Swine flu Q & A

Part of a baby's protection against the H1N1 flu depends on its most natural interactions with its mother, but other measures are needed as well. Below, Tribune reporters address questions from readers about the swine flu virus:

Q: Do newborn children have any antibodies in to fight the virus, or are they at a huge risk to die from the virus?

A: "Babies are indeed born with some of their mother's antibodies against influenza," said the University of Chicago's Kenneth Alexander, a pediatric infectious disease specialist, "and more antibodies are transferred in breast milk, another reason why breast-feeding is the best form of nutrition for babies."

But the anti-influenza antibodies from the mother and in breast milk are insufficient to prevent infection entirely, he said, which means newborns are more at risk of contracting severe influenza than older children, particularly newborns with heart and lung problems common in premature babies.

"Unfortunately, infants respond poorly to flu vaccine until age 6 months, so that doesn't help us much either," he said. "That is why it is so important that family members of young children seek flu immunization to create a 'cocoon' of protection around the infant."

Q: Can the virus be passed through breast milk to my 2-month-old daughter?

A: "Influenza virus does not pass in breast milk," Alexander said. "Babies catch flu the same ways that all of us do. They inhale droplets from the coughs and sneezes of infected people, or babies acquire the virus by direct contact. This is why it is important to wash your hands before handling a young infant."

Q: My mother had the Spanish flu in 1918 at age 4. It is a subtype of the H1N1 flu. Does she have an immunity to H1N1?

A: There is no current evidence that exposure to and recovery from the 1918 Great Influenza offers any protection against the 2009 H1N1 influenza, said Dr. William Schaffner, an infectious disease and immunization expert at Vanderbilt University Medical School.

Q: Does having H1N1 give you permanent immunity to it?

A: People who had laboratory-confirmed cases of H1N1 in the spring or who currently have it will not get infected with this particular strain again, according to Dr. Julie Morita, medical director for the Chicago Department of Public Health's immunization program.

But that does not mean you are permanently immune to swine flu.

"It is possible that in subsequent seasons the virus may change a little ... and even people who were sick previously no longer will be immune to it," Morita said.

Every year there is a seasonal flu epidemic because of minor changes in the virus, according to Morita. When a pandemic occurs, as it did with H1N1, it is a completely new virus.

"We don't expect the H1N1 strain will change dramatically in the coming years, but there may be a small enough change that people will get infected again, even if they had it this year," Morita said.

Q: Does the H1N1 vaccine include adjuvants, such as squalene?

A: Adjuvants boost a person's immune response to vaccines, but neither the H1N1 vaccine nor the seasonal flu vaccine includes any adjuvants, according to the U.S. Centers for Disease Control and Prevention.

The CDC did, however, purchase squalene to have on the shelf in case of an emergency or as a contingency plan, said Dr. Anne Shuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

"If the virus mutates and becomes much, much different and more severe, we might need to add adjuvants in order to have an immune response that's effective," Shuchat said during a CDC podcast. "But for the time being, we really aren't expecting to use them."

For years, there have been claims by some Gulf War veterans that the Department of Defense added squalene to the anthrax vaccine in 1999 to stretch the supply, causing Gulf War syndrome, an autoimmune disease. However, several independent panels have investigated the allegations and found no evidence that squalene was added to the vaccine, according to the U.S. Food and Drug Administration.

Europe has safely distributed seasonal flu vaccine with squalene since 1997, federal health officials said. But in the U.S., the only adjuvants licensed for use are aluminum gels or aluminum salts, used in vaccines for illnesses such as tetanus, diphtheria and childhood hepatitis, officials said.

Q: Is it possible to contract seasonal flu and H1N1 flu simultaneously?

A: It is possible to get both viruses at the same time, but it is not something that happens frequently, said Dr. Joshua D. Jones, a communicable-disease specialist at the Chicago Department of Public Health.

As of now, there is hardly any seasonal flu circulating across the country, so if someone contracts the flu, it is likely H1N1. However, Jones said, by January, seasonal flu will have started to appear, and it is likely there will be two strains circulating in the population.

"It is very likely the two flu seasons will overlap," said Jones, explaining that the seasonal flu season normally starts in November. "Seasonal flu starts to peter out around April or May. We don't know how long the H1N1 season will go on, but it could last all winter."

The seasonal flu vaccine cannot protect against H1N1, so health officials recommend that people get both the seasonal flu vaccine and the H1N1 vaccine.

Q: My 15-year-old, my 10-year-old and I were all diagnosed with H1N1 on Oct. 19. My 10-year-old had it the worst, resulting in three doctor's visits and two chest X-rays. He is better, but he still feels weak and dizzy and is not back to 100 percent. I am also very tired and I still have a cough. Why are we still feeling symptoms almost a month later?

A: People can experience prolonged symptoms for two weeks or more after being diagnosed with H1N1, said Dr. Tina Tan, an infectious-disease specialist at Children's Memorial Hospital. It is not unusual to continue to feel tired and fatigued or to have a lingering cough, Tan said. But in your case, the prolonged symptoms are unusual. Tan suggests that you return to your doctor to be re-evaluated.

"You need to make sure you don't have something else that might have cropped up," said Tan, referring to a secondary bacterial infection or some other infection that is currently circulating.

Q: Tell me how to treat a sick child other than using over-the-counter medications. I've seen herbal teas that promote respiratory health. What about chicken soup?

A: There isn't simply one great treatment for influenza in otherwise healthy, low-risk children and teens, said Dr. Beth Volin, director of pediatric primary care at Rush University Medical Center. But "the supportive measures you mentioned are certainly worth trying," she said.

It is essential, Volin said, that children get plenty of rest, and it is recommended that they stay home from school or day care until at least 24 hours after the fever is gone.

As it turns out, chicken soup is more than just a folk legend. Dr. Stephen Rennard, a researcher at the University of Nebraska Medical Center, found that chicken soup contains an anti-inflammatory mechanism that eases the symptoms of respiratory tract infections.

For sore throats or as an expectorant, Volin suggests honey, which can help children over age 1. For children, especially those under age 6, health experts advise against combinations of over-the-counter cold and flu preparations and pain medications.

As far as other ways to ease the symptoms, Volin suggests fluids such as juice and electrolyte solutions. Another idea -- give them Popsicles, which can ease sore throats and make staying home sick more enjoyable.

Q: A partner in my law firm has a wife and daughter who were just diagnosed with H1N1. He insists on coming into the office. How safe is it for our employees who are pregnant, have compromised immune systems and have small children at home?

A: If your co-worker has no flulike symptoms, there is no reason he should not go to work, according to Dr. Tina Tan, an infectious disease specialist at Children's Memorial Hospital.

"Since he is not showing any symptoms, he should not be able to spread the virus to anyone who is around him in the workplace," Tan said. "Just because someone in his house has it does not mean he will catch it. But obviously, he will have to be more vigilant, and if he does develop symptoms, he should stay home."

The flu virus normally is transmitted by respiratory droplets. That is why it is so important to wash your hands and cough and sneeze into your sleeve, Tan said.

Q: My sister is in her early 30s and has asthma. When she made an appointment with the Cook County Health Department in the northwest suburbs, she was asked to disclose her yearly earnings. Why are income and other personal information required?

A: The Cook County Department of Public Health routinely asks for Social Security numbers, salaries of householders, ethnicity, and maiden names of mother and paternal grandmother from anyone seeking county medical assistance, because much of the assistance is need-based in nature, said spokeswoman Amy Poore.

"All of our personnel who make appointments are trained to explain very clearly what other options there might be for callers to find vaccine, in part to make best use of supplies," Poore said. "The ethnicity, age and gender are useful information we need to measure the scope of who we are serving."

Q: I have the flu and I'm expecting a houseful of people this weekend for a kids' birthday party that has been planned for weeks. Do I cancel? Even if my symptoms are better, is my house a hotbed for infection?

A: If you have flulike symptoms on Friday, then you should not host a birthday party for children on Saturday, according to Tan. Children are among the most prolific carriers of the H1N1 virus, and they have a high risk of serious illness. So every precaution should be made to protect them.

"It's not the house. It's basically [the reader] or anyone else who is sick that will spread the virus," Tan said. "The house itself is fine as long as you take precautions and clean things off."

Q: It took me weeks to get my two children vaccinated for H1N1 flu. Because they are under 10, they are supposed to get a second vaccination four weeks after the first to ensure they are immune. What happens if the vaccine is still in short supply in December and I have the same difficulties?

A:"It doesn't matter if the second dose is given more than four weeks after the first," said Dr. James McAuley, a pediatric infectious disease expert at Rush University Medical Center.

"The recommendation is to get the second shot for children under 10 years old about 28 days after the first shot, but it can be done safely as early as 21 days after the first one," he said.

Experts know that children under 10 do not respond as well as adults and older kids to the flu vaccine. So when younger children get the initial H1N1 vaccine, only 25 to 30 percent of them develop the amount of antibodies needed to fight off the virus.

"The second vaccine dose bumps them all the way to 95 percent protection," McAuley said. "But the problem with waiting for six weeks for the second dose means your children spend more time without protective antibodies to fight off the flu."

"From all we're hearing, the amount of vaccine available increases each week, so by December we hope it won't be such a big problem for parents to find it."

Q: We lost a family member to H1N1 flu. He was 25. We have a huge family, of all ages. Since this is such a virulent virus, should we take any precautions at the visitation and funeral?

A: Health officials said a dead body does not shed H1N1 virus, so there is no need to fear contracting the virus from your deceased loved one. However, it is possible that those who were in close contact with him before his death may have contracted the virus. Doctors suggest that everyone take precautions, such as washing their hands frequently.

"That means getting vaccinated (if you are in a high risk group) and being extra cautious not to spread it," said Dr. Joshua D. Jones, a communicable disease specialist at the Chicago Department of Public Health.

Studies have shown that flu viruses left on hard surfaces such as hymnals or chairs can continue to infect people for two to eight hours.

Q: My 6-year-old son has an anaphylactic reaction to eggs but has an underlying health condition that puts him in the highest of the high-risk segment (for H1N1 flu). The rest of our family will get the vaccine, but what are the best things we can do to keep him safe?

A: You are right not to get the vaccine for your son without consulting a physician. The H1N1 and regular seasonal flu vaccines are made from chicken eggs and contain egg protein, so people who have severe reactions to eggs are among those who generally should avoid flu vaccines of any type.

It appears that your son has a severe reaction, but for others, simple nausea or other minor symptoms don't always mean one is allergic to eggs, according to Dr. Joshua D. Jones, a communicable-disease specialist at the Chicago Department of Public Health. That is why it is very important to get a doctor's diagnosis.

Jones recommends that you try to keep your son away from people who are infected or who have a high risk of becoming infected. That could mean staying away from playgrounds and other places where children -- the most prolific carriers of the virus -- gather.

Short of that, you should engage in what Jones called "watching waiting." That means you should watch him closely for symptoms, and if they do develop, take him to the doctor quickly. At that point, the doctor might begin treatment with Tamiflu or other antivirals.

Q: I am trying to conceive. Should I get the H1N1 vaccine now or wait until I am pregnant? Is it safe to get pregnant within a week or two of getting vaccinated?

A: Unless you are in a high-risk population group (already pregnant, youngsters 6 months to 24 years old, health care or emergency worker, adults ages 25 to 64 with serious health problems), you may have to wait a few more weeks to be vaccinated. Health officials say vaccination is essential for the safety of the mother and the fetus.

Q: How long is a person with H1N1 considered infectious?

A: According to the U.S. Centers for Disease Control and Prevention, infectious people can spread the virus a day before the symptoms appear, and they can remain contagious for five to seven days after getting sick. Doctors said some people remain contagious longer than that, particularly children and people with weakened immune systems.

Q: I am a little overweight (6-foot-1, 220 pounds) and I smoke 20 cigarettes a day. Should I get the vaccine?

A: The verdict is still out on whether moderately obese people, with a body mass index in the 30 to 40 range, have an increased risk of complications from H1N1, according to Tom Frieden, director of the CDC. But one thing is clear, he said: People who are very obese, with a BMI of 40 or more, face serious risk of complications.

"Most people with a body mass index that high also have health problems, such as diabetes or heart disease," Frieden said.

Smoking also compromises your respiratory system, so you should get the vaccine when it becomes available, according to Kenneth Alexander, University of Chicago infectious-disease specialist.

"In the meantime," said Alexander, "for the people who love you, try to quit, and keep trying until you succeed. They'll love you for it."

Q: I am a pediatrician in suburban Cook County. We signed up to receive the vaccine, and have yet to get it. I hear it is going to go to local pharmacies before we get it. They only vaccinate children 9 and above. ... Who is going to ensure that infants and asthmatics get vaccinated?

A: The Illinois Department of Public Health processes vaccine orders within the state and oversees the order in which providers receive shipments. Kelly Jakubek, a spokeswoman, said doctors' offices should get their orders filled as more vaccine is produced and assured that retail drugstores will not have it before physicians have it.

"We currently are only placing orders for hospitals and health departments, which we consider the front line of health care," she said.

Chicago vaccine providers are under a similar system in which the first shipments go to places that serve the most at risk, said Dr. Julie Morita, medical director of the Chicago Department of Public Health. Her department places the orders and selects the providers to get the first H1N1 vaccine shipments.

"Our priority is to get the early vaccine to high-risk providers," Morita said, "and once the majority have gotten vaccinated, then it can go to retail providers. We can't guarantee a limitless supply, so there may be breaks in supplies for a time, and then get orders filled later on."

Q: My daughter, 10, got the nasal vaccine for H1N1 (and four days later had) a high fever, chills, dizziness, sore throat, cough and congestion. (She) missed a week-plus so far of school. Can you get swine flu from the live vaccine? It seems she has.

A: Vaccine experts say the virus in the nasal vaccine is so weakened that it is impossible to get flu from it. But it takes several days to two weeks before the vaccine's protective immune response kicks in, said University of Chicago infectious-disease specialist Kenneth Alexander. It is likely that your daughter had the misfortune of catching the flu before the vaccine could take effect and protect her from it.

"Alternately," he said , "she might have had either the seasonal flu or another viral infection altogether."

Q: My dad had Guillain-Barre syndrome. Should I get the H1N1 vaccine?

A: A vaccine developed for a 1976 swine flu pandemic was blamed for causing a rise in incidence of the rare neuromuscular disorder, but the uptick was so slight "that it makes it hard to know if there is a real relationship with Guillain-Barre and that vaccine," Alexander said.

Health officials have been watching closely ever since, and no subsequent vaccine has been linked to the disorder, Alexander said, so you should be safe.

On Monday, the U.S. Centers for Disease Control and Prevention put out a fact sheet on Guillain-Barre syndrome that can be found at its Web site,

Q: I am 80 years of age. Should I get the H1N1 vaccine?

A: Health experts say that people 65 and older are least likely to contract swine flu, and therefore they are not on the priority list for vaccination. However, if elderly people do get sick, they have a high risk of developing serious complications from H1N1.

Blood samples taken from older people indicate that they possibly have pre-existing immunity to the H1N1 virus, according to the U.S. Centers for Disease Control and Prevention. Health officials suggest that elderly people get their seasonal flu vaccine first and get in line behind high-risk groups for the H1N1 vaccine. However, health officials advise that elderly people see a doctor immediately if they develop flulike symptoms.

Q: Is it true that someone who just received the seasonal flu vaccine must wait before receiving the H1N1 vaccine?

A: Seasonal and H1N1 shots can be given on the same day, but health officials recommend that they be given in different arms.

Since the nasal sprays are made from live but weakened virus, seasonal and swine nasal mists should not be taken together, but rather three to four weeks apart, according the CDC. It is safe to receive a seasonal flu shot and the H1N1 nasal mist at the same time, and vice versa.

"The only thing you can't get is two nasal sprays at the same time," said Dr. Julie Morita, medical director of the Chicago Department of Public Health's Immunization Program.

Q: If you get an H1N1 shot, is it 100 percent positive you won't get the flu?

A: The effectiveness of vaccines varies depending on the age group and underlying medical conditions, health experts said. In general, seasonal flu vaccines are 70 to 90 percent effective, according to Dr. David Tayloe, president of the American Academy of Pediatrics.

However, it is too early to determine the effectiveness of the H1N1 vaccine. "We have not had the vaccine long enough to know how many of those immunized will develop immunity or how long they will be immune," said Tayloe.

He stressed, however, that the swine flu vaccine is made using the same procedure as the seasonal flu vaccine and that vaccination is the best way to guard against contracting H1N1.

Q: How long does it take for the H1N1 vaccine to become effective, once administered?

A: Health experts say it takes about two weeks after receiving the vaccine for antibodies that protect against H1N1 to develop in the body.

Q: I took my dog to my father's nursing home and was informed that dogs were now banned because they carry the flu virus. True or false?

A: Dr. Kimberly May, of the American Veterinary Medical Association, said there is no evidence to date that dogs or cats have contracted H1N1. However, there is a case involving a ferret in Portland (Ore.) that was infected by its owner.

It is possible, May said, that someone could contract the virus by touching a pet that has been contaminated, much like touching a table that has someone's nasal droplets on it.

A dog, however, is not going to contract the virus and bring it home to the family.

Q: What is the comparison between the fatality rates for H1N1 flu and seasonal flu, and is H1N1 considered more of a danger than seasonal flu?

A: Since the pandemic began in April, more than 1,000 deaths from H1N1 have occurred, including about 100 children, and more than 20,000 hospitalizations in the United States, according to the U.S. Centers for Disease Control and Prevention. The CDC estimates that about 36,000 people die of seasonal flu-related causes annually, although the number fluctuates.

It is good news, according to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, that the swine flu continues to be "very mild" for most people. "But there is no question we are seeing very severe cases hit in populations normally not susceptible to the flu, and without underlying health conditions in some cases," she said this week. "Young people and pregnant women have been particular targets of that."

Q: Is it true that people who get the H1N1 mist are getting a live virus which they can shed, infecting people with depressed immune systems?

A: The nasal spray is made from live, weakened virus. There is a bit of "shedding" -- where some of the vaccine escapes. But the amount is so small, there is no need to worry about spreading it in the general population, according to Dr. Julie Morita, medical director of the Chicago Department of Public Health's immunization program.

The only concern, she said, is among health care professionals who care for people whose immune system is compromised. "A doctor in a regular setting can get the nasal spray and not worry about shedding, but those taking care of people with a weakened system should not get the vaccine or go to work immediately after taking it," she said.

Clinical studies show the risk of getting infected after contact with attenuated, or weakened, vaccine virus is minuscule -- between 0.6 and 2.4 percent.

Q: My children, ages 2 and 5, got the first round of H1N1 shots, but the doctor said she wasn't sure she will have the second dose a month later. Are they protected with just one shot?

A: Health officials recommend that children under the age of 10 receive two doses of vaccine, separated by four weeks. Health officials said every attempt should be made to obtain the second dose in order to achieve full protection. More vaccine is on its way so people should check regularly with their doctor, school and local health departments.

Q: Our mom is really sick and we aren't sure if it's swine flu. If we wear masks and sort of keep a distance from her, will we be OK?

A: A bit more than that is needed to avoid the virus, according to the CDC. If possible, your mom should be in a private room away from common areas of the house and use a separate bathroom. If she has to be around others, she should wear a mask. Everyone should wash hands regularly. If you are under 24, you might consider getting an H1N1 vaccine.

Q: I am pregnant with triplets, due to give birth in 10 days. I brought my 2-year-old son, my husband and my mom (our caretaker) to Truman College's clinic on Saturday. We waited in line for 5 1/2 hours for the vaccine. ... What kind of screening are they doing for these shots, just first come, first served?

A: With a limited supply of vaccine at each clinic, Chicago Health Department officials are trying to limit it to high-priority groups. But mostly they are relying on people being honest when asked in line if they fall into one of those groups.

"We're trusting people to do the right thing," said Julie Morita, director of the department's immunization program.

According to Tim Hadac, a department spokesman, officials are confident that nearly everyone who got vaccines at the first clinics was in a high risk group, although a "small percentage" might have slipped through. Some people had asthma, diabetes, immune disorders and other chronic illnesses that would not always be obvious to other people in line, he said.

Overall, those eligible for early vaccines are health care workers; pregnant women; children and young adults ages 6 months to 24 years; people who live with or care for infants younger than 6 months; and people ages 25 to 64 with chronic health conditions. The public clinics are being offered Tuesdays, Thursdays and Saturdays at six City Colleges campuses as long as there is demand and supply.

Q: We are going to visit my in-laws for Thanksgiving and we were told we can't see my father-in-law unless we have H1N1 shots. I have chronic sinusitis plus a diminished immune system, so how likely am I to find the vaccine before Thanksgiving? Is there a list of locations that have the vaccine?

A: You should call your doctor or health care provider to see if it is available, and where. Once the vaccine is readily available, a list of health departments and pharmacies will be made available on the Illinois Department of Public Health Web site,

The vaccine continues to be in short supply across the country because of production delays. Health officials have said they expect a better supply by mid-November and that by early December, the vaccine should be widely available. Most vaccine is now going to local health departments and hospitals.

Q: The city of Chicago has the vaccine. DuPage County has it. Cook County Department of Health -- nada. Why is Cook County so behind?

A: Cook County Health Department officials said they got their initial 20,000 doses of vaccine late last week. Six thousand doses were allocated to hospitals in suburban Cook County and about 5,000 doses to public schools in Palatine, the first district designated for student vaccinations. Other doses have been reserved for health care workers at the county Health Department. No vaccine is currently available for public clinics, a county spokesman said. Officials were "cautiously optimistic" the department will get more vaccine early next week that will allow for public clinics to begin soon in suburban Cook County.

Q: Are there precautions a family should take regarding trick-or-treat candy this Halloween?

A: State and local health officials recommend giving out wrapped candy. Rather than allowing children to reach into a bowl, hand it to them. Children should wash their hands, use sanitizer and wash any fruit or other food.;