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Four-year-old Sam Ledrew of St. John's waits to receive his H1N1 vaccination. (Paul Daly/Paul Daly)
Four-year-old Sam Ledrew of St. John's waits to receive his H1N1 vaccination. (Paul Daly/Paul Daly)

Ask André Picard

A guide to H1N1 for parents Add to ...

The H1N1 virus has begun to spread in earnest and the high-profile death of a 13-year-old Toronto boy has awakened the public to the potential dangers of the virus.

Many parents are worried and looking for clear information about the flu and how to treat it. The Globe and Mail's public health reporter, André Picard, tries to clear up the "conflusion" by answering reader questions. Mr. Picard has also answered your questions on the and

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Please note that this information is not medical advice. Rather, it is an attempt to synthesize and explain in plain language information from public health officials and medical experts.

Q: I'm pretty sure my daughter has the flu. Can I give her cough syrup?

A: There is very little evidence that over-the-counter cough syrups, cough drops and cold and flu medicines are of any benefit. In children, these products can actually be dangerous. The best treatment for a cough is hydration, so if you are sick sip water and chicken soup.

Q: My child is complaining about achiness - can I give my child Tylenol or baby Aspirin for the pain?

A: Children under the age of 18 should never be given ASA (Aspirin and similar products) because it can cause a rare but deadly condition called Reye's syndrome. So-called baby Aspirin is not a product for children, it is a low-dose product for adults. Tylenol (acetaminophen), Advil (ibuprofen) and similar products can be used to treat pain. But recent research has suggested that Tylenol can pose risks to children with asthma and allergies. In all instances, it wise to consult a pediatrician before giving medication - especially a new medication - to a child.

Q: I read that the 13-year-old child who died of H1N1 had taken fever reducers. Are they dangerous?

A: Products like Tylenol, Advil and concoctions that contain these drugs can be used to treat pain and reduce fever. The danger is not necessarily the product per se but that they can mask symptoms and create a false sense of security. Fever, in itself, is not dangerous unless a child's temperate is extremely high. However, some research suggests that artificially lowering fever can reduce the immune response, prolong illness and actually endanger children. As a result, some countries like Japan, say that fever reducers should never be used in children.

Q: What about babies?

A: Babies under the age of six months should not get the H1N1 vaccine. Some public health officials believe that children under age of three should get non-adjuvanted vaccine. But parents, siblings and caregivers of very young children should get the vaccine to minimize the risk of infecting the baby.



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Q: Should older children get the H1N1 vaccine?

A: The vaccine is recommended for all Canadians over the age of six months, with few exceptions. However, it is recommended that children under the age of 10 get the vaccine in two half-doses, three weeks apart, instead of a single dose. The two-shot process is used because children do not produce as strong an immune response to the antigen as adults do.

Q: My son is five so he is supposed to get two shots, at least three weeks apart and then it takes time for the vaccine to work. Does that mean he won't be protected for at least a month?

A: Currently it is recommended that children under 10 get two half-doses at least three weeks apart. However, the body will start producing antibodies immediately to the vaccine should confer partial protection. There is also growing evidence that only one shot is needed for children.

Q: Is it true that children only need one shot, not two?

A: An expert committee of the World Health Organization has revised its earlier recommendation and said that one shot of the vaccine is adequate for children. The Public Health Agency of Canada said it is reviewing the matter. In the meantime, get that first shot.

Q: Is there anyone who should not get the vaccine?

A : Anyone with a severe allergy to egg proteins (egg and egg-based products), chicken protein or any of the constituent parts should not get the vaccine. Those other ingredients include thimerosal, sodium chloride, disodium hydrogen phosphate, potassium dihydrogen phosphate, potassium chloride, and trace amounts of formaldehyde, sodium deoxycholate and sucrose. People with latex allergy should also tell clinic personnel, who often wear latex gloves. People who cannot get the vaccine can take antivirals like Tamiflu as a preventive measure.

Q: Is there an egg-free version of H1N1 available for those with allergies?

A: There is no egg-free version of the vaccine available in Canada.



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Q: So children with asthma and who use an inhaler can get the vaccine?

A: Children with asthma - many of who use inhalers that contain steroids - are a priority group for vaccination because, if they contract the H1N1 virus, they are at higher risk of complications. But bear in mind that many children with asthma also have allergies, so check the list of potential allergens (see above.)

Q: If people can infect others before they get sick and after they get better shouldn't we all stay home?

A: It is true that people can infect others when they have no visible or audible symptoms. But the reality is that they are far more likely to spread the virus when they are sick because of the coughing, runny nose and so on.

Q: It seems like there are a lot of kids with the flu. Why is that?

A: There's a certain predictable rhythm to the spread of the flu in communities each year: First you see spread among children (who are often in large groups and have slightly less developed immune systems), then it moves to older people. Usually, that is seniors but with H1N1 it is the 15-50 age group. When flu is widespread in children, you start to see an increase in hospitalizations a week or two later. Then sadly, you see a peak in death two or three weeks afterwards.

Q: Who can I call if I have more questions?

A: The Public Health Agency of Canada has a H1N1 hotline 1-800-454-8302. Most provinces and health regions also have telehealth lines that you can call for information, including where to get a flu shot.



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