7Flu Team Frequently Asked Questions

H1N1 flu (called "novel H1N1", "pandemic H1N1" and "swine flu") is a new strain of influenza ("flu") virus causing illness in people. In April 2009 this specific type of H1N1 flu was first reported in the United States. H1N1 flu has now been found in many other areas of the world.

H1N1 flu is not the same as "seasonal" flu which occurs every year, during the winter and early spring, however H1N1 flu causes symptoms that are usually similar to seasonal flu, is spread like seasonal flu, and can be prevented like seasonal flu.

H1N1 flu can be very serious. In the U.S., several thousand people were hospitalized and several hundred died between April and August, 2009. Because H1N1 is a new virus, our bodies have not built up any resistance to it. That is why so many people may get sick. Like seasonal influenza, H1N1 can cause mild to severe illness in most people, but certain people are at "high risk" of serious complications. People at high risk of serious H1N1 influenza complications include:

• Children younger than 2 years old*
• Adults 65 years and older
• Pregnant women and women up to 2 weeks from end of pregnancy
• People with certain chronic medical conditions (such as asthma, heart failure, chronic lung disease) and people with a weak immune system (such as diabetes, HIV)
• People younger than 19 years of age who are receiving long-term aspirin therapy

*It is also important to know that children who are 2 years though 4 years of age also have a higher rate of complications compared to older children, although the risk for these children is lower than the risk for children younger than 2 years.

• Seasonal flu is caused by different flu viruses than H1N1 flu.
• Seasonal flu occurs every year, most often during the winter and early spring, while H1N1 has been seen in the late spring, summer and fall of 2009 so far
• Because H1N1 is a new virus, our bodies have not built up any resistance to it. That is why so many people may get sick.
• Seasonal flu most severely affects people 65 years and older, whileH1N1 is also currently being seen more often in children and young adults between the ages of 5 and 24 years old

Symptoms are similar to seasonal flu and include fever, cough, sore throat, muscle aches, headache, chills and general weakness. Some people also have diarrhea and vomiting. These symptoms can range from mild to severe. Generally, flu symptoms last three to seven days.

The flu and the common cold are both respiratory illnesses but they are caused by different viruses. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness and dry cough are more common and intense with the flu. Colds tend to develop gradually, while the flu tends to start very suddenly. People with colds are more likely to have a runny or stuffy nose.

No. People often get confused about the differences between the flu and a "stomach bug." These illnesses are very different. Flu is an illness of the respiratory system, including the nose, throat and lungs. Symptoms include fever, cough, sore throat and a stuffy or runny nose. Flu symptoms may include vomiting and diarrhea in some people. A "stomach bug" is an illness of the body's gastrointestinal system (stomach and intestines) caused by different germs. Symptoms of a "stomach bug" include nausea, diarrhea and vomiting, and usually do not include cough, sore throat, and runny or stuffy nose

There is no need for children and adults with mild flu symptoms to be tested for the H1N1 flu virus. Testing does not usually affect treatment or medical advice. Most people with the flu who are generally in good health will recover without needing to visit a doctor. People with severe symptoms may be tested for H1N1. People with underlying or chronic medical conditions, such as diabetes, asthma, heart disease or weakened immune systems, should talk to their doctor if they develop flu symptoms to ask if they should be tested.

Seasonal flu is a disease of the body's breathing system, including the nose, throat and lungs. Flu is short for "influenza." Seasonal flu is caused by a virus.

In New England, the yearly flu season usually begins in late fall and lasts through March. Seasonal flu is a little different from "H1N1" flu, which was first recognized during April of 2009 and quickly spread to many parts of the world (becoming a "pandemic" or global outbreak). But seasonal flu causes symptoms like H1N1 flu, is spread like H1N1 flu, and can be prevented like H1N1 flu.

The most common symptoms of flu are fever, cough, and sore throat. They can also include body aches, headache, chills, runny nose and feeling very tired. Some people also have diarrhea and vomiting. Symptoms last from a few days to up to a week or more.

Seasonal flu can be very serious. Every year in the U.S. seasonal flu causes thousands of hospital admissions and deaths. Some people are at higher risk of serious health problems when they get the flu. This includes pregnant women, infants, the elderly and people with medical conditions like asthma, diabetes, heart disease, kidney disease and weakened immune systems.

Every year in the United States, on average:

• 5% to 20% of the population gets seasonal flu;
• more than 200,000 people are hospitalized because of seasonal flu complications, and;
• about 36,000 people die from seasonal flu

Both seasonal and H1N1 flu are able to spread easily from one person to another. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza.

People also can get the flu by touching something (a phone, door knob, toys) with the flu germ on it and then touching their mouth or nose. Follow these important guidelines to prevent influenza illness.

These simple steps can protect you and others from both seasonal and 2009 H1N1 influenza.

• Get a seasonal flu vaccination. Vaccination against influenza is the most effective way to prevent illness.
• Get a vaccine for 2009 H1N1 influenza (swine flu) if you are in one of the groups at risk for H1N1.
• Cover your nose and mouth with a tissue every time you cough or sneeze and discard the tissue into a wastebasket.
• If you do not have a tissue, sneeze or cough into your upper sleeve.
• Clean your hands with soap and water or an alcohol-based hand cleaner, especially after coughing or sneezing
• Avoid touching your eyes, nose or mouth.
• Try to stay in good health by getting enough sleep, drinking plenty of fluids and eating nutritious food.
• Do not go to work or school if sick.
• Avoid close contact with people who are sick.
• Clean frequently touched surfaces with a household disinfectant.

Flu viruses, including the H1N1 virus, can survive on surfaces for several hours. When the wet droplets on objects like doorknobs, phones and toys are completely dry, the virus can't cause infection.

If someone you live with is sick with the flu, it is important to clean frequently touched surfaces often with regular household cleaner, especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children. It can be very difficult to keep these types of surfaces free of virus, which is why washing your hands often is so important.

Infants less than 6 months old are at high risk for serious flu-related complications, but cannot get a vaccine or anti-flu drugs. All family members in the house who are able to get the vaccine should have it when possible so flu is not brought into the home. Additional ways to protect your infant include: avoiding large crowds during flu outbreaks, having people wash their hands before touching your baby, and avoiding kissing or close contact by members of the family who may be ill. In general, it is best for anyone who may be sick not to have close contact with your baby.

No. Breastfeeding is really important in young babies when their immune system is still developing because breast milk has antibodies in it that help protect babies from infection. It is OK to take anti-flu medicines to prevent the flu while you are breastfeeding. You should make sure you wash your hands often and take everyday precautions. However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to help you care for your baby. If you become sick, you can wear a disposable facemask while breastfeeding or someone who is not sick can give your baby your expressed milk. If you have questions about breastfeeding, call your doctor or your baby's doctor.

Symptoms usually start one to four days after a person has been exposed.

People infected with seasonal and novel H1N1 flu are most likely to infect others from one day before getting sick until 24 hours after their fever resolves (without the use of fever-reducing medication). The virus can be "shed" (or can be spread even without symptoms) for longer time periods in some people, especially people with weakened immune systems and children. In general, people with flu are most infectious (able to spread influenza) while they have a fever.

The Massachusetts Department of Public Health does not recommend that members of the general public wear facemasks to protect against H1N1 flu. Evidence shows that this is not effective in preventing spread of flu in the community. People often use masks incorrectly, or contaminate them when putting them on and taking them off, which could actually increase the risk of infection. The use of facemask should never replace other steps to prevent the spread of flu, including washing hands often with soap and water, staying away from other people when they are ill, and avoiding crowds and gatherings as much as possible.

However, there are some circumstances where a facemask may be used to reduce the spread of the flu especially for persons who are at high risk for complications from the flu. Some examples are:

• If you are in a high risk group for complications from the flu you should try to avoid close contact (within 3- 6 feet) with household members who are sick. If close contact with a sick individual is unavoidable, consider wearing a facemask.
• If you are breast feeding your baby while you are sick, try to wear a face mask so your baby does not get sick.
• If you are sick with the flu and need to go to a doctor's office, to an emergency room, or to any other healthcare facility, wear a facemask if it is available and tolerable. Healthcare personnel may also ask patients who are coughing or have symptoms of a respiratory infection to put on a mask when they enter a facility.
• In schools, students and staff with flu-like illnesses should be put in a separate room until they can be sent home. Ill persons should wear a facemask if possible and those caring for them should wear masks too.

Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others, including the flu virus. It is best to wash your hands with soap and clean running water for 20 seconds (as long as it takes to sing "Happy Birthday" twice). However, if soap and clean water are not available, use an alcohol-based product to clean your hands.

Alcohol-based hand sanitizers significantly reduce the number of germs on skin and are easy to use. To use an alcohol-based hand sanitizer, apply the product to the palm of one hand and rub hands together. Rub the product over all surfaces of hands and fingers until hands are dry.

Yes, alcohol-based hand sanitizers are safe when used correctly to clean hands. Alcohol-based hand sanitizers are poisonous and should not be ingested (eaten). They are also flammable and should be kept away from fires and flames.

Keep alcohol-based hand sanitizers out of the reach of children and supervise your children when they are using hand sanitizers. If swallowed, get medical help or contact a Poison Control Center right away (800-222-1222).

During the flu season or during a pandemic to minimize your chances of getting the flu, in general you might consider staying away from public gatherings, especially those that are likely to involve very close contact with other people. Also, during the current pandemic caused by the H1N1 flu, or even during seasonal flu season, public health officials may recommend other ways to protect the community's health by staying away from other people.

Follow the same steps and precautions for H1N1 flu that you would to avoid ordinary seasonal flu:

• If you are taking care of someone with the flu, speak with your doctor to see whether anti-flu drugs are recommended.
• If you are taking care of someone with the flu, speak with your doctor to see whether anti-flu drugs are recommended.
• If possible, place the person with flu in a separate room, away from the common areas of your home. Respiratory treatments that may be associated with coughing, such as inhalers and nebulizers, should be used by the ill person in a separate room away from common areas of the house when possible.
• Limit your contact with the sick person. Avoid close contact such as kissing and do not share towels, drinking glasses, eating utensils or toothbrushes with the ill person.
• If you must have close contact (within 3-6 feet) with or are providing care to a member of your household with the flu AND you are at increased risk of severe illness or complications, consider wearing a disposable facemask. After removing the facemask, throw it in the trash and immediately wash your hands or use an alcohol-based hand gel. All household members should regularly wash their hands with soap and water or use an alcohol-based hand gel especially after every contact with the sick person. The sick person should also regularly wash his or her hands with soap and water or use an alcohol-based hand gel.
• Provide tissues to ill persons to use to cover their mouth and nose whenever they sneeze, cough or blow their nose. Make sure they immediately throw their used tissues in a nearby wastebasket. Both ill and well persons should wash their hands or use an alcohol-based hand gel after touching used tissues, similar waste and after emptying wastebaskets or trash receptacles.
• Do not give aspirin or aspirin-containing products to infants, children and young people under 18 years old. These products can increase the risk of a rare and serious illness called Reye syndrome.
• Avoid having visitors. If visitors must enter the home, they should avoid close contact with the sick person.
• If you are washing the bed sheets and towels for the sick person, you should use household laundry soap and tumble dry on a hot setting if possible. Avoid "hugging" laundry close to your body when you are carrying it, and clean your hands with soap and water or alcohol-based hand rub after handling dirty laundry.
• Monitor well household members closely for the development of illness. Talk to your doctor about taking antiviral medication to prevent the caregiver from getting the flu.

Most people who get the flu can be cared for at home. Treatment with anti-flu drugs is usually not needed for healthy people who have symptoms of mild flu or appear to be getting better when sick with the flu.

According to the Massachusetts Department of Public Health, there are a few ways to treat a fever and make someone feel more comfortable:

• Give fever-reducing medicines like Acetaminophen (Tylenol® or store brand), Ibuprofen (Advil®, Motrin®, or store brand), or Aspirin (Bayer® or store brand)
• Children and teens with the flu should never take aspirin, because a rare but serious disease called Reye syndrome can occur.
• Keep the room comfortably cool.
• Make sure they are wearing light-weight clothing.
• Have them drink fluids, especially water.
• Consider sponging them with lukewarm water if they have a high fever.

Children:

• Never give aspirin to children 18 years and younger. It can cause a dangerous illness called Reye Syndrome.
• Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
• Children 5 years of age and older and teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin, Nuprin), to relieve symptoms.
• Children younger than 4 years of age should NOT be given over-the-counter cold medications without first speaking with a health care provider.

If you have other health problems or are pregnant, you should contact your doctor.

What else?

• Stay home and do not go to work or school if you are sick. The CDC recommends that: you stay home for at least 24 hours after your fever is gone without the use of fever-reducing medications.
• Cover your nose and mouth with a tissue every time you cough or sneeze. Then throw the used tissue in a waste basket and clean your hands after disposing of used tissue. If you don't have a tissue, sneeze or cough into your upper sleeve.
• Clean your hands with soap and water, especially after coughing or sneezing. You can also use alcohol-based hand cleaner.
• Try to limit contact with others to keep from getting them sick.
• If you have other health problems, you may wish to contact your healthcare provider by telephone.
• Talk to your doctor if symptoms seem severe or ongoing.

Antiviral (anti-flu) drugs are prescription medicines (pills, liquid or an inhaler) that can be used to treat H1N1 flu, or to prevent infection with H1N1 flu viruses. There are currently two drugs approved to treat H1N1 flu. The drugs work best if started soon after the start of symptoms. While getting a flu vaccine each year is the first and most important step in protecting against flu, antiviral drugs are a second line of defense in the prevention and treatment of flu.

Treatment with anti-flu drugs is usually not needed for healthy people who have symptoms of mild flu or appear to be getting better when sick with the flu. However, persons with flu-like illness who have severe symptoms and need medical care should receive anti-flu medication promptly.

People sick with any type of flu should make sure to drink plenty of fluids, get plenty of rest, eat healthy foods, wash their hands frequently and stay home to avoid spreading the flu to other people. Over the counter pain relievers may help people with the flu feel more comfortable. Children and teens with the flu should never take aspirin, because a rare but serious disease called Reye syndrome can occur.

Yes. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in the body. The two prescription anti-flu medications doctors can prescribe to treat both seasonal and H1N1flu are oseltamivir (oss-el-TAM-eh-veer), brand name "Tamiflu," and zanamivir (zan-AM-i-veer), brand name "Relenza.".

Anti-flu drugs can make your illness milder and help you feel better faster. They may also prevent serious flu complications. Anti-flu drugs are especially important for people who are very sick (hospitalized) or people who are sick with the flu and who are at increased risk of serious complications from the flu, such as pregnant women, young children and those with chronic health conditions.

Tamiflu has been approved for use in children as young as 3 months old. Babies younger than 3 months should only be treated with Tamiflu if they are critically ill. (There have been no studies done in this age group).

The drug is safe, but it can cause nausea and vomiting in children.

Parents and guardians should monitor their children every morning for flu-like symptoms (fever of 100.4°F or greater, cough, sore throat, body aches, headache, chills, fatigue or possibly diarrhea or vomiting).

Keep your child home until at least 24 hours after he or she no longer has a fever or signs of a fever. This fever-free period must be without the use of fever-reducing medicines (any medicine that contains ibuprofen, such as Motrin, or acetaminophen, such as Tylenol). For many people, they can expect to stay home for about 4 days: 3 days with fever and one more day without any fever or taking any fever reducing medicines. However, some people may be sick for longer than 3-5 days and should be prepared to stay home as long as it takes for their fever and other symptoms to go away.

Pregnant women should always call their provider with flu symptoms and then assess need to be seen based on that interaction.

Seek emergency medical care if you have any of the following:

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
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

In general, anyone who wants to reduce their chances of getting seasonal flu can get vaccinated. It is especially important that the people listed below get a seasonal flu shot every year.

• Children aged 6 months up to their 19th birthday
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions like asthma, diabetes, heart disease, kidney disease and weakened immune systems
• People who live in nursing homes and other long term care facilities
• Anyone else who might spread flu to someone at increased risk of having serious health problems from flu. For example, health care workers, direct care staff, and people who live with or care for anyone on the list above.

The nasal spray flu vaccine is only for healthy people age 2 - 49 years and who are not pregnant. Everyone else should get a flu shot.

There are some people who should not be vaccinated. They include:

• People who have a severe allergy to chicken eggs
• People who have had a severe reaction to an influenza vaccination in the past
• People who have had Guillain-Barré syndrome should talk to their doctor or nurse.
• Children less than 6 months of age
• People who live in nursing homes and other long term care facilities
• People who are sick with a fever (these people can get vaccinated once their symptoms resolve)

Ask your doctor about getting the seasonal flu vaccine. To find out how to get the seasonal flu vaccine, contact a doctor or your local health department. You can also visit flu.masspro.org or call 866-627-7968 to find a public flu clinic near you.

Five groups have been identified by CDC to get this vaccine as it becomes available:

• pregnant women;
• persons who live with or provide care for infants under 6 months of age (e.g., parents, siblings, and daycare providers);
• health-care and emergency medical services personnel;
• persons age 6 months to 24 years;
• persons age 25 to 64 years who have medical conditions that put them at higher risk for influenza-related complications. Note: Current studies indicate the risk for infection among persons over 65 years of age is less than the risk for persons in younger age groups.

There are some people who should not be vaccinated. They include:

• Children less than 6 months of age
• People who have a severe allergy to chicken eggs should not get vaccine made from eggs.
• People who have had a severe reaction to an influenza vaccination in the past
• People who have had Guillain-Barré syndrome should talk to their doctor or nurse.
• People who are sick with a fever (these people can get vaccinated once their symptoms lessen)

Flu shots can be given at the same time and in 2 different sites (e.g. left arm and right arm). But you cannot get both the seasonal flu nasal-spray vaccine and the H1N1 nasal-spray vaccine at the same time. Talk to your doctor about which vaccine is right for you and your children.

Yes, seasonal and H1N1 vaccines are among the safest medications that are administered to people, including prescription drugs and over-the-counter medications.

Like any vaccine or medication, seasonal and H1N1 vaccines should be administered by trained health professionals who will determine which vaccine is best suited to each patient. A patient with an allergy to eggs, for example, should avoid vaccines derived from eggs in order to avoid an allergic reaction to the vaccine.

The bottom line is this: Flu is a serious respiratory disease that causes thousands of deaths every year in the United States. It is preventable. Keeping safe from the flu greatly outweighs the very small risk of side effects from both seasonal and H1N1 vaccines.

According to the CDC, how well the flu vaccine works depends on how close the match is between the flu vaccine and the types of flu viruses that are circulating in the community. Every year, scientists try to predict what types of flu viruses are most likely to cause illness each year so these strains can be included in the vaccine. In years when the vaccine strains and the virus strains are well-matched, the vaccine can reduce the chances of getting the flu by 70%-90% in healthy adults. The vaccine may be somewhat less effective in elderly persons and very young children, but vaccination can still prevent serious complications from the flu. In healthy adults less than 65 years of age, the flu vaccine can also prevent lost work days, and keep you from having to see the doctor or using unnecessary antibiotics.

No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection. In the meantime, you are still at risk for getting the flu. That's why it's better to get vaccinated early in the fall, before the flu season really gets under way. Results of testing the H1N1 vaccine suggest that the body develops a similar response to H1N1 vaccine in the same amount of time.

Yes. There is no data which suggests that seasonal flu vaccine or H1N1 vaccines cause birth defects. Therefore, it is safe to give these vaccines to pregnant women anytime during pregnancy and postpartum even while breastfeeding.

Most children under the age of 10 will need two shots of H1N1 vaccine, separated by approximately 3 - 4 weeks. In order to better protect children against the flu, they need two doses.

Yes, vaccines are tested in people before they are approved for wider use. Vaccines are only approved for wider use if the testing (called a "clinical trial") shows that the vaccines are safe to use. Once vaccines are approved and are being used throughout the country, any problem following vaccination should be reported by healthcare providers to a national reporting system. This reporting of "adverse events" allows the safety of the vaccine to be continuously monitored.

The CDC, in conjunction with the Massachusetts Department of Public Health (DPH), local boards of health, and healthcare providers, provide careful and on-going monitoring of any potential problems related to a vaccine.

H1N1 vaccine is being made exactly the same way seasonal flu vaccine is made every year, and with the same testing process required before distribution. It is as safe as seasonal influenza vaccine.