The rest of the country can learn from New York's experience with the H1N1 virus. Continue to use available and inexpensive preventive measures, such as hand washing, covering your cough, and staying at home if you're sick. Getting the flu stinks. Most have had it and, and most get better. It also has great potential to cause severe illness in high-risk individuals as we have seen year after year, and as I wrote last April.

That is why I still believe that the number one way to prevent influenza is to get vaccinated annually. I do. My children do. My patients do. We are now in the middle of a pandemic influenza outbreak throughout the United States. "Flu season" doesn't start until January or so. So do something about it and get vaccinated.

Time-line of H1N1 swine flu news April 24, 2009

On Friday, April 24, 2009 I received a message from the New York City Department of Health advising me of a conference call to discuss the recent outbreak of swine flu in the United States, and possibly at a school in Queens, New York. That seems like a long time ago.

Since then, there have been an increasing number of suspected and confirmed cases reported in several states including Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio, and Texas as well as other countries, including Mexico, Canada, New Zealand, the UK, Israel, and Spain.

Most of the disease outside of Mexico has been described as mild illness with few hospitalizations, though on Wednesday, April 29, 2009 it was reported that a 23 month old child in Texas died from complications of the virus. This is sad, but this is not surprising or unique to swine flu. It is what influenza does. It is why Pediatricians and public health officials press so hard for universal vaccination.

The last Influenza season (2007-2008) alone, almost 100 children died from complications of laboratory confirmed influenza, and according to the U.S. Centers for Disease Control and Prevention (CDC) estimates, on average, influenza is believed to contribute to 226,000 hospitalizations and 36,000 deaths per year in the United States. Annual vaccination continues to remain the best method for preventing influenza and its potentially severe complications. Unfortunately, there is no vaccine to protect humans against swine flu, at least not currently; therefore good infection control practice is recommended to try to prevent the spread of the virus. These are the CDC guidelines; they are not innovative guidelines, and most children are already familiar with them:

1. Cover your nose and mouth with a tissue when you cough or sneeze.
   
   
2. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
   
   
3. Put used tissues in the trash.
   
   
4. Clean your hands after coughing or sneezing. Wash with soap and water or with alcohol-based hand cleanser.
   
   
5. Avoid touching your eyes, nose, and mouth.
   
   
6. Caregivers should avoid face-to-face contact with infected individuals and clean their hands with soap and water or an alcohol-based hand rub after contact.

If you haven't been fortunate enough to avoid an infection with influenza (swine or other) there are some additional recommendations I can offer you.

1. First, call your pediatrician if your child develops flu symptoms, such as fever, cough, sore throat, headache, chills, muscle aches, and fatigue.
   
   
2. Most mild cases of influenza, especially in children over 2 years of age, can and should be managed at home to prevent the spread of the virus to others.
   
   
3. As with much other flu-like illness, treatment is basically supportive, including comfort measures, such as the use of antipyretics (acetaminophen, ibuprofen, Tylenol, Motrin, and Advil). Remember that children 18 years of age and younger should never be treated with aspirin or aspirin-containing medications, such as bismuth subsalicylate (Pepto-Bismol), unless prescribed by a physician. This is due to the increased risk of Reye Syndrome.
   
   
4. In some cases treatment with an anti-viral medication such as oseltamivir (Tamiflu) or for children over 7 years old, zanamivir (Relenza) is a possibility. You should talk to your physician about the indications.
   
   
5. For children less than 2 years of age and for older children with known risk factors for severe disease, such as immune deficiencies, kidney disease, congenital heart disease, hematologic disease, and severe lung disease, treatment with an antiviral drug is recommended to prevent serious illness.
   
   
6. You should always talk to your physician to determine whether testing or admission to a hospital is warranted.

Testing for swine flu is not very accurate, which is why the CDC generally refers to the symptoms as influenza-like-illness (ILI). The rapid flu tests which are currently available on the market are believed to identify positive cases less than 70% of the time, which means almost a third of the time a patient who actually has swine flu will not have a positive test. This limits the effectiveness of the test as a diagnostic tool, and in some states and cities, such as New York City, testing is not even being recommended.

Lastly, this situation is evolving, and there are daily updates by local, state, and federal health agencies.

REFERENCE: CDC; "Weekly US Map: Influenza Summary Update."