbreak occurs at a school, the local public health department can help provide recommendations for how to reduce the spread of H1N1 at that school. Parents can reduce their child’s individual risk of infection by vaccinating their children.

In general, schools can help reduce the risk of widespread infection by making sure children and caretakers stay home if they are sick with a fever. Children and caretakers with fever should stay away from school until 24 hours after their fever has resolved (without the use of any anti-fever medications such as Tylenol or Motrin). Children should be taught to cough or sneeze into a tissue rather than into their hands. Caretakers should follow this same precaution. Regular handwashing and/or the use of hand sanitizers by children and staff are also crucial preventive measures.

PARENT QUESTION:

With the holidays approaching, and therefore lots of large family gatherings, what guidelines do you recommend that parents of preemies follow to avoid having their children get sick?

DR. LE-BUCKLIN'S ANSWER:

For large family gatherings, I recommend having hand sanitizer all around the home and having everyone use it upon entry to the home and before holding babies. Avoid having visitors who have symptoms of an infection, including fever, runny nose, cough, sore throat, vomiting, or diarrhea. Timely vaccination of premature babies is also important in reducing their risk of serious infections.

PARENT QUESTION:

RSV is, of course, another concern for parents of young children. Is there an age that, once reached, we can relax a little about RSV, i.e., if contracted, the consequences will not be as serious?

DR. LE-BUCKLIN'S ANSWER:

RSV (respiratory syncytial virus) is most serious in children under one year of age, with infants less than 6 months of age being the most severely affected. After one year of age, the chance of severe RSV infection is relatively low in otherwise healthy children.