Information on Children Less Than Five Years of Age and the H1N1 Flu Virus

Updated: December 11, 2009

• Know what to look for
• Signs of Severe Illness
• How to Protect Your Child or Yourself
• H1N1 Flu Vaccine
• Antivirals for Treatment of the Flu
• Considering the Options – Getting the Flu versus Vaccines and Antivirals

As with the seasonal flu, children less than five years old and especially those less than two, are more likely to catch the H1N1 flu virus, and if they do catch it, they are more likely to develop severe complications, like pneumonia or breathing problems. This can put their health at serious risk. That’s why it’s important for parents and caregivers of children to reduce the risk of H1N1 exposure.

H1N1 Flu Virus: Know What to Look for

Like seasonal flu, some people who get the H1N1 flu will have mild illness while others may become very sick. To date in Canada, most cases of the virus (especially in children) have been mild and sick individuals have recovered quickly.

An average flu sickness (both H1N1 and seasonal) may show the following symptoms:

Almost Always:	Common:	Sometimes:
Sudden onset of: Fever Cough	Fatigue Sore throat Decreased appetite Muscle aches Headache Runny nose	Nausea Diarrhea Vomiting

In children less than five years of age, nausea, diarrhea and vomiting may be more common and fever less common. In infants less than two months old, H1N1 can progress rapidly to severe illness. If your child develops flu symptoms, keep them at home until their fever is gone and they are back to their normal activity level, usually within one week. If their symptoms worsen, it’s important to speak to a medical professional. Give them plenty of fluids and if they have a fever use fever-reducing medications that are safe for children such as acetaminophen or ibuprofen. Cough and cold medicines are not safe for children six years of age and younger and aspirin is not safe for children 18 years of age and younger.

H1N1 Flu Virus: Signs of Severe Illness

If your child develops the following symptoms, seek immediate medical attention:

How to Protect Yourself and your Child

There are some simple steps that parents and caregivers can take to help protect themselves and their families from the flu.

• Wash your child's hands or teach your child to wash their hands often with soap and warm water for at least 20 seconds or use a hand sanitizer with an alcohol content of at least 60-90% (these are safe for children to use with supervision). If hands are visibly dirty, they should be cleaned with soap and water.
• Cover their coughs and sneezes if you can with a tissue. Throw the tissue away and wash your hands. When they are old enough, teach your child to cough and sneeze into their arm, not in their hand.
• If your child is six months of age or older, have them get BOTH the seasonal and the H1N1 flu vaccines. The seasonal flu shot will not protect against the H1N1 flu. This flu season (fall/winter) we will likely see H1N1 flu cases and seasonal flu cases – make sure your children are protected against both types of flu by getting both shots.
• Keep your child at home and away from day care or other group activities if they are sick. Wait until they are symptom-free and able to participate in all normal activities before sending them back to day care. Keep sick children away from other children until they are symptom free.
• Talk to your child about the flu and explain to them how “germs” can spread and why staying healthy is important. Ask your children what they have heard about the flu and answer questions honestly at a level that they can understand. Use the conversation as an opportunity to remind children what they can do to avoid getting sick.
• Keep common surfaces and items, including toys, clean and disinfected with regular household disinfectants.
• Encourage children to keep their hands away from their faces.
• Keep your children healthy. Encourage them to eat healthy food and stay physically active to keep their immune systems strong.

For more information about the H1N1 flu and the seasonal flu, such as information about how to take care of someone at home with the flu, please visit www.fightflu.ca or call 1-800 O CANADA, TTY 1-800-926-9105.

H1N1 Flu Vaccine

Getting an H1N1 flu vaccine is the single best way to protect your child from the H1N1 flu virus. A vaccine produces immunity to a disease by stimulating the production of antibodies (proteins in our bodies that fight diseases).

This year, there will be two flu vaccines – the regular seasonal flu vaccine and the H1N1 flu vaccine. Speak to your health care provider for advice on whether your child should get either or both flu vaccines.

There will be two types of H1N1 flu vaccine available: adjuvanted and unadjuvanted.  An adjuvanted vaccine includes a substance that boosts an individual's immune system and increases their response to a vaccine.  Adjuvants are included in common vaccines such as tetanus and hepatitis B.  The adjuvant in Canada’s H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E.  An unadjuvanted vaccine has no “booster” element.

The Public Health Agency of Canada recommends that children over the age of six months should be vaccinated against the H1N1 flu virus.  See the H1N1Flu Vaccine Dosing Recommendations page for specific recommendations depending on the age of your child.

Antivirals For Treatment of the Flu

If your child develops the flu your health care provider may prescribe antivirals for treatment of the flu.

Antivirals are prescription medications used to treat the flu. They do not make you immune to the virus, if taken shortly after getting sick (within the first 48 hours), they can reduce flu symptoms, shorten the length of illness and may reduce serious complications.

Antivirals may not be suitable for everyone.  Talk to your health care provider about whether they are right for your child.

Considering the Options – Getting the flu versus getting a vaccine or taking an antiviral

When considering your options about vaccination there are a number of factors that you should think about. This chart explains the risk of getting the flu versus the benefits and risks of getting an H1N1 flu vaccine and/or taking antiviral medication if your child gets the flu.

If you catch the H1N1 Flu

If your child becomes sick with the H1N1 flu there is a chance they could develop severe flu symptoms and be hospitalized.

Knowledge is your best defence. Take steps to protect yourself and your child.

	Getting the H1N1 Flu Vaccine	Taking antivirals after getting the H1N1 flu.
Benefits/Facts	Vaccines have proven benefits. Getting the H1N1 flu vaccine is the single best way to protect your child and those around your child from the H1N1 flu virus.	Antivirals may decrease the severity of sickness.
	Your child cannot get the flu from the flu vaccine.	Antivirals MUST be taken within the first 48 hours of the onset of symptoms.
	Vaccines are safe. The dangers from vaccine-preventable diseases (like the flu) are many times greater than the risk of a serious reaction to the vaccine.	If your child has the flu, talk to your health care provider about treatment options. Antivirals may be one of the treatment options that they recommend.
	The flu vaccine is safe and effective for children six months of age and older.	Recently Health Canada approved the use of antivirals for H1N1(oseltamivir, known as Tamiflu) for children less than one year of age.
	With the H1N1 flu vaccine your child will have some immunity to the current strain of the H1N1 flu virus within 10 days.
Risks	Vaccines can have side effects but they are usually mild. You need to weigh the risks of side effects with the risks of serious health problems for your child if they catch the flu.	There is a risk of side effects with any medication including antivirals. The most common side effects of the antiviral oseltamivir include nausea, vomiting, diarrhea, abdominal pain and headaches.
	The most common side effects of the flu vaccine are soreness in the arm where the vaccine was given, sore or red eyes, itchiness and for some a mild fever. Most people experience no serious side effects from the flu vaccine.	The H1N1 flu virus can adapt and develop resistance to a specific antiviral drug – this means that the drug would no longer be effective in treating the H1N1 flu.
	About one person for every 100,000 doses of vaccine distributed will have a severe reaction to a flu vaccine, including anaphylaxis or Guillain-Barré Syndrome (GBS).	Rare cases of anaphylaxis and serious skin reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiform, have been reported with the antiviral oseltamivir.
Myth Busting	Vaccines do not cause autism. A number of medical studies and expert advisory groups, including the World Health Organization’s Global Advisory Committee on Vaccine Safety, have concluded that there is no connection between vaccines and autism.	Antivirals are not appropriate for everyone. Talk to your health care provider about whether taking antivirals is right for your child.
	Thimerosal is a form of mercury used in the H1N1 flu vaccine to stabilize it and maintain its quality during storage. Thimerosal is a different form of mercury than the mercury known to cause health problems. The amount in flu vaccines is much less than the daily limit recommended – for example a can of tuna fish has more mercury than the thimerosal in the H1N1 flu vaccine.	Antivirals are usually taken in pill form (Tamiflu) or as an inhaled medication (zanamivir).
	If you receive the H1N1 flu vaccine you are at no greater risk of acquiring Guillain-Barré Syndrome (GBS), a neurological condition that occurs in approximately two in 100,000 people per year and is most often associated with foodborne infections. The possible risk of acquiring GBS from the flu or a flu vaccine is very small.	Antiviral drugs given for treatment of the flu usually need to be taken for five days.
	An adjuvanted vaccine is a vaccine that includes a substance that boosts an individual's immune system and increases their response to a vaccine. An unadjuvanted vaccine has no “booster” element. Adjuvants are included in common vaccines such as tetanus and hepatitis B.  The adjuvant in Canada’s H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E.