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					Sound Advice

This is an edited transcript of a radio interview recorded in December 2009.

Dr. Joseph Bocchini is a pediatrician and chair of the American Academy of Pediatrics
Committee on Infectious Diseases. Dr. Bocchini is also chairman of the Department of Pediatrics
at Louisiana State University Health Sciences Center in Shreveport. Welcome, Dr. Bocchini.

Dr. Bocchini: Thank you. I’m happy to be here.

Q: Doctor, the CDC is reporting that H1N2 infections are on the downturn. Does that mean the
danger is over?

Dr. Bocchini: It does not. We know from previous outbreaks that influenza tends to come in
waves, so that we would expect some increase activity. . It reaches a peak, and then it’ll decrease
in activity, and then we would expect another wave. And since it’s very early in the influenza
season, we do expect that there will be additional waves of influenza. Now, this may be caused
by the same H1N1 influenza that we have seen throughout the summer and now early fall and
winter, or it may be some of the seasonal influenza viruses that that may take over and produce
additional waves. So it’s very important that we remember that the concern for influenza is not

Q: Is there still a shortage of vaccine?

Dr. Bocchini: The supply of vaccine is improving each week. The CDC estimates that
approximately 10 million doses of H1N1 vaccine is becoming available each week, so we expect
a improving supply over the next month. Everyone who should receive the vaccine should
ultimately have a chance to get it.

Q: Who should have priority now while there’s still a somewhat limited supply?

Dr. Bocchini: With limited supplies, the CDC has recommended five different groups of
individuals who should receive the vaccine first. Very importantly, this includes children from 6
months of age through 18 years of age. This is important because young children appear to be at
the highest risk for hospitalization associated with this H1N1 pandemic influenza virus.

In addition to children, pregnant women are at increased risk, and they should all receive vaccine
as well. Parents and caregivers of children younger than 6 months of age should also receive the
vaccine because we cannot give the vaccine to children younger than 6 months of age, and as a
result, the only way to protect them is by immunizing those people who are around them. In
addition, healthcare workers and first responders, that is individuals who work with patients,and
essential people in the community -- firemen, policemen -- are also on the list for receiving the
vaccine first.
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Q: If your child has received one dose of vaccine and then gets the flu, does he still need the
second dose?

Dr. Bocchini: Yes, individuals who have had influenza should still receive the vaccine even if
the diagnosis is made in a physician’s office. Because frequently, we’re making the diagnosis on
clinical findings, and in many cases the clinical findings may not be completely accurate. In
addition, in other cases, we’re making the diagnosis based on laboratory findings, and some of
the laboratory tests that are routinely used are not completely accurate as well. Therefore, an
individual who has influenza based on a clinical diagnosis or an office-based laboratory test
should continue to receive vaccines on schedule to be sure that they are fully protected against

Q: I know the CDC has been examining this vaccine for any potential side effects. Have they
found any serious problems with it? How safe is this vaccine turning out to be?

Dr. Bocchini: The CDC has been monitoring the safety of this vaccine very carefully through a
number of mechanisms that are already in place. And in addition, (they) have established further
monitoring so that they could have almost an on-time, current view of side effects. The evidence
is that this vaccine is safe. The reports of side effects of this vaccine or events that occur after the
vaccine are very similar to what we see with seasonal influenza vaccine, and seasonal influenza
vaccine has a remarkable track record of safety. So the evidence so far, and this is with many
doses of vaccine now having been given to the general public, is that this vaccine is safe.

Q: Besides getting the vaccine, what’s the best way to keep your family healthy? I’ve heard
about people taking extra vitamin C or using hand sanitizer all the time or disinfecting wipes or
even flushing your nose with saltwater. Are any of these effective?

Dr. Bocchini: I think the most effective way to keep your family safe is to follow the standard
recommendations that we make for prevention of any infectious disease. And that is careful,
frequent handwashing and making sure that you avoid individuals who are already ill or have
symptoms of illness. Because influenza virus spreads by coughing, you are at risk of acquiring
the disease if you’re within 3 or 4 feet of an individual who is ill and coughing. Individuals
should wash their hands frequently, especially after coming in contact with objects that many
people might use, such as a doorknob. Frequent handwashing is with regular soap and water.
People can just remember that it takes about 20 seconds to sing the Happy Birthday song twice,
and so that’s a good way to be sure that you’ve washed your hands adequately. In addition, if
you’re in places where there is no sink and soap and water, you can use the alcohol-based hand
wipes that work just as effectively when the hands are relatively clean. If the hands have any
significant dirt or particles on them, you need soap and water to wash them.

There is no evidence of vitamin C makes a significant difference in our risk for uh developing
infection after exposure, and I would not recommend routine nasal flushing with saltwater as a
way to attempt to reduce infection. There’s no evidence that will help.

     John Ystrom     Producer/Recording Engineer       773-252-8070
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Q: What’s the latest advice on antiviral medications? Who should get them, and when should
they get them?

Dr. Bocchini: Currently, the recommendation is that those children and adults who are at risk for
complications of influenza should receive antiviral therapy as soon as the diagnosis of influenza
is made. They would include young children 2 years of age and younger, any child that has an
underlying pulmonary problem such as asthma, a child with diabetes, children with sickle cell
disease and other hemoglobin disorders, children with chronic metabolic disorders such as
kidney disease and liver disease. They also include children with significant neurodevelopmental
disorders as well.

So if any of those individuals have not received vaccine, they should receive vaccine as soon as
it is available, but in addition, if they develop an influenza-like illness, they should contact their
physician as early as possible so that they can be evaluated and a decision made about use of
antiviral therapy. Antiviral therapy is best used when it is given within 48 hours of onset of the
symptoms, so we want to know about illness early so we can treat those children early in the
course of the illness.

In addition we would also recommend antiviral therapy for those individuals who have more
severe disease because in that case, you may make a difference in the duration of infection and
and make those individuals better more quickly. The third group of individuals that we routinely
treat are any individuals with influenza severe enough to be admitted to the hospital.

Q: If your child is sick with something that looks like the flu, what symptoms could indicate you
need to call the doctor or you need to go to the emergency room? What are the red flags that
parents should watch out for?

Dr. Bocchini: Well, some of the red flags are related to the respiratory system, so if a child
seems to have difficulty breathing, has a change in the color of their skin or their lips, those are
indications that there may be a respiratory complication, and those children need to be seen. In
addition, some children have significant amount of vomiting and/or diarrhea associated with
influenza, and because of that, they may not be able to take an adequate amount of fluids to
maintain their hydration. So if they are unable to keep fluids down, that’s another reason why a
an individual should contact their physician or visit an emergency room.

Thirdly, if a child develops significant changes in behavior, so if they become sleepy or irritable
or just don’t look or act right, that’s another reason why parents should become concerned. And
at least contact their physician or, as I indicated earlier, if more severe visit the emergency room.

Q: Doctor, do you have any other final advice for parents?

Dr. Bocchini: I think parents should realize that although this influenza pandemic is very
significant and children are at risk, most children will have an uncomplicated infection and
recover without difficulty. It’s very important that parents follow normal recommendations for
reduction of exposure and when sick, be very careful to follow recommendations from their

     John Ystrom     Producer/Recording Engineer       773-252-8070
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physician. Keep in touch with their physician and with public health officials. So another thing
that’s important is to just keep up with r recommendations that are being made by local health
authorities as well as their physicians. They will be up-to-date and know the current
recommendations for prevention and management of this potentially serious disease.

     John Ystrom    Producer/Recording Engineer     773-252-8070