Special Patients - FAQs:

To learn more about febrile seizures, visit the following sites:

• The National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke Febrile Seizures Information Page.
• The American Academy of Pediatrics healthy children website, which offers additional information about febrile seizures.

Yes, the shingles vaccine is recommended for healthy seniors.

Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old and older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV), or people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation are also at greater risk to get shingles.

Some people should NOT get shingles vaccine.

• A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.
• A person who has a weakened immune system because of
  • HIV/AIDS or another disease that affects the immune system,
  • treatment with drugs that affect the immune system, such as steroids,
  • cancer treatment such as radiation or chemotherapy,
  • a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
• Women who are or might be pregnant

For information about whether you should get a shingles vaccine, talk with your health care provider.

More information about Shingles and the vaccine from CDC and FDA:

• About Shingles
• Transmission of Shingles
• Signs and Symptoms
• Complications
• Prevention and Treatment
• FDA information about the vaccine

The safety profile of Fluzone High-Dose vaccine is similar to that of regular flu vaccines, although adverse events (which are also reported after regular flu vaccines) were reported more frequently after vaccination with Fluzone High-Dose.  The most common adverse events experienced during clinical studies were mild and temporary and included pain, redness and swelling at the injection site and headache, muscle aches, fever and malaise. Most people had minimal or no adverse events after receiving the Fluzone High-Dose vaccine.

This vaccine is approved for marketing in 0.5 mL preservative-free, single dose, prefilled syringes.

Febrile means "having a fever."

A seizure is a convulsion or fit of uncontrolled body movements.

A "febrile seizure" refers to a seizure/convulsion in a child associated with a fever.

In children younger than 5 years old, having a fever for any reason (illness, vaccination, etc…) can bring on a febrile seizure. During a febrile seizure, a child often has spasms or jerking movements—large or small—and may lose consciousness. Febrile seizures usually last only a minute or two, and do not cause any permanent neurological damage. They are most common with body temperatures reaching 102°F (38.9°C) or higher, but also can occur at lower body temperatures or when a fever is going down. 

The majority of children who have febrile seizures recover quickly and have no lasting effects. However, febrile seizures often result in a visit to an emergency room and can be very frightening for parents and caregivers.

About 1 in 3 children who have one febrile seizure will have at least one more febrile seizure during childhood. Most children (greater than 90%) who have a seizure will not develop epilepsy. Genetic predisposition (i.e., family history) and other factors such as cerebral palsy, delayed development, or other neurological abnormalities increase a child’s risk for developing epilepsy after a febrile seizure.

People with certain types of disability have a higher risk of getting flu-related complications, such as pneumonia. Some physical disabilities can affect how well your body fights off infection.

People with conditions that affect their immune system, which controls how well your body fights off infections (including chronic and respiratory diseases) are at increased risk for getting more severe illness and requiring hospitalization.

If you have one of the disabilities listed below, you may be at increased risk of becoming infected or having unrecognized illness.  You should discuss your risk of illness with your healthcare provider. Disability groups at risk of getting flu and/or having unrecognized flu symptoms include:

• People who have limited mobility or who cannot limit coming into contact with others who are infected, like staff and family members
• People who have trouble understanding or practicing preventive measures such as hand washing
• People who may not be able to communicate symptoms of illness
• People who may not be  monitored closely for symptoms of illness

There are everyday actions people can take to stay healthy. Try to avoid close contact with sick people.

Flu spreads mainly person-to-person through the coughing or sneezing of infected people. If you get sick, the CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

• Be sure to continue taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.
   
• Test your blood glucose every four hours, and keep track of the results.
   
• Drink extra (calorie-free) liquids, and try to eat as you normally would. If you can’t, try to have soft foods and liquids containing the equivalent amount of carbohydrates that you usually consume.
   
• Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.
   
• Check your temperature every morning and evening. A fever may be a sign of infection.

Call your health care provider or go to an emergency room if any of the following happen to you:

• You feel too sick to eat normally and are unable to keep down food for more than 6 hours.
• You're having severe diarrhea.
• You lose 5 pounds or more.
• Your temperature is over 101 degrees F.
• Your blood glucose is lower than 60 mg/dL or remains over 300 mg/dL.
• You have moderate or large amounts of ketones in your urine.
• You're having trouble breathing.
• You feel sleepy or can't think clearly.

For more information, see:

• Diabetes and the Flu
• Taking Care of Your Diabetes at Special Times: When You Are Sick from the National Diabetes Information Clearinghouse fact sheet, Your Guide to Diabetes: Type 1 and Type 2.

The information below is important for people with heart disease, stroke, and cardiovascular disease.

• Maintain a two week supply of your medications.
• Do not stop taking your medications without first consulting your health care provider, especially in the event of influenza or a respiratory infection.
• People with heart failure should be alert to changes in their breathing and should promptly report changes to their health care provider.
• It is especially important to wash your hands often with soap and water and follow other basic hygiene to avoid infection.

No, because mothers make antibodies to fight diseases they come in contact with, their milk is custom-made to fight the diseases their babies are exposed to as well.  This is really important in young babies when their immune system is still developing.  

It is OK to take medicines to prevent the flu while you are breastfeeding.  You should make sure you wash your hands often and take everyday precautions (http://www.cdc.gov/flu/protect/habits.htm). 

However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to care for your baby.  If you become sick, someone who is not sick can give your baby your expressed breast milk.

 Yes, one of the best things you can do for your sick baby is to keep breastfeeding.

• Do not stop breastfeeding if your baby is sick. Give your baby many chances to breastfeed throughout the illness.  Babies who are sick need more fluids than when they are well.  The fluid babies get from breast milk is better than anything else, even better than water, juice, or Pedialyte® because it also helps protect your baby’s immune system.


• If your baby is too sick to breastfeed, he or she can drink your milk from a cup, bottle, syringe, or eye-dropper.

Yes. At this time, there are no studies suggesting harm to a pregnant woman or her unborn baby if she takes antiviral medicine.  The flu can cause severe illness and even death in pregnant women. Taking antiviral medicine can help prevent these complications.

If a pregnant woman thinks she has flu, she should call her doctor right away.  If needed, he or she will prescribe an antiviral medicine that treats the flu.  The medicine is most helpful if it is started soon (within the first 48 hours) after the pregnant woman becomes sick.

Not everyone with flu in the general population needs to get antiviral medicines.  Flu antiviral medicines should be used mostly to treat people with the flu who have a condition that increases their chances for serious problems from flu, such as pregnant women. These medicines are also used to treat people with flu who have more severe flu illness or who are in the hospital.

Clinical judgment is needed to decide if a person should be treated with antiviral medicines.

Children at increased risk of pneumococcal infections include those with anatomic or functional asplenia (including sickle cell disease), patients taking immunosuppressive chemotherapy, those with congenital and acquired immune deficiency (including HIV infections), those with chronic renal disease and healthy Native American, Alaskan Native, and African American children. Children less than 60 months of age in out-of-home child care are at 2-3 fold higher risk of experiencing invasive pneumococcal infections than children in home care.

Most people who get the seasonal flu will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks.  Some people, however, are more likely to get flu complications that result in being hospitalized and occasionally result in death.

Pregnant women are at higher risk for severe complications and death from seasonal influenza.

Treatment with oseltamivir (Tamiflu®) or zanamivir (Relenza®) is recommended for pregnant women with suspected or confirmed influenza and can be taken during any trimester of pregnancy. The duration of antiviral treatment is 5 days.

Flu is more dangerous than the common cold for children. Each year, seasonal flu places a large burden on the health and well-being of children and families.

• Children commonly need medical care because of influenza, especially before they turn 5 years old.
• Each year an average of 20,000 children under the age of 5 are hospitalized because of influenza complications.
• Some children will die from the flu each year. During the 2007-08 flu season, CDC received reports that 86 children died from influenza-related complications.
• Severe influenza complications are most common in children younger than 2 years old.
• Children with chronic health problems like asthma and diabetes are at especially high risk of developing serious flu complications.

This year there is a new and very different flu virus spreading worldwide among people called 2009 H1N1 flu. This virus may cause more illness or more severe illness than usual. Children are at high risk from this influenza virus as well.

Yes, prior to an outbreak, employers may inquire which employees may need to stay home, telework or work an alternate schedule to care for children in the event students are dismissed from school and child care centers are closed.  

Please keep in mind that asking employees questions, prior to a pandemic, about their health conditions or related absenteeism may raise issues under the Americans with Disabilities Act¹ (ADA).

Although there are no Federal privacy laws that are applicable in these circumstances, there may be state laws governing privacy of which you should be aware.  It is recommended that prior to any pandemic influenza outbreak, you consult with legal counsel and human resource specialists to develop a plan of action specific to your workplace.

_______________________________

¹The EEOC enforces Title I of the ADA.  The ADA’s provisions in regards to disability-related inquiries, medical examinations, and confidentiality apply to all applicants and employees of covered employers, regardless of whether those individuals have disabilities, as defined by the ADA.  By contrast, other ADA requirements apply only if an applicant or an employee is an individual with a disability under the ADA.

It cannot be definitively established in advance, however, whether a future pandemic influenza would rise to the level of a disability under the ADA.  Therefore, this answer provides guidance for employers that would comport with the ADA even if a future pandemic illness was found to be an ADA disability.

Note: As an overall matter, employers should be guided in their relationship with their employees by federal, state, and local employment law, and by the company-specific application of these laws as reflected in employee handbooks, manuals, and contracts (including bargaining agreements).

Not all of the employment laws referenced apply to all employers or all employees, particularly state and local government agencies.  For information on whether a particular employer or employee is covered by a law, please use the links provided for more detailed information.  This information is not intended for federal agencies or federal employees -- they should contact the U.S. Office of Personnel Management (OPM) for guidance.

Covered employers must abide by the Family and Medical Leave Act (FMLA) as well as any applicable state FMLA laws.  An employee who is sick, or whose family members are sick, may be entitled to leave under the FMLA.  The FMLA entitles eligible employees of covered employers to take up to 12 weeks of unpaid, job-protected leave in a designated 12-month leave year for specified family and medical reasons which may include the flu where complications arise that create a “serious health condition” as defined by the FMLA.

There is currently no federal law covering employees who take off from work to care for healthy children, and employers are not required by federal law to provide leave to employees caring for dependents that have been dismissed from school or child care.  However, given the potential for significant illness under some pandemic influenza scenarios, employers should review their leave policies to consider providing increased flexibility to their employees and their families.  Remember that federal law mandates that any flexible leave policies must be administered in a manner that does not discriminate against employees because of race, color, sex, national origin, religion, age (40 and over), disability, or veteran status.

Note: As an overall matter, employers should be guided in their relationship with their employees by federal, state, and local employment law, and by the company-specific application of these laws as reflected in employee handbooks, manuals, and contracts (including bargaining agreements).

Not all of the employment laws referenced apply to all employers or all employees, particularly state and local government agencies.  For information on whether a particular employer or employee is covered by a law, please use the links provided for more detailed information.  This information is not intended for federal agencies or federal employees -- they should contact the U.S. Office of Personnel Management (OPM) for guidance. 

The seasonal flu shot can be given on the same day as any other vaccine, including the shingles and the pneumococcal vaccine. If given on the same day, the shots should be given in different sites on the body. If desired, they can also be given at any interval before or after each other.

Depending on the severity of the pandemic, the Centers for Disease Control and Prevention (CDC) may recommend closing child care, schools, colleges, and universities and recommend other child social distancing measures.  Employers should be very cautious about establishing child care centers for employees that have children because this could undermine CDC’s child social distancing recommendations and contribute to the spread of pandemic influenza. Also, bringing children into the workplace may increase the likelihood of the virus entering the workplace and infecting employees.  Employers should consider other alternatives such as staggered shifts or teleworking as a first step to enabling families to remain productive at work while caring for one another.

Note: As an overall matter, employers should be guided in their relationship with their employees by federal, state, and local employment law, and by the company-specific application of these laws as reflected in employee handbooks, manuals, and contracts (including bargaining agreements).

Not all of the employment laws referenced apply to all employers or all employees, particularly state and local government agencies.  For information on whether a particular employer or employee is covered by a law, please use the links provided for more detailed information.  This information is not intended for federal agencies or federal employees -- they should contact the U.S. Office of Personnel Management (OPM) for guidance.

Anyone with asthma is at higher risk for flu-related complications, such as pneumonia. Along with everyone else, if your child has asthma you should:

• Follow an updated, written Asthma Action Plan developed with your doctor. Follow this plan for daily treatment and for controlling your asthma symptoms.
   
• Make sure that his or her updated, written Asthma Action Plan is on file at school and/or at the child care center. Be sure that the plan and medication(s) are easy to get to when needed.
   
• Everyone with asthma who is older than 6 months should get a flu shot every year to protect against the seasonal flu. Children aged 6 months to 8 years who never have had a seasonal flu shot may need two doses the first time. Persons with asthma should not use the inhaled "FluMist®" vaccine.
   
• Certain antiviral drugs, prescribed by health care professionals, are medicines that fight the flu virus by stopping it from growing in your body. They make you feel better faster and may prevent serious flu problems. Flu treatments work best if they start within two days of when you get flu-like illness.
   
• Persons with flu infections might also get bacterial infections. These persons will also need to take antibiotics to fight the bacterial infection. Some signs of bacterial infection are severe or prolonged illness, or illness that seems to get better but then gets worse.
   
• Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu. This can cause a rare, but serious, illness called Reye’s syndrome.

Influenza vaccine has not been shown to increase the risk of Bell's Palsy. A history of Bell's Palsy is not a reason to defer influenza vaccination.

If you have questions or concerns about when you should get the seasonal flu vaccine, talk to you doctor.

For more information about flu vaccines, please visit the resources below:

Flu.gov Vaccination Page
http://www.flu.gov/individualfamily/vaccination/index.html

About the Flu
http://www.flu.gov/individualfamily/about/index.html