I imagine that you may be getting tired of reading my blogs on swine flu, and I can assure you, we are all (pediatricians that is) tired of talking about it too. But, from the phone calls that our office is being inundated with, there are still more questions and concerns about the H1N1 (swine) flu.

Fortunately, in our part of the country it seems that we have started to see fewer “flu-like” illnesses and the waiting rooms at our office are not quite as crowded. That may not be the same in other areas of the country as now 46 states report widespread flu activity.

Even though we seem to be seeing fewer cases of presumed H1N1 flu in our area, we do not know, and no one knows, if this virus is going to quietly fade away, or if we will see a second wave of H1N1 later this year and into 2010.  Unless you can truly predict the future, we will all just have to wait and see.

With that being said, the H1N1 vaccine is becoming more widely available and there are prioritized groups that should begin getting vaccinated.

There are two types of H1N1 vaccine, just like the seasonal flu vaccine. There is an injectable “killed” vaccine and there is a live-attenuated nasal vaccine (similar to seasonal Flu-mist nasal spray).

Children between six months and two years of age should receive the injectable flu vaccine. This injectable vaccine should also be given to pregnant women and to children ages two to 24 years who have underlying chronic medical conditions that prevent them from taking the nasal flu mist (refer to http://www.cdc.gov/ to see the list of those conditions) for those children between the ages of two to 24 years who are otherwise healthy, the injectable or nasal H1N1 vaccine may be given (it is approved for use up to 50 years of age).

The other targeted group to receive the H1N1 vaccine is parents, siblings and caregivers of infants under six months of age. Again, the majority of those may receive the nasal vaccine and injectable may be used when appropriate for older individuals.

In our office the most current problem comes with trying to prioritize groups that receive the first doses of vaccine and to explain to others that they too will get the vaccine once the vaccine supply increases, as it should in the next several weeks. This is a true lesson in patience, and in taking turns, just like we teach our own children. Those with the most risk should get the first doses of vaccines. Don’t you agree? There is just not a way to vaccinate 100 million people in a day.

Lastly, the Centers For Disease Control and Prevention in a news conference yesterday, reiterated that antivirals like Tamiflu, should be given to children who are at higher risk for complications. Tamiflu should not be given “routinely” to those patients who are above the age of two years, and who do not to appear to be extremely ill. It does not need to be given to all household contacts.

For most, the illness is self-limited and may be treated with rest, fever control, hydration and TLC (tender loving care, for the younger set that looks at me like, “what does that mean?”). In all cases your doctor needs to see any child who seems to be having respiratory distress, is not taking fluids, or seems to be getting worse rather than better after several days.

So, continue to wash your hands, cover your mouths and get your vaccines, as they are available. We have a long way to go this flu season and besides coughing into your elbow.

I hope PATIENCE may be the other lesson everyone learns during the fall and winter this year.

That’s your daily dose, we’ll chat again soon.