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Should Your Child See a Doctor?

Swine Flu (H1N1 Flu) Exposure

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Definition

  • Exposure (Close Contact) to person with Swine Flu (H1N1 Flu)
  • Questions about Swine Flu
  • Your child has NO symptoms of Swine Flu (no fever, cough, sore throat, runny nose)
  • Children with symptoms of Swine Flu following Exposure (Close Contact) should be managed using the Swine Flu (H1N1 Flu) topic

Exposure (close contact) to swine flu definition

  • HOUSEHOLD CLOSE CONTACT: Lives with a person with Swine Flu.
  • OTHER CLOSE CONTACT (within 3 feet, 1 meter; touching distance) with a person with Swine Flu. Examples of such close contact include kissing or embracing, sharing eating or drinking utensils, close conversation, and any other direct contact with respiratory secretions of a person with Swine Flu. Includes being in the same child care center room or carpool.
  • NOT CLOSE CONTACT: In same building. Activities such as walking by a person or sitting across a waiting room from a person with Swine Flu for a brief period of time (per CDC May 2009). Being in the same school, church, workplace or building also is not Close Contact.
  • NOT CLOSE CONTACT: In same community. Lives in a community where there are one or more confirmed cases of Swine Flu is not an Exposure. Living in the same state or country (e.g., Mexico) carries even less risk.

High-risk children for complications from swine flu

Children are considered HIGH-RISK for complications if they have any of the following conditions:

  • Lung disease (such as asthma)
  • Heart disease (such as a congenital heart disease)
  • Cancer or weak immune system conditions
  • Neuromuscular disease such as muscular dystrophy, cerebral palsy, epilepsy.
  • Diabetes, sickle cell disease, kidney OR liver disease
  • Diseases requiring long-term aspirin therapy
  • Pregnancy
  • Healthy children under 2 years old are also considered HIGH-RISK (CDC: September 2009).
  • Note: All other children are referred to as LOW-RISK

Swine flu (H1N1 flu): General information

  • Cause: The H1N1 virus is a combination virus that contains genes from swine flu, avian flu and human flu. Cases of swine flu in humans were first detected in Mexico during March 2009. An outbreak of swine flu in humans occurred in the U.S. and Canada in April 2009. By June 2009, the WHO declared it a global pandemic.
  • Severity of Symptoms: Symptoms of swine flu can be mild to severe, just as with regular human flu. Thus far in the US and Canada, the symptoms have generally been mild to moderate.
  • Transmission: The swine flu virus is spread via airborne droplets, from sneezing and coughing, just like other influenza viruses. It also can be transmitted by hands contaminated with secretions. It no longer has anything to do with pigs; it is only spread person-to-person. Swine flu is NOT transmitted by eating pork.
  • Expected Course: Like regular flu, the fever lasts 2-3 days, the runny/congested nose 1-2 weeks and the cough 2-3 weeks. With some flu viruses, the fever lasts 4 or 5 days.
  • Contagious Period: A person is contagious for 1 day prior to and for 7 days after the onset of symptoms (e.g., the fever and cough).
  • Incubation Period: After exposure, a person will come down with swine flu symptoms in 4 to 6 days (5 days on the average). An outer limit rarely could be 7 days. This virus has a longer incubation period than seasonal flu (1 to 3 days).
  • Attack Rate: The chance of getting swine flu depends on the degree of exposure and is always higher for household contacts. While the attack rate is unknown for this virus, it should be high (20-50%) because there is no natural immunity to swine flu viruses.
  • Diagnostic Test: At this time, testing is mainly indicated for patients with severe disease (CDC, May 2009). Accurate testing takes 2 or 3 days.
  • Treatment: See below.
  • Prevention: Prevention measures include avoiding sick people and crowds (social distancing). Hand washing is very important. A complete list of preventive tips is available on the CDC website.
  • Vaccine: The best way to prevent Swine (H1N1) Flu is to get a yearly, seasonal flu vaccine. This year, H1N1 is included in the regular flu vaccine and no separate flu shot is needed.

Prescription antiviral drugs for swine flu

  • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the start of flu symptoms. They can be started later in some cases.
  • The CDC recommends they be used for: 1) any patient with severe symptoms AND 2) for all HIGH-RISK children (see that list) with any flu symptoms.
  • The CDC doesn't recommend antiviral drugs for LOW-RISK children with mild or moderate Swine Flu illness.
  • Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not cure the disease.
  • Side effects: Vomiting in 10% of children.

Internet resources for the U.S.

When to Call Your Doctor for Swine Flu (H1N1 Flu) Exposure

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • Swine Flu EXPOSURE (Close Contact) within last 7 days AND your child is HIGH RISK for complications of flu (age under 2 years OR underlying heart or lung disease OR weak immune system, etc) (see that list)

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Age over 6 months and needs flu shot

Parent care at home if

  • Swine Flu Questions
  • Swine Flu Prevention
  • Tamiflu Questions
  • Swine Flu EXPOSURE within the last 7 days AND NO Symptoms
  • Swine Flu Minor Contact (same school or gathering, etc) BUT No True EXPOSURE (Close Contact) AND NO Symptoms

Home Care Advice for Swine Flu (H1N1 Flu) Exposure

Swine flu questions

  1. Swine Flu — General Information:
    • An outbreak of Swine Flu in humans started in Mexico and the U.S. in April 2009.
    • By June, it had spread to most countries in the world.
    • So far, this Swine Flu virus is not as dangerous as feared.
     
  2. Swine Flu — Symptoms:
    • The symptoms of Swine Flu are the same as those seen with regular human influenza.
    • The main symptoms are fever, cough, sore throat and runny nose.
    • Fever is usually present.
    • Other common symptoms are muscle pain, headache and fatigue.
    • Some people also have vomiting and diarrhea, but never as the only symptom.
     
  3. Swine Flu — Diagnosis and Flu Tests:
    • If Swine Flu is widespread in your community and your child develops flu symptoms with fever, then he or she probably has Swine Flu.
    • Your child doesn't need any special tests.
    • You should call your doctor if your child is HIGH-RISK for complications of flu: 1) under 2 years of age OR 2) has underlying health problems. (e.g., see the HIGH-RISK list)
    • For LOW-RISK children, you don't need to call or see your child's doctor, unless your child develops a possible complication of the flu.
     
  4. Swine Flu — Treatment:
    • Tamiflu (oseltamivir) is the main antiviral drug used to treat Swine Flu in children.
    • Treatment is recommended for any patient with severe symptoms AND for HIGH-RISK patients (see that List) with any flu symptoms.
    • Treatment is generally not recommended for LOW-RISK children with mild to moderate Swine Flu illness (per CDC).
    • Most patients recover without taking Tamiflu.
     
  5. Swine Flu — Contagiousness and Return to School:
    • Symptoms usually start within 4-6 days of exposure to a person with swine flu (7 days is an outer limit). If more than 7 days pass from exposure without your child developing symptoms, your child should be safe and not get swine flu.
    • Keep your child home and out of child care or school for at least 24 hours after the fever is gone (CDC: August 2009).
    • The Swine Flu virus is spread by airborne droplets, from sneezing and coughing, just like other influenza viruses. It also can be transmitted by hands contaminated with secretions.
    • Swine Flu is NOT transmitted by eating pork.
     
  6. Call Your Doctor If:
    • You have other questions or concerns
     

Swine flu prevention

  1. How to Protect Yourself from Getting Sick:
    • Wash hands often with soap and water.
    • Alcohol-based hand cleaners are also effective.
    • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
    • Try to avoid close contact with sick people.
    • Try to avoid unnecessary visits to the ER and urgent care centers because those are the places where you are more likely to be exposed to Swine Flu, if you don't have it.
     
  2. How to Protect Others — Stay Home When Sick:
    • Cover the nose and mouth with a tissue when coughing or sneezing.
    • Wash hands often with soap and water, especially after coughing or sneezing.
    • Limit contact with others to keep from infecting them.
    • Stay home from school or work for at least 24 hours after the fever is gone (CDC, August 2009).
     
  3. Face Masks:
    • Face masks refer to disposable masks labeled as surgical or dental masks.
    • For healthy people, face masks may help reduce the risk of getting swine flu in crowded settings, if Swine Flu becomes prevalent (CDC).
    • Avoiding sick people and frequent handwashing are more effective preventive measures.
    • At the present time, face masks are not needed in the U.S. for healthy people. (Possible exception: households where a family member has Swine Flu).
    • Sick people should wear a face mask if they must leave their home to seek medical care.
     
  4. Vaccine:
    • The best way to prevent Swine (H1N1) Flu is to get a yearly, seasonal flu vaccine.
    • This year, H1N1 is included in the regular flu vaccine and no separate flu shot is needed.
     
  5. Anti-Viral Medication:
    • Tamiflu can be used for prevention following close contact with a person who has Swine Flu.
    • It is only recommended for HIGH-RISK patients (CDC).(see that list)
     
  6. Call Your Doctor If:
    • You have other questions or concerns
     

Tamiflu questions

  1. Treating Swine Flu — Tamiflu:
    • Tamiflu can reduce the symptoms of Swine Flu illness.
    • Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not cure the disease.
    • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the onset of flu symptoms.
    • Indications: Severe symptoms OR underlying health problems (HIGH-RISK group)
    • Most patients have mild to moderate symptoms and Tamiflu treatment is not necessary.
    • Unnecessary overuse of Tamiflu causes resistant strains of the virus. (8/2009 some resistance has occured)
    • Tamiflu also has side effects: Vomiting in 10% of children.
     
  2. Preventing Swine Flu — Tamiflu:
    • The drug Tamiflu may help prevent Swine Flu (prophylaxis).
    • Indications: Recent close contact with person with confirmed Swine Flu AND the exposed person is in HIGH-RISK group (age under 2 years, underlying heart or lung disease, weak immune system, etc) (CDC)
    • It is effective only while your child is taking it and ceases once your child stops taking it.
    • Your child should only take Tamiflu if your child's physician recommends it.
     
  3. Personal Stockpiling of Tamiflu Not Recommended:
    • Definition: Some people request a prescription for Tamiflu for all family members just in case they come down with flu symptoms. They currently are well and have not been exposed to Swine Flu.
    • Doctors are opposed to this practice, as is the CDC and your State's Public Health Department.
    • The supply of Tamiflu is limited and needs to be kept available for patients who have severe symptoms OR have underlying health problems.
     
  4. Call Your Doctor If:
    • You have other questions or concerns
     

Swine flu exposure within the last seven days and no symptoms

  1. Reassurance:
    • Although your child was exposed to Swine Flu, your child does not have any symptoms.
    • Symptoms usually develop within 4-6 days of exposure to another person with swine flu (7 days is an outer limit).
    • Most likely your child will not get Swine Flu.
    • Even if your child did develop symptoms of Swine Flu, at this time, anti-viral treatment (Tamiflu) is not indicated for LOW-RISK children.
    • So far, the symptoms of Swine Flu have been mild to moderate and the same as those seen with regular human flu.
    • Patients recover from Swine Flu with supportive symptom care.
     
  2. Call Your Doctor If:
    • You have other questions or concerns
     

Swine flu minor contact (same school) but no true exposure (close contact) and no symptoms

  1. Reassurance:
    • To catch Swine Flu, your child would need to have close contact with an infected person.
    • Close contact includes kissing or embracing, sharing eating or drinking utensils, close conversation, interactions within 3 feet (1 meter), being in the same child care group or car pool, etc.
    • Because your child did not have close contact, it is highly unlikely that he will develop Swine Flu.
    • Even if your child did develop symptoms of Swine Flu, at this time, anti-viral treatment (Tamiflu) is not indicated for LOW-RISK children.
    • Patients recover from Swine Flu with supportive symptom care.
     
  2. Call Your Doctor If:
    • You have other questions or concerns
     

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review: 9/1/2010

Last Revised: 9/1/2010 10:49:33 AM

Copyright 1994-2010 Barton D. Schmitt, M.D.

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