Makers Say Cold and Cough Medication Should Not Be Used in Children Under 4

The manufacturers of over-the-counter cough and cold medicines said that such products should not be used in children under 4.

The leading makers of the products decided to voluntarily change the label after consulting with the Food and Drug Administration (FDA), according to the Consumer Healthcare Products Association, an industry trade group.

While pediatric versions of cough and cold remedies will still be available in supermarkets and pharmacies, they will have a new label that warns against use in children under 4. The labels will still recommend an appropriate dose for older children.

“In addition, for products containing certain antihistamines, manufacturers are voluntarily adding new language that warns parents not to use antihistamine products to sedate or make a child sleepy,” Linda Suydam, president of the Consumer Healthcare Products Association, said in a statement.

Expect to see such label changes during the 2008–2009 cough and cold season, the group said.

The use of cough and cold medications in very young children has come under scrutiny in recent years.

In January 2008, the FDA said such products should not be given to children under 2 years of age. Some children, mostly under 2, have died due to the misuse of the remedies. The Centers for Disease Control and Prevention estimates that 7,000 children under 11 are treated in emergency rooms each year due to problems with cough or cold remedies.

Parents could accidentally administer an overdose to children by using multiple products that contain similar ingredients, or by giving children the incorrect dose.

The FDA met last week to discuss the issue, and is considering a ban on such products for children ages 2–6.

Manufacturers are trying to do a better job of educating parents and caregivers. In addition to other recommendations, they say that caregivers should:

• Follow dosing recommendations exactly and use the measuring device sold with the product• Avoid combining medicines that contain the same ingredients• Never use such products to make a child sleepy
• Avoid combining medicines that contain the same ingredients• Never use such products to make a child sleepy

CDC: H1N1 cases decrease as vaccine availability increases

Atlanta, Georgia Health officials on Friday reported a slight decrease in H1N1 flu activity nationwide.

The Centers for Disease Control and Prevention said 43 states now have widespread flu activity, compared with 46 states last week and 48 states at the beginning of November.

"It's still much greater than we would ever see at this time of year," Dr. Anne Schuchat, director of the CDC's

National Center for Immunization and Respiratory Diseases, said in a news conference.

Schuchat added that while some parts of the country are seeing a small decline in flu cases, other areas, including Maine and Hawaii, have seen a bit of a surge.

It's too early to know if the worst is over in terms of the flu season, she said.

"Even though we saw a little bit of a decrease this week, it is still higher than the peak activity in many years," she said.

Flu season doesn't usually start until December. But when the H1N1 virus emerged in April, the spread of the flu never stopped, effectively stretching last year's flu season into the new one.

The CDC also said 21 more deaths from H1N1 in children were reported in the past week, bringing the official toll of confirmed pediatric H1N1 deaths in the United States to 171.

Schuchat said the number doesn't reflect the true picture.

"We believe the estimates we provided last week give a better picture of the full toll that the virus has taken in the first six months of the pandemic," she said. Last week the CDC reported that it estimated 540 children had died from complications of this flu virus so far. In an effort to limit further spread of the virus as millions of Americans begin traveling for the holidays, the CDC has launched a public awareness campaign.

Schuchat urged everyone to take simple precautions.

"Travel only when you are well," she told reporters. "Wash your hands often. ... Cover your cough and sneeze with tissues or with your sleeve. ... And get vaccinated against flu, particularly if you're in a targeted population." More people will be able to get vaccinated, according to the CDC, because more vaccine continues to be available.

States have been able to order a total of 54.1 million doses of H1N1 vaccine so far, Schuchat said.

"That number is 11 million doses more than we were at a week ago."
In response to a report from Norway that a couple of people died from a mutated form of the H1N1 virus, Schuchat said the CDC is aware that the mutated form had been identified, but that H1N1 vaccine and antiviral medications still are effective against H1N1.

Some cases of H1N1 that show resistance to the antiviral Tamiflu have been identified in North Carolina and Wales. But Schuchat said Tamiflu-resistant influenza viruses have been "quite rare" so far. Tamiflu doesn't cure the flu, but can reduce symptom severity and duration of illness by about a day if taken within the first day or two of getting sick.

Majority of adult Americans don't want H1N1 shot

More than half of all adult Americans say they don't want to get the H1N1 flu vaccine, according to a new national poll.

The Opinion Research Corporation survey released Wednesday also indicates that the number of adults who have tried to get the vaccine but were turned away is higher than the number of adults who have gotten a swine flu shot

According to the poll, 55 percent of adults don't want to get the swine flu vaccine and don't plan to get a shot. Another one in five say they want to get inoculated but haven't taken any steps to do so; 14 percent want a shot and have tried to get it but have been unsuccessful. Just 7 percent have been inoculated for H1N1.

Why are more than half of all Americans shunning the vaccine?
"The perception that the vaccine has dangerous side effects is the top reason," says CNN polling director Keating Holland. "Roughly half of those who don't want a swine flu shot say that the possibility of side effects is one reason why they don't plan to get the vaccine. That works out to 28 percent of the adult population who don't plan to get inoculated due to the risk of dangerous side effects."

So far officials of the National Institutes of Health say they've seen no serious side effects in clinical trials and that study subjects who have been immunized have generated a good response.
The Centers for Disease Control and Prevention recommends the vaccine for certain high-priority groups because they are more likely to have serious complications if they develop swine flu. These groups include: pregnant women; caregivers and household contacts of children younger than 6 months; everyone between the ages of 6 months and 24 years; and people ages 25 to 64 with existing health problems.

Most frequently asked H1N1 question

One in four American adults say they don't plan on getting a shot because they are not in a high-risk group, with 21 percent indicating they don't plan on getting vaccinated because they only go to a doctor when they are sick. Most of those respondents are men.

What about the 14 percent who have unsuccessfully tried to get the vaccine?

"Some say they don't know where to go. That works out to 4 percent of the total adult population who want to get inoculated but haven't been able to locate a medical facility that is giving swine flu shots," Holland said. "A bigger group, 5 percent of the total population say that they found a facility with the vaccine but were turned away because they were not in a high-risk group or for some other reason. And 3 percent of all adults say they found a facility that had the vaccine but it ran out before they got there."

Add together those last two groups, and the number of Americans who actively sought the vaccine but were turned away for some reason is 8 percent of the total adult population, roughly the same number as the 7 percent who have been inoculated so far.

The Opinion Research Corporation poll was conducted November 13-15, with 1,014 adult Americans questioned by telephone. The survey's overall sampling error is plus or minus 3 percentage points.

All About Swine Flu

What exactly is the swine flu?

“Swine influenza is a known cause of flu in pigs. But once in a while, through mutations, it can acquire the ability to attack humans,” Ericsson explained. Formally named swine influenza A H1N1, this strain “appears to have components from human, pig and bird viruses,” he said.

How easy it is to become infected?

That’s not yet entirely clear. “We know it’s passed on through the ‘droplet route,’ which means that if I’m within three to six feet of somebody and they cough or sneeze I might get some of that spray inhaled through my eyes or nose,” he said. “If that happens, and if they have the flu, you can easily get it.” It’s less clear if you could be infected simply by being in a room where exhaled droplets might still be lingering. As with other flu viruses, people can sometimes become infected by touching something with a virus on it — a desktop, a doorknob — then touching their eyes, nose or mouth, according to experts at the U.S. Centers for Disease Control and Prevention. You cannot get swine flu from eating pork.

What can I do to protect myself?

“Cough etiquette is the critical thing. You should be cautious about your own behavior — covering your mouth and nose when you cough or sneeze in public,” Ericsson said. Avoiding crowds, and avoiding folks who are sick or don’t use “cough etiquette” is also important, experts say, as is avoiding handshakes, kissing, or touching your eyes, nose or mouth. Also very effective: frequent hand washing, using either soap and water or alcohol-based hand cleaners. The effectiveness of face masks is still “controversial,” Ericsson said. If a true pandemic emerges, then mask wearing “might not be a bad idea” in crowded environments, he said. “And if you are ill you should certainly stay home from work” to avoid spreading the illness, he added.

What are the symptoms of infection?

“Basic flu-like symptoms: a high fever, a bothersome dry cough, maybe a little gastrointestinal upset like belly pains or diarrhea, and general malaise,” Ericsson said. “Basically you will feel just plain rotten.” Flu symptoms typically appear within hours, experts say, whereas common cold symptoms emerge more gradually, are milder, and only rarely include high fever. “Typically, most people with any significant flu are going to have a fever of at least 101,” Ericsson said.

Why does swine flu appear to be more deadly in Mexico than in the United States?

“I suspect we just haven’t seen enough cases to see its full potential [in the U.S.] yet, and we’ll just have to wait and see,” Ericsson said. On the other hand, “Maybe it’s mutated since Mexico, and that is why it’s appeared to be less dangerous among the cases we’ve seen so far in the U.S,” he said.

Is there an effective, available vaccine?

The answer is no, not yet, although scientists at the CDC and elsewhere are beginning the vaccine process — which typically takes months. “The current flu shot isn’t going to do anything with [swine flu], because the virus is very capable of changing its clothes and wrapping itself up differently to evade our body’s defenses,” Ericsson noted.

If I get infected, is there an effective treatment?

Yes, according to Ericsson. The swine flu so far seems to be susceptible to two prescription drugs, Tamiflu and Relenza, which can shorten the course of the illness. Antibiotics, which only fight bacteria, are useless against the flu virus.

Is there enough Tamiflu and Relenza to cover all Americans?

“We’ve got stockpiles,” Ericsson said, “but if we ever get into a real pandemic there is a risk that these not unlimited resources may get used up.” That could mean prioritizing certain high-risk or otherwise important groups. And Ericsson stressed these two drugs won’t do much to help people who become infected but only fall mildly or moderately ill. “They should be reserved for people who fall seriously ill and are hospitalized, and for whom it could be a matter of life or death,” he said.

Bottom-line: How dangerous is the virus and how big is my risk?

Unfortunately a good answer to that question isn’t here yet. Right now, Ericsson said, “it’s a moving target, and we just don’t fully know the full story yet. But I would have to say that, at this point, I do not think the average American on the street is at any great risk.”

Vitamin C and Zinc can fight Colds?

The überhealthy don’t shrug off an impending cold—they attack it. Jenny Spring, 29, of Cambridge, Mass., takes a double shot of vitamin C and zinc at the first ominous sniffle or throat tickle that could be a sign of a cold or the flu. She sips the powdered drink mix Emergen-C (it packs 1,000 mg of vitamin C) once or twice a day, followed by a few blasts of Zicam, an over-the-counter zinc nasal spray. "I’ve warded off coughs and colds long enough that I don’t remember the last time I had one," she says.

Although vitamin C and zinc for cold prevention remain controversial, some studies show that C is especially helpful for people who are under extreme stress and that zinc can prevent viruses from multiplying. Experts say there’s no harm in trying—and just believing these remedies work may help too.

Make C work for you: Neil Schachter, MD, director of respiratory care at Mt. Sinai Medical Center in New York City, suggests a more conservative amount of vitamin C (500 mg a day) at the first sign of a cold. And the Institute of Medicine advises drawing the line at 2,000 mg daily to avoid gastrointestinal or kidney problems. As for zinc, it’s available in many forms. Don’t care for nose sprays? Dr. Schachter suggests taking zinc lozenges several times a day when a cold starts.

8 Ways Swine Flu is Changing Cough Society

Flu season is here, and this year, people are actually taking notice. The outbreak of the H1N1 influenza virus, commonly known as swine flu, has people reevaluating the way they live, travel, interact with each other, and even how they eat.

The World Health Organization (WHO) officially declared the virus a pandemic in June, and it announced in early September that at least 3,205 people have died from the virus. And while more than 60% of Americans say they are "not too" or "not at all" worried about swine flu affecting them or their families, according to a Washington Post–ABC News poll, the scare has left its mark on many parts of society, both in the United States and abroad. Here, eight ways swine flu is changing the world.

1.People may finally get flu shots.
In the 2005–2006 season, so many people did not get the vaccine that 18 million doses had to be thrown away. If this pandemic has a silver lining, it's that more people are making the decision to actively protect themselves against germs in general—and that's good news, since every year even the "regular" seasonal flu (and complications from the flu) kill about 36,000 Americans, and anywhere from 250,000 to 500,000 people worldwide.

An August Gallup poll found that 55% of respondents see themselves getting a swine-flu vaccine if one becomes available, up from 46% in May. And while the H1N1 vaccine won't be available until at least mid-October, seasonal flu shots this year are being administered earlier than usual—and recommended more strongly by health officials—in anticipation for increased interest.

Many drug stores, employers, and schools are already offering the seasonal flu vaccine, and some counties are administering the shots at no charge. On September 22, for example, CVS pharmacy will give free flu shots in New York City on the plaza of CBS's The Early Show.

Still, many people are skeptical of either shot's effectiveness, and probably won't get vaccinated or give the vaccine to their children. Pregnant women are especially at risk, but typically have very low rates of vaccination due to worries that the shots won't be healthy for their babies.

2. People are reconsidering cultural greetings.
The French are well known for offering la bise, a quick peck on each cheek, as a way of saying hello and good-bye. But with the fear of transmitting the H1N1 virus, some schools and companies—and even the health ministry's swine-flu hotline—recommend avoiding this practice. One mayor in a small French town has actually banned the kisses, telling National Public Radio, "What's the point in the preventative hand-washing when people are still kissing each other all the time?"

Spanish, Mexican, and Lebanese government officials have also discouraged kissing greetings, and school officials in New York have even discouraged students from exchanging high fives. John M. Barry, the author of The Great Influenza, warns that handshaking too could come under fire if the spread of the virus gets worse. "Any specialist would say that shaking hands is not a great habit if you're interested in controlling an infectious disease."

3. It's scarier than religion.
Swine flu is even changing some long-held religious practices: The Archdiocese of New York told Catholic New Yorkers they may refrain from the traditional handshaking at mass. One rabbi in Brookline, Mass., told National Public Radio that he suggested congregants at his temple greet each other with a "Buddhist bow" or an "Obama fist bump" during September's High Holy Days.

Muslims celebrating Ramadan in Kuwait and Lebanon have been advised not to hug, and, if the flu outbreak worsens, mosques could consider asking people to bring their own prayer mats to services. In Spain, Roman Catholics are being asked to refrain from kissing a statue of the country's patron saint, and Italy has banned the kissing of two vials thought to contain the blood of a saint.

4. Schools, workplaces, and day-care centers are changing policies.
Telling an entire country or religious congregation to stop shaking hands or kissing may prove tricky to control, however. "It's easier to implement when a school or an institution or a company collectively decides, 'We're not going to do this for the duration of this epidemic,'" says Pascal James Imperato, MD, a dean and distinguished professor of public health at SUNY Downstate Medical Center, in Brooklyn. And many are doing just that.

Colleges have updated handbooks to urge students and professors to stay home with even the slightest feeling of illness and to frequently clean often-touched objects in their dorms, such as remote controls and doorknobs. Offices are creating policies allowing employees to work staggered shifts or providing them with the materials needed to work from home. And day-care organizations have urged parents to consider making back-up plans should the centers need to cut their services with short notice.

5. People are scared to eat pork.
China, Russia, and Ukraine were quick to ban pork produced in the United States when the virus was first detected, and soon a total of 27 countries had followed suit. The boycotts have wreaked havoc on the pork industry, causing the government to actually bail out farmers who have been forced to sell their pork at lower costs, Time magazine reports.

The irony, of course, is that it's not at all possible for H1N1 to spread through eating infected bacon or hot dogs—and even so, there have been zero cases of infected pigs in the United States. The H1N1 virus actually has avian, swine, and human genes, and it may not even make pigs sick, scientists say. Unfortunately for pork producers, "swine flu" is a much more sensational and media-friendly name.


6. Tourism to Mexico has suffered.
When the first cases of swine flu were thought to have originated in Mexico, the Centers for Disease Control and Prevention initially recommended canceling all travel plans south of the border unless the trip was absolutely essential. Three weeks later, the warning was lifted.

The WHO now insists that international travel does not need to be restricted. Barry agrees: "At this point, the virus is everywhere," he says. "Where are you not going to go to avoid it? But that doesn't mean that there aren't people who wouldn't be a little panicked."

Those panicked travelers delivered quite a hit to Mexico's tourism industry, which was already in trouble due to violence- and drug-related publicity. Travel website TripAdvisor.com reported a 50% decrease in searches for Mexican destinations by May, according to SmartMoney.com. Hotels and airports sat empty in May, and airlines flying to Mexico have also reported millions of dollars in losses that they claim are flu-related.

The good news? If you still want to go, you can get flights and hotel rooms on the cheap.
Quickly after the virus first surfaced, consumers became caught up in the hype about the pandemic, says Dr. Imperato; they turned to whatever precautionary merchandise they could get over-the-counter. Logical purchases included face masks and antibacterial soaps, but plenty of other companies have cashed in on the marketing craze in over-the-top and even unrelated ways, as well.

There are flu kits (complete with full-body suits), swine-flu-spam computer-virus protection, a viral stop-the-spread online game, and, of course, all sorts of pig paraphernalia.

8. Coughing and sneezing are practically federal crimes.
Symptoms of sickness may not be against the law quite yet, but there does seem to be an abundance of dirty looks going around in response to simple public throat clearing. It seems that everyone is more aggressively cautious of coughing and sneezing in public, and perhaps rightly so.

A simple sneeze sends as many as 100,000 droplets of germs from your mouth and nose into the air within 3 to 5 feet at about 100 miles an hour, according to CNN's AC360°. The germs can then hang in the air for up to a minute, so even if the droplets don't land on a nearby person, he or she could still walk through the germy cloud and catch a virus. Even worse, coughing or sneezing into a hand and then touching a public space, like a subway pole, a door handle, or a shared computer keyboard, spreads the range of the germs. But even if you've seen dirty looks exchanged on the train or in the grocery store, it's probably a mild reaction compared to what Asian countries—which suffered through a deadly SARS epidemic in 2002 and 2003—are now experiencing. Jane Parry, a science journalist and researcher living in Hong Kong, notes that the emergence of H1N1 has strongly reinforced flu prevention techniques and attitudes about germ transmission.

"Handshaking fell out of favor during SARS, and it's totally acceptable now to not shake hands, especially if you are wearing a face mask," Parry says. "It's considered common courtesy now to wear a mask when you have a cold to protect others. Once swine flu came along, that expectation that you wouldn't cough near anyone else became even more pronounced. People would visibly reel away from you if you coughed."

In schools in Hong Kong, children with runny noses or coughs are required to wear masks, and any child with a fever is automatically sent home, Parry adds. Staff members working in food stores are also required to wear masks at all times, and Asian people are much more likely to wear face masks on airplanes, where air is filtered and recirculated through the cabin.

These measures may seem over-the-top to Americans, but is it possible they could become commonplace throughout the world? Only time will tell. For now, remember traditional cold and flu etiquette: Cough or sneeze into a tissue, or at least use your elbow and sleeve (instead of your hands) to cover your mouth.

Warning avoid spitting

London, England A UK health agency has warned footballers to stop their "disgusting" habit of spitting as it could lead to the spread of the H1N1 virus.

A spokesman for the country's Health Protection Agency was quoted by the Press Association as saying: "Spitting is disgusting at all times. It's unhygienic and unhealthy, particularly if you spit close to other people.

''Footballers, like the rest of us, wouldn't spit indoors so they shouldn't do it on the football pitch. If they are spitting near other people it could certainly increase the risk of passing on infections."

''It's about setting examples for young people who idolize them,' the spokesman was quoted as saying.

The warning comes after several football teams were struck by the virus commonly known as swine flu, including English Premier League football clubs Blackburn Rovers and Bolton Wanderers and French team Paris St. Germain.

The French football league sparked controversy last Sunday when it decided to postpone a match between PSG and Marseille because PSG players Ludovic Giuly and Mamadou Sakho and two members of the coaching team were diagnosed with the H1N1 virus on Saturday.

"What would people have said if the match had gone ahead and the Marseille team had caught the virus? The medical commission gives us their professional opinion. We have to follow it as much as we can," said Frederic Thiriez France's football league president.

The Health Protection Agency later tried to play down the spokesman's comments, saying he had been "misinterpreted."
Spokeswoman Louise Brown told CNN: "Spitting is not a major cause of spreading swine flu infections. Our general advice is that people who have swine flu should stay at home."

She added: "For people with flu, it is essential that they wash their hands if they have coughed or sneezed onto them in order to destroy the virus and help to stop infecting other people."