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Back to flu

With schools opening, it's time to prepare for swine strain that targets the young

By Stephen Smith
Globe Staff / August 31, 2009

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ATLANTA - He’s one of the nation’s top flu fighters. But for Dr. Marty Cetron, the battle begins at home.

That’s where, like parents all across the country, he is preparing his three children - they’re 9 to 15 years old - for the arrival of a fall flu season unlike any in their lifetimes. This will be the season of our dual discontent: Disease trackers expect both seasonal influenza and the novel swine strain to circulate. And swine flu, which made its US debut in the spring, has shown an unusual propensity for making the young sick while sparing the old.

So Cetron, an avuncular official here at the US Centers for Disease Control and Prevention, is telling his kids to wash their hands and cover their coughs. He’s talking about the importance of vaccination. And he’s trumpeting a measure used through the ages to stanch the migration of viruses: Stay home when you’re sick.

“What I try to point out to my kids is that by doing this for yourself, by staying home when you’re sick and giving up that party or that swim meet, not only are you likely to get better quicker because you’re not stressing your immune system, but you’re being a better citizen to your friends,’’ said Cetron, director of CDC’s Division of Global Migration and Quarantine.

“I tell them, you don’t know whether your teammate’s parent is undergoing chemotherapy for cancer. It may be that Johnny can handle this infection just fine, but when he goes home, his mom is being treated for breast cancer, and what is that going to mean?’’

For parents and students, school administrators and school nurses, the dawning academic year presents unprecedented challenges.

Some children - mainly those 9 and younger - may require as many as four flu vaccinations (two for seasonal flu, two for swine flu). Families will need to develop strategies for who will tend to sick youngsters and, potentially, who will stay home with children if schools are forced to close, now considered an option of last resort. And workers should consult with their bosses in advance to clarify policies governing time off to care for ill family members.

“It’s going to be a unique flu season,’’ said Dr. Thomas Frieden, the recently anointed CDC director who was chief of the New York health department when swine flu walloped that city in the spring.

There are few viruses more unpredictable than influenza. With a change here, a change there in their genetic machinery, flu germs can be more transmissible - or less. A change in genetic clothing can also render a vaccine less effective.

Making flu prognostications, therefore, is like slogging through a scientific quagmire. That was evident last week when a presidential advisory panel suggested swine flu could kill 30,000 to 90,000 Americans this fall and winter - an almost absurdly broad range of possibility. CDC scientists, the nation’s top flu investigators, distanced themselves from the panel’s most dire estimates. In the four months since the swine flu virus known scientifically as H1N1 landed in the United States, 556 deaths have been confirmed, including 11 in Massachusetts.

One thing is beyond dispute: The swine flu germ has proven to be a particular threat to the young. A CDC report last week showed, for example, that 5- to 14-year-olds in Chicago were 14 times more likely to be infected with the virus than adults above 60.

Findings such as that - and they’re hardly singular to Chicago - turn long-standing beliefs about the flu on their heads. Historically, the disease has been viewed as a scourge of the aged, its potentially lethal consequences most feared among the elderly. But sophisticated laboratory tests show the immune systems of older adults provide an unusually hearty shield of protection against this specific virus - evidence, specialists said, that earlier in their lives, they were exposed to an ancestor H1N1 virus that forever put their immune system on high alert for related strains.

Three of every five deaths blamed on swine flu have happened in people younger than 50. While many of those who succumbed had chronic maladies such as asthma, diabetes, or heart disease that made them more vulnerable, other victims were previously robust.

And the virus has never gone away, not even during the summer months, when flu strains are usually quiescent.

“There are a lot of pediatricians who are saying, ‘This is bizarre. I’m still seeing kids in the clinic who are influenza positive,’ ’’ said Dr. Dan Jernigan, deputy director of CDC’s Influenza Division. “It says when kids get back together and congregate, there’s a good likelihood transmission is going to go back to where it was in the spring.’’

Vaccines will figure prominently in campaigns to slow that spread. But while shots and sprays against seasonal flu should become available within the next few weeks, vaccine against swine flu is still being brewed and isn’t expected to become widely available till mid-October.

“So,’’ said US Health and Human Services Secretary Kathleen Sebelius, in Atlanta to speak at a flu conference, “the messages, as simple as they may be, of hands and home are going to need to be driven over and over again.’’

The hands part is pretty straightforward. Hand-washing has been shown to halt the spread of flu viruses and so can using a tissue or the crook of your arm when coughing or sneezing. Dispensing with handshakes can help, too.

But what happens if flu hits you or your children with its calling card of fever, cough, sniffles, aches, and pains?

“I tell my 5-year-old son, ‘Tell Mommy if you are starting to not feel well because then you need to stay home from school,’ ’’ said Kris Sheedy, who specializes in crafting disease-prevention messages at CDC. “It can’t hurt for parents to start talking about these things with their children.’’

Specialists acknowledge, though, that remaining home from work can be a daunting - and even costly - proposition.

“We know that it’s very challenging, especially for the low-wage workers where if they don’t work, they don’t get paid, the family doesn’t eat,’’ said Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases.

As a result, agencies such as the Boston Public Health Commission are cajoling employers to be generous in allowing workers to take time off, both for their own well-being and that of their family.

Those same health authorities are embarking on campaigns to encourage vaccination against, first, the seasonal flu and, then, the swine variety, which is expected to require two doses, given three weeks apart.

The federal government is purchasing 195 million doses of swine flu vaccine, which, initially, will be targeted toward five groups: pregnant women; people who care for children younger than 6 months; children and young adults from 6 months to 24 years; adults from 25 to 64 with chronic health problems; and health care and emergency service workers.

Already, focus group research suggests the swine flu vaccine, which is undergoing studies to test its safety and effectiveness, may meet with resistance from inoculation-wary parents.

“Many of them expressed a lot of concern about the 2009 H1N1 vaccine,’’ Sheedy said. “Those concerns centered around the fact that it was new and that it was being developed quickly. There were comments, ‘This is new, I don’t want my child to be a guinea pig.’

“But attitudes and demand can change very quickly depending on what happens with this disease.’’

Stephen Smith can be reached at stsmith@globe.com.

What the symptoms are
■ Fever
■ Cough
■ Sore throat
■ Runny, stuffy nose
■ Body aches and chills
■ Headache
■ Diarrhea and vomiting seen in some swine flu patients

What to do if you get sick

■ If you are otherwise healthy and do not have chronic medical problems, stay home, avoiding contact with others. Remain there until at least a day after your fever has subsided without aid of fever-reducing medications. Health authorities discourage such patients from flooding emergency rooms.

■ If the flu makes you severely ill or you have asthma, diabetes, heart disease, or other underlying health problems that can spark complications, contact your doctor. Children experiencing fast or troubled breathing, bluish or gray skin tone, inability to drink enough fluids, severe or persistent vomiting, and extreme lethargy or irritability may need urgent care. Adults experiencing fast or troubled breathing, pain or pressure in the chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting may need urgent care.

■ Medications such as Tamiflu and Relenza may blunt flu symptoms and shorten the illness, although they work better the sooner they’re given after symptoms start. Health authorities have recommended amid the ongoing outbreak that patients with the most severe illness be given priority.

■ For more information, go to www.cdc.gov/h1n1flu

How to stop it

Wash your hands
Warm water and soap and alcohol-based gels help prevent flu germs from spreading.

Cover your mouth
If a disposable tissue isn’t handy, cough or sneeze into the crook of your arm.

Get vaccinated
Seasonal flu vaccine will be available in a few weeks. Swine flu vaccine is expected in mid-October; two doses will be needed.