This whole Swine Flu situation has been making us nuts. But when we heard that the first person in the U.S. to die from Swine Flu was a toddler, we really lost it. And we figured you were probably losing it, too. So we asked our pediatric experts—JJ Levenstein and Diane Truong of MD MOMS—to give us some tips and help us put things in perspective.

Here, everything a worried mom needs to know about Swine Flu:
Simply speaking, Swine Flu is just a new, unexpected strain of Influenza A. We are all familiar with the concept of new strains of Flu—it’s why we need to revaccinate every year to keep up with changes in the makeup of Flu viruses. But since Swine Flu only comes around once or twice a century, most humans have no acquired or natural immunity. Swine Flu strains are typically not included in Flu vaccines, and thus more people may be susceptible to illness in a pandemic situation.

The good news is that, unlike many strains of Influenza that are not responsive to therapy, this Swine Flu strain, H1N1, is TREATABLE with Tamiflu or Relenza. Because the US Government has stockpiled Tamiflu, we anticipate ample supplies to treat this strain of the Flu should it continue to spread.

We must remember that the total number of cases of confirmed Swine Flu in the US really amounts to a relative handful (as of April 30th, 109 cases nationwide), and that with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in perspective that the cases described so far in the US have been mild to moderate in severity (aside from a tragic exception in the case of the recent death of a toddler in Texas), and that local communities affected are reacting appropriately and outcomes have been good so far.


Are babies and toddlers more or less susceptible?

Babies and toddlers who are below school age are less likely to be exposed to social situations, which would then expose them to Swine Flu. However, if infants and toddlers do become infected with Influenza, they are more likely to have a more severe or prolonged illness which can be associated with more complications.

When should you call your pediatrician?

If your child has a sudden onset of fever along with sore throat, cough, headache or body aches, call your pediatrician. Reports from Mexico seem to indicate that the Swine Flu presents with an acute onset of high fever, and a rapid progression to the other symptoms. If you bring your child within a day or two of fever onset, anti-viral therapy is more likely to be effective. Most health care providers are equipped to diagnose Flu in their offices. If your doctor suspects your child has Influenza, he/she may perform a wash of your child’s nasal secretions and submit it to your local public health department for analysis by the CDC.

When should you NOT call your pediatrician?

If it seems your child has the common cold or stomach flu virus-both are common at this time of the year. Do not call your doctor to obtain anti-viral therapy “just in case.” This important therapy is reserved for those truly in need. Don’t call your doctor if your child has NO symptoms and you have NOT traveled to a high-risk area or had contact with a person suspected of having H1N1 (Swine Flu).

Are there any special considerations for pregnant women?

Pregnant women are deemed to be in the high-risk group, if again, we take our experiences from past Influenza pandemics. They should take precautions to reduce their risks of contracting Swine Flu. These actions include frequent handwashing, covering coughs, avoiding contact with ill people and reducing unnecessary social activities in crowded settings. If a pregnant woman has Swine Flu, she can be treated with antiviral therapy, though these drugs have not been formally tested for use in pregnancy. Past experiences with Tamiflu and Relenza have shown them to be safe and effective in pregnancy with no observed ill effects seen in their newborns.

What are Tamiflu and Relenza?

Tamiflu (oseltamivir) and Relenza (Zanmivir) are both FDA-approved anti-flu antibiotics that have been used to treat Influenza in the past, and are deemed to be effective against the current Swine Influenza A virus (H1N1). They work best if started within 48 hours from the onset of Flu symptoms.

What’s the difference between Tamiflu and Relenza?

Tamiflu is approved for treatment in patients one year of age or older. It is available in liquid and pill form and should be taken twice a day for five days for active Flu. During pandemic conditions, there are dosage recommendations extending down to 3 months of age. Relenza is for treatment of patients who are 7 years or older. It is also for preventative treatment for patients 5 years or older. It is taken twice a day for 5 days and inhaled directly into the lungs.

Are Tamiflu and Relenza “okay” for babies/toddlers? Nursing moms? Pregnant women?

FDA approval of these antivirals are as per the ages described above. However during epidemics, Tamiflu can be used for children down to 3 months of age under the Emergency Use Authorization clause (EUA). Nursing moms and pregnant women can be treated with both Tamiflu and Relenza.

Is there a shortage of either one?

The US government has a stockpile of these antivirals, but judicious use of these medications is recommended, as we don’t want to risk developing viral resistance to the drugs. That means that these medications should not be used daily “just in case” for prevention. They are to be used only in the event of H1N1 illness and for household contacts of Flu victims.

What are the downsides of taking Tamiflu or Relenza as a preventative?

Tamiflu has side effects that may include nausea, vomiting, abdominal pain, seizures, or behavior changes. Relenza may cause breathing problems, especially in patients with underlying lung disease or asthma. It may also cause seizures, confusion or abnormal behavior.

Taking either drug in a preventative regimen is indicated only under certain specific circumstances. Essentially, these medications are recommended for the very young, or very old or those with chronic underlying illnesses who have been exposed to suspected or confirmed Swine Flu. These include household contacts, school contacts or travel contacts to high-risk areas.

Should I keep my baby/toddler under any sort of quarantine if I live in a city where Swine Flu has been confirmed?

It’s always easier to prevent illness than to diagnose and treat, however it is reasonable to move about your community and do the things you need to do if you have reasonable control over whom you come in contact with. For example, a day-long jaunt to a large indoor play place may not be advised if you have H1N1 in your community. But a birthday party in your home attended by healthy, asymptomatic children is reasonable. This is the time when communities need to work together to preserve public health—so keep attuned to the advisories delivered by your local health departments.
While we would advise against unnecessary crowded or social contacts, obviously if you live in a densely populated urban area like New York City, staying locked in your home and not using public transportation is not always practical. The most critical advice we can offer as pediatricians is that we all do our part to stay healthy and prevent unnecessary spread of germs. This means STAY HOME if you feel sick and WASH YOUR HANDS (and your childrens’ hands) a lot…especially after you come in from the outdoors or a social situation.

Can you help us understand the death of the toddler and calm our worst fears?

Remember that Flu from Influenza claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter- and the great majority survive and thrive. Of this number, in 2007-2008, 83 were children. So deaths in this age group represent a minority, albeit a tragic one. While we would never ever want to minimize the grief that the family of this toddler is experiencing, one death from Swine Flu, relative to the total average number of deaths from Flu every year, is not a cause for public panic.

It is still too early to tell how severe this now prolonged Flu season will be, but remember that summer is coming, and the Flu virus tends to wane with warm weather. Keeping this in mind, we anticipate a short outbreak, with the help of Mother Nature. So hang in there, and let’s all help by staying calm and being sensible.

For more information on Swine Flu, including symptoms, incubation period, and current statistics visit the CDC.