Protecting Families Against the H1N1 Virus

Amy Garcia, RN, MSN
Executive Director of the National Association of School Nurses
Tuesday, August 25, 2009 1:30 PM

Amy Garcia, executive director of the National Association of School Nurses, will discuss precautionary steps families can take during the school year to avoid getting the H1N1 virus and what to do if a member of their household becomes sick. She was online Tuesday, Aug. 25 at 1:30 p.m. ET.


Amy Garcia: Hi! I am Amy Garcia RN. I am the executive director of the National Association of School Nurses. NASN is a professional organization. Our members take care of children in public and private schools in the United States and around the world. NASN supports school nurses to keep children in school, healthy and ready to learn.


Arlington, Va.: I have five kids in four different schools ranging in age from 18 months to 12 years old. Aside from the hand washing lecture, what other things can I tell my kids to do at school to keep their exposure to a minimum?

Amy Garcia: Great question. Your children will follow your lead, so model for them:

1. Wash your hands with soap and water for 20 seconds (about the time it takes to sing Happy Birthday twice)

2. Cover your cough or sneeze with a tissue or into your elbow or shoulder.

3. Stay home when you are ill. Use a thermometer to check for a fever. Stay home for 24 hours after the fever is completely gone.

4. Take advantage of the vaccine when it becomes available -- both seasonal flu vaccine and H1N1. If you have any questions, ask your school nurse or health care provider.

5. If you or a family member develop the flu, notify your health-care provider early as there are antivirals that may lessen the severity.


Minneapolis: So, isn't the H1N1 strain still just the flu? Is the concern that we just don't know how it will react, as compared to the flu that we usually get every year? Or is it something more than that?

Amy Garcia: This strain of H1N1 flu is novel, meaning new. So it spreads easily because people have not been exposed and do not have antibodies to it. This strain of H1N1 concerns me for several of reasons:

1. It disproportionately impacts children and pregnant women.

2. There seems to be a higher incidence of pneumonia, possibly because this virus replicates deep inside the lung.

3. It spreads very easily and quickly. My school nurse friends who have witnessed outbreaks describe large numbers of children getting very sick, very quickly.

4. The H1N1 virus may mutate to be more deadly, and still very contagious.


Children under six months: Hello!

I have an infant who will be six months old in late October. What precautions can I take and ask his daycare provider to take to ensure that he is as safe as possible during what is predicted to be the height of the outbreak?

Also, I'm tentatively planning a trip to the west coast about the same time (not by choice, but for a family obligation). I could potentially postpone this airplane trip until next spring. What would you do, thinking of the health of a six month old? Thank you!!

Amy Garcia: Your child is very lucky that you are thinking ahead.

Handwashing and covering coughs are critical. Make sure your day care is careful to exclude children with a fever. We know that children shed this virus easily, so attention to detail is important.

When the vaccine becomes available, ask your health-care provider if it is right for your child.

Trust your instincts on travel. It has been mothers' wisdom for many years to keep infants out of crowds.


Mumbai, India: What could be the best way to protect from H1N1?

Amy Garcia: has excellent recommendations for families, schools, workplaces and other settings.

The key things to do are:

1. Regular, thorough hand washing

2. Cover your coughs and sneezes

3. Stay home when ill

4. Ask your health-care provider about being vaccinated for both seasonal and H1N1 flu when the vaccines are ready


Rome, N.Y.: Why aren't schools required to have tissues and hand sanitizers in every room? "An ounce of prevention..."?

Amy Garcia: Every parent should ask the school district:

What is your plan to keep my child safe and healthy?

Do we have a school nurse, full time in my child's school?

Is there plenty of soap and water or hand sanitizer available?


Alexandria, Va.: Thank you for taking our questions. About a week ago, our kids got sick -- fevers and a cough they still have. They are 3 and 6 years old, so it was hard to know if they had any other flu symptoms, but their dad and I subsequently got sore throats and muscle aches. We are wondering if we had mild cases of H1N1, but we didn't go to the doctor since we read that physicians have stopped testing for H1N1 and recommend staying home. Is there anything else going around right now that would mimic flu symptoms? I am unable to find any information about H1N1's prevalence in this area, or a good definition of what a mild case would feel like, so any information you can provide would be appreciated.

Amy Garcia: Flu symptoms can be tough to distinguish. Flu comes on quickly and has a fever, aches and pains. Children may also have GI symptoms.

Although we are focused on H1N1, seasonal flu is always a threat that should not be underestimated. When you or a family member are ill, notify your health care provider early. Anti-viral medications may help lessen the severity of the symptoms. Rest and fluids are important. If there are any problems breathing, seek medical care IMMEDIATELY!


Rockville, Md.: I have three kids, ages 7, 5, and six months. Would you recommend the baby also get the swine flu vaccine? Would you recommend travel to Mexico during Thanksgiving week? My kids' pediatrician seems to think Cancun would be safer than the U.S. in November because the U.S. will be in the midst of flu season.

Amy Garcia: Ask your physician or health-care provider if the vaccine is right for your baby.

The H1N1 is pandemic, meaning that it is widespread in many countries. I am a big believer in keeping babies away from crowds, whenever possible.

I hope that this flu does not spread widely, and that the vaccines are effective once they become available. I would love to go to Cancun this fall!


Washington, D.C.: My 19-year-old son currently has the H1N1 virus. (But, just for my own information, which antivirals do you recommend?) He is at a Southern state university far from here, but is getting the treatment. Couple of questions. How long does he need to stay inside his room? Does having it now sort of fortify him against future flus, as I've heard? Are there any other precautions he should take now and later, and what about people who he comes in contact with? Thanks.

Amy Garcia: There are two antivirals currently on the market. Your son's health care provider will prescribe what your son needs. Anti-virals should be given as soon as possible after exposure and symptoms.

The Centers for Disease Control currently recommend that persons with the flu stay away from school or work for 24 hours after the fever is completely gone. That means gone without medication.

Anyone who has the flu needs to get plenty of rest and fluids and to seek medical care immediately if there is a problem breathing or any question.


Fort Washington, Md.: My son has chronic tonsillitis. He is scheduled for a tonsillectomy and adenoidectomy in mid-September. I am worried that his illnesses have weakened his immune system. Is there anything I can do to boost his immune system?

Amy Garcia: Your son will need a healthy, varied diet and plenty of sleep, both of which boost the immune system.

He should follow the standard precautions about hand washing, etc. that I have addressed in other questions. Talk to your health-care provider about the flu vaccine and any other measure that would be right for your son.


Rockville, Md.: Mrs. Garcia, why is it that the flu typically thrives in cold weather months? It seems it needs a warm, humid environment to thrive in. I cannot seem to make sense of this.

Amy Garcia: Colds and flu are more easily transmitted during the cold weather months because we are inside more -- and thus, closer together. Schools are open, and that contributes to the spread of disease in a big way! Children shed the flu virus more easily than adults.

We also know that cold weather dries out the airways which is one important part of your body's natural defense.


Rockville, Md.: Mrs. Garcia - Thanks for taking my question. Wouldn't you say that even despite the fear of the H1N1 this flu season that we have a lot more understanding and protection than the folks in, say, 1918? I guess health-care advocates have a fine line to walk between calming the public's fear and spreading too much information that could cause panic.

Amy Garcia: You are right. We have an understanding of the virus, we have vaccines, airway support, antibiotics to treat complications like pneumonia, and easier access to health care than our ancestors did in 1918.

That said... this strain of influenza seems to spread rapidly.


More prevention advice: I know this sounds like a no-brainer but shouldn't parents also be "extra focused" on the eating habits of their children to strengthen their immune systems?

I don't think that tons of Vitamin C would ward off the the flu, but an active and healthy child certainly has a better shot at quick recovery.

Amy Garcia: I couldn't say it any better myself.

A healthy, balanced diet, and plenty of sleep for ALL of us!


Gainesville, Va.: When should a teacher get a swine flu shot?

Amy Garcia: Teachers should get a flu shot when they become available. There will be two vaccinations this year -- one for seasonal flu and one for the H1N1 strain. Both are important.


Boston: Is it true that the elderly will have to wait to get the H1N1 vaccine? My mother is 92 and she insists the vaccine will go to children and young adults first.

Amy Garcia: The H1N1 flu occurs more often and is more severe among children and pregnant women. We don't know why, but the elderly may have immunity tied to past epidemics. Your mother's health-care provider will know about her specific needs.

Your mother should be SURE to get the seasonal flu vaccine as early as possible, and should ask her health care provider if her pneumocoocal pneumonia vaccine is up to date.


Massachusetts: I've heard from a few people and read in a few journals that the human race has seen the H1N1 virus before. First around 1918 with the Spanish influenza and then again there was an H1N1 outbreak in the '70s. I just don't understand how this "swine flu" H1N1 virus can be different from previous outbreaks of H1N1.

Amy Garcia: Yes. There have been several epidemics/pandemics in the past. There is a strain of H1N1 virus that is included in the seasonal vaccine most years. However, it is NOT the same strain as this new H1N1 virus.


Washington, D.C.: I have a child with egg allergy. Is it possible for him to get the vaccine or is there one that is acceptable?

Amy Garcia: Ask your child's health-care provider about his or her specific need.


Philadelphia: I've heard conflicting advice about mask-wearing. Are masks effective?

Amy Garcia: Cold and flu viruses are typically transmitted through the nose and mouth. In certain settings, masks may make sense. The website speaks to this.


Metro?: Is there any way of protecting myself against H1N1 on the Metro? (Short of holding my breath and refusing to touch anything?)

Amy Garcia: My 17-year-old son and ride the metro to and from school and work most days. I carry hand sanitizer, because I do touch surfaces. I also stand away from anyone who is coughing or sneezing. If the cases or severity increase, I may choose other options.


Why we get colds in the winter: I've recently learned that it is because our exposure to sunlight is much less so we get much less Vitamin D. I learned this in the comments page of a Washington Post article that recommended Googling Vitamin D council.

Amy Garcia: Vitamins are an important part of a balanced diet, which protects us from disease all year long. Ask your health-care provider if vitamin supplements are right for you.


Virginia: Will the nasal spray vaccine be available for H1N1 this fall? Two of my children have a severe egg allergies and cannot get the regular vaccine, but it's my understanding that the spray would be okay for them. Also, what is the age cutoff for this? My older daughter is 4, but my son is currently only 15 months.

Amy Garcia: The nasal vaccine may be the first to be ready for the public. Ask your health-care provider about your child's allergy.

The CDC recommendation is vaccine for 6 months and up. has more about the specifics.


Philadelphia: There is a theory that the people who were either exposed to or got the 1957 flu may have an immunity to this year's flu. If I was alive in 1957 but did not get the flu then, am I in the category of those believed to be immune?

Amy Garcia: Typically, the human body develops antibodies to cold and flu viruses one strain or type at a time, either through exposure or vaccination. When you are exposed to a certain strain, you may be protected from that strain the next time it circulates.

Be sure to consider both the seasonal flu vaccine and the H1N1 vaccine.


Wheaton, Md.: Are there any extra precautions that college students can take? Staying home isn't that helpful when home is a dormitory. Will enough vaccine be available for them?

Amy Garcia: College students should be particular about handwashing, covering coughs and being isolated from other students when ill. The CDC is concerned about all students having access to a vaccine, including college students.

I also suggest you make sure your pre-teen and teens, including college freshman talk to your health care provider about a meningococcal meningitis vaccine, as this is a rare, but potentially deadly illness that spreads this time of year.


In-home care: When should our children's in-home care providers have the vaccines this season?

Amy Garcia: Child care workers should receive the vaccine when it becomes available.


Rockville, Md.: "Children shed the flu virus more easily than adults"

Maybe you should define your use of "shed". I'm thinking most people here will read "shed" as getting rid of (i.e. heal) when you are using it meaning impart, release, send forth, etc (i.e. spread).

Amy Garcia: Children sneeze and cough more, potentially spreading the virus further. I don't know about your kids, but mine sometimes forget to cover their cough. This is what I mean by the word "shed".


Fairfax County, Va.: General question for my family: My local grocery store is offering walk-in flu vaccinations (not swine flu, of course, but the regular kind). Is there any downside to getting these now, a month or two earlier than we usually do? The supply seems plentiful and there are no lines.

Is there any advantage at all to getting these vis a vis swine flu, or is it just a totally different illness? I'm thinking at least you won't have regular flu at the time when you contract swine flu, if you get vaccinated now for regular flu.

Amy Garcia: I have already received my seasonal flu vaccine. There used to be a concern that it should be given before fall, but the recommendations have changed. It is not too early to be protected from the seasonal flu.


New York, N.Y.: How effective are the drugs Relenza and Tamiflu in treating H1N1 and are they recommended for preschoolers?

Amy Garcia: The antivirals have been shown to be effective at lowering symptoms when given early in the course of the disease. Ask your health-care provider if the antivirals are right for your child.


Rockville, Md.: As a concerned parent, I want to know why there isn't a vaccine for the H1N1 virus yet. When can we expect a vaccine to be made available to the public?

Amy Garcia: It takes months to manufacture and test an influenza vaccine.

Last Spring, the CDC and the World Health Organization identified this new H1N1 virus as a big problem, AFTER the seasonal flu vaccine was already in production. As a nurse, I am impressed that trials have already started.


Clifton, Va.: How many people die each year from the normal flu and how does that compare with the 90,000 predicted deaths to swine flu?

Amy Garcia: Typically, the seasonal flu in the United States causes 200,000 hospitalizations and 35,000 + deaths. Influenza is always serious.


Washington, D.C.: What are the contraindications for the vaccine? What side effects have been seen?

Amy Garcia: The vaccine trials are not complete yet. Watch the Web site for more information.

I know that many people worry about vaccines, but we are lucky to live in a country during a time when there is protection from deadly diseases that have wreaked havoc throughout history. This generation has not seen polio, tetnaus, measles, diptheria and other diseases that maim and kill. In my travels to other countries, I have personally seen children die from tetnaus and whooping cough -- diseases which are easily prevented.


Fairfax, Va.: Are there any teaching aids or games to teach kids to wash their hands?

Amy Garcia: Yes.

And Kathleen Sebelius, the Secretary of HHS, sponsored a contest for videos on flu prevention!


Memphis, Tenn.: We don't get sick days at my work at all, not even full-time people, and vacation must be scheduled in advance. I work full time I'm worried about what I'll do if my child (third grade), spouse (enrolled in college) or I should get this flu. If I miss work, I risk losing my job, and also, just missing a few days jeopardizes everything: my mortgage, my car payment, etc. People come to work sick here all the time because we have no paid sick days and they can't afford to miss work. This is my biggest concern about this epidemic. Isn't there anything the government can do to help protect me and my family from a greedy employer of over 250 people who refuses to provide sick days and may not excuse my absence and certainly won't pay me?

Amy Garcia: The National Association of School Nurses has been supportive of Rep. DeLauro's bill that provides earned sick leave for part time employees.

School nurses regularly hear from parents who are afraid they will lose their job if they take off work to care for a sick child.

Many cities are encouraging employers to allow for time off for illness so that we are not forced to work sick or send our children to school when they are sick.


Traveling: My mother-in-law, 77 years old, needs to travel this week Israel. We've been told that their hospitals are full of people with H1N1. We are debating if we should allow her to travel at all. Is there any preventive measure we can take, or a vaccine to give?

Amy Garcia: Your mother should talk with her health-care provider -- the person who knows her health history. The H1N1 vaccine is not ready yet, but the seasonal flu and pneumococcal pneumonia vaccines are available.


Birmingham, Ala.: I have a child with mild asthma. Are there extra precautions I should take with regard to treating his asthma this fall and winter?

Amy Garcia: Children with chronic health conditions like diabetes and asthma should be very high priority for receiving the vaccine.

Talk to your health-care provider about your child's asthma action plan. Make sure that there is a plan to prevent asthma attacks.


Alexandria, Va.: The CDC is recommending the "regular" flu shot and the H1N1 vaccine this fall/winter, correct? Does this apply to everyone in the home, plus the caregiver? Guidelines were offered for children in school, do you have any suggestions/guidelines for children who are taken care of at home? When is the best time to vaccine our children (they're 1 and 2 years old)?

Amy Garcia: Complicated question -- YES! I am going to refer you to for the specifics.


Reston, Va.: What steps can we take to keep our preschooler with reactive airway disease safe from the swine flu? (She already does a low daily dose of inhaled steroids and everyone in our household gets a flu shot every year.) I recognize the importance of frequent handwashing, sanitizing hands when soap and water are not available, coughing/sneezing into the elbow rather than the hand, keeping her away from sick people (and large crowds should swine flu hit the area), and keeping her immunity strong through proper diet and good sleep habits. But preschool has me worried, since of course if one child (or his or her sibling) gets sick, it's likely that there will be a big outbreak among the children. Also, are there concerns about the safety of the swine flu vaccine for small children?

Amy Garcia: The H1N1 vaccine has just started trials, so I don't know of any concerns. It sounds like you are doing a great job caring for the unique needs of your child.


Philadelphia: Who pays for the vaccines? I have read that some states, including my state which has yet to have its state government budget approved, have not authorized the purchase of the vaccine. If this is true, what does this mean to the availability of vaccines in Pennsylvania?

Amy Garcia: The federal government will pay for the H1N1 vaccine given in social settings (health department, schools, etc.) Most health plans also pay for the vaccine and administration.


Amy Garcia: Thank you for the wonderful questions.

I want to refer you to for more information.

School nurses are also a great resource for your questions about the flu. Best, Amy


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