The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Frequently Asked Questions about H1N1 (swine) Flu for Parents of Children with Complex Medical Needs October 21, 2009 The Massachusetts Department of Public Health (DPH) has received many questions about H1N1 (swine) flu from families whose children have special health care needs. We hope that the following answers will be helpful. Please remember that your child's pediatrician and other health care providers are the most knowledgeable and best sources of information regarding concerns about your child's health. 1. Is the vaccine safe and how might it interact with existing medical conditions and necessary medications? All vaccines must be licensed by the U.S. Food and Drug Administration (FDA) before they can be used in the United States. Before the FDA approves a license, vaccines are tested extensively to ensure they are safe. Each year manufacturers identify the expected strain of flu and add it to regular seasonal flu vaccine. H1N1 (swine) flu vaccine is being made using the same processes and technology and by the same manufacturers as are used for regular seasonal flu vaccines with the addition of the H1N1 strain. If the H1N1 virus had appeared earlier, it would have simply been included in this year’s regular seasonal flu vaccine. Next year, it will likely be included in the regular flu vaccine. In addition, the Centers for Disease Control (CDC) and state health departments will be monitoring very closely for any signs that the H1N1 vaccine is causing unexpected adverse reactions, and the Vaccine Adverse Event Report System (VAERS) system is in place to report suspect events and investigate rapidly. Any questions regarding interactions with other medications or impacts on existing medical conditions should be discussed with your health care provider. 2. Where and when should my child be vaccinated? You should get your children vaccinated as soon the H1N1 flu shot becomes available. You can get it from your doctor or nurse, and from some pharmacies. Some communities will also provide flu shots at schools and local boards of health. Children under age 10 years will need two doses, spaced approximately 3 to 4 weeks apart. 3. If my child is sick can I get a rapid diagnosis of H1N1? Rapid influenza tests, used in some medical offices and emergency rooms, can help in the diagnosis and management of patients with signs and symptoms of flu. However, a rapid flu test can be negative even when someone has H1N1 flu (called a false negative result). So, negative rapid flu tests can not be used to say someone does not have H1N1 flu. All individuals with flu- like illness should be isolated for 24 hours after their fever has gone away without fever reducing medicines. This will likely take 3-5 days. 1 4. Should I keep my vulnerable child home if there is suspicion that anyone at school or child care has been exposed to or has confirmed H1N1 (swine) flu? It is important to talk to your doctor if your child has special medical needs as they may be at higher risk for complications from the flu. In general, state and local public health officials recommend that students can--and should--continue to go to school, as long as they are not sick and do not have flu symptoms. Flu-like symptoms include: fever (over 100.4 degrees F), with cough and/or sore throat. Additional symptoms of H1N1 (swine) flu include runny nose, stuffy nose, headache, body aches, feeling very tired, and sometimes vomiting or diarrhea. 5. Do I have the right to know if school, EI or day care staff has been exposed to or have a confirmed case of H1N1 before they come into contact with my child? Please be assured that the all schools and child care facilities are taking appropriate steps to limit the spread of illness. Flu is highly likely to be in the school but also in the community, whether or not there is a confirmed case. Parents should assume that they and their children could be exposed to this new flu at school, at work or anywhere else in the community. In order to limit the spread of H1N1 (swine) flu, DPH has recommended a policy focused on keeping all students and staff with symptoms of flu out of school and related school activities during their period of illness and recuperation, when they are potentially infectious to others. 6. Who prescribes Tamiflu and is it safe for children with complex medical issues? Tamiflu is only available by prescription from your healthcare provider and is indicated for the treatment and prevention of flu in people 1 year and older. Please talk to your doctor about any concerns you may have regarding Tamiflu and your child’s existing medical conditions. 7. Are there other medications that might help my child? All children aged 6 months through 18 years should get a seasonal flu shot every year. You should get your children vaccinated as soon the flu shot becomes available. According to the CDC, antiviral drugs can treat both seasonal flu and the new H1N1 (swine) flu. These drugs can make people feel better and get better sooner. But they need to be prescribed by a doctor and they work best when started during the first two days of illness. These drugs can be given to children. The priority use for these drugs is to treat people who are seriously ill or who have a medical condition that puts them at high risk of serious flu complications. 8. What should I look for to indicate that my child is sicker than expected with H1N1 (swine) flu? The symptoms of H1N1 (swine) flu virus are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with the H1N1 (swine) flu virus have also reported diarrhea and vomiting. According to the CDC, in children, emergency warning signs that need urgent medical attention include: • Fast breathing or trouble breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not waking up or not interacting 2 • Being so irritable that the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough 9. How can I find out if there are confirmed cases in my city or town? Stay informed by getting up-to-date information on swine flu and what you can do to keep your family healthy from the Massachusetts Department of Public Health at www.mass.gov/flu, the Centers for Disease Control website, www.flu.gov or the 24 hour toll-free information line that Massachusetts residents can call for general information about H1N1 (swine) flu. Just dial 211. 10. Are hospitals making plans to care for children who contract H1N1 and will local hospitals have the training and resources to care for children with complex medical needs? The state has been working hard to mobilize multiple agencies in health and public safety, including hospitals, to ensure that they are ready to provide needed care. If your child has complex medical needs, please speak with your regular doctor to develop a plan to prepare for a possible H1N1 (swine) flu infection. 11. In the event of a serious outbreak or epidemic where can I call to get the most up-todate information? Stay informed by getting up-to-date information on swine flu and what you can do to keep your family healthy from the Massachusetts Department of Public Health at www.mass.gov/flu, the Centers for Disease Control website, www.flu.gov or the 24 hour toll-free information line that Massachusetts residents can call for general information about swine flu. Just dial 211. 12. If there is less vaccine available than originally anticipated, will children and youth with special health care needs have priority over typically developing children to receive the vaccine? Prioritization for vaccination would be based on clinical conditions that might put a child at increased risk for complications from the flu. While some children with special needs will have these conditions, others will not. However, if there is adequate vaccine supply, all kids and youth, aged 6 months - 24 years should be vaccinated with the H1N1 (swine) flu vaccine and all kids up to age 18 years should be vaccinated with the seasonal flu vaccine. 13. Can a public school, day care or Early Intervention program exclude a child if another member of his/her family becomes symptomatic with influenza? At this time, state and local public health officials recommend that students can--and should-continue to go to school, as long as they are not sick and do not have flu symptoms. Flu-like symptoms include: fever (over 100.4 degrees F), with cough and/or sore throat. Additional symptoms of H1N1 flu include: runny nose, stuffy nose, headache, body aches, feeling very tired, and sometimes vomiting or diarrhea. 14. Are there any ways besides hand washing and use of hand sanitizer to minimize the transmission of H1N1? In addition to hand washing and the use of hand sanitizer which are both important ways to prevent the spread of flu, additional steps to be taken include: • Get both the H1N1 and seasonal flu shots. Vaccination is the best way to keep you and your child from getting the flu. 3 • Teach your children to cough or sneeze into their elbow—not their hands! Cover coughs and sneezes with tissues or by coughing into the inside of their elbow. They should wash their hands after blowing their nose or coughing into a tissue. • Teach your children to avoid touching their nose, mouth or eyes. They should keep their hands away from their face. • If you think your child is getting the flu keep them home. It is very important that your child does not go to school or other places where they could spread the flu virus to other people, such as group childcare, after school programs, the mall, or sporting events. 4