This is not your grandfather's flu.

In fact, unlike the flu in past years, the H1N1 virus that reached pandemic status back in April is much less likely to hit your grandparents than your children. That's just one of the many differences between Swine Flu and the normal yearly outbreak of influenza.

In an average flu season, there are 200,000 people hospitalized and 60 percent of those are 65 and older. Newly created estimates released last week for the first time by the Centers for Disease Control and Prevention conclude that an estimated 98,000 people have been hospitalized as a result of the Swine Flu. Fewer than 10 percent of those are 65 and older.

And that brings up another huge difference with Swine Flu. The peak flu season is normally between January and March. But the H1N1 virus has been quite active beginning in the summer. In just six months, ending Oct. 17, CDC officials estimated there have been 22 million cases of flu in the country and 3,900 deaths. And there's still six weeks to go until January, the normal peak of flu activity.

Will the pandemic be more of a problem beginning in January? There's no way to tell, said Dr. Hank Bernstein, a professor of pediatrics at Dartmouth University and member of the Committee on Infectious Diseases for the American Academy of Pediatrics.

But Bernstein and other pediatricians and experts say the early and widespread outbreak, combined with the high numbers of hospitalizations and deaths, mean the Swine Flu should be taken very seriously. "The numbers are startling," Bernstein said. "It's understandably worrisome for families."We want them (parents) to understand the disease is potentially problematic for any child."

Dr. Alanna Levine said she gets the question all the time in her Rockland County practice in New York State about the extent of the dangers of Swine Flu. "I want parents to take home the message not to live in fear, but that you need to be prepared. This is not a disease to be taken lightly."

One reason is that so many more people are at risk from Swine Flu, the doctors said. While seniors are most susceptible to flu in most years, the Swine Flu has targeted younger people. Kids from 6 months to 24 years are especially likely to get the virus.

On top of that, there is a large group of people who fall in the high-risk group because of pre-existing conditions, experts said. That includes pregnant women, infants, people with asthma, diabetes, heart disease, weakened immune systems and neurologic conditions. Bernstein said he believes Swine Flu is so widespread because a much larger than normal portion of the population is vulnerable.

"More people are susceptible, so the attack rate is higher," he said, comparing Swine Flu with seasonal flu outbreaks in previous years. "Instead of 10 to 20 percent of kids at risk, for example, that figure may be closer to 50 percent, Bernstein said.

Both Bernstein and Levine agreed that many kids who get the flu have only a mild disease that isn't that much different than seasonal flu. But there are no guarantees. Bernstein pointed out that a number of healthy children die from season flu every year.

Levine, meanwhile, told the story of an 8-year-old in Texas whose parents recently called their doctor about flu-like symptoms. The child had no pre-existing conditions so the parents were told to monitor the conditions and only call back if the situation didn't improve. Two days later, the mother brought her son in and a flu test confirmed a case of Swine Flu. Four days later, the child died.

About two-thirds of flu deaths involve a child with pre-existing medical conditions like asthma, Levine said. "But I would argue that one-third of the cases involved healthy kids," she said. "This really just reinforces the need to vaccinate."

Bernstein and Levine emphasized the following points for parents to remember for the rest of flu season:

  • Get vaccinated. CDC officials say they are aware there are people worried about potential side effects, but maintain the vaccine is as safe as seasonal flu vaccines in the past. Levine confirmed that fear of the vaccine was an issue voiced by a number of her patients. "I just try to explain how important it is to get the vaccine."
  • Don't relax. If your child gets the flu, watch them closely, Levine and Bernstein said. "Monitor their breathing and how they are acting," Bernstein said. "You need to be quite cautious."
  • Stay in touch with your doctor. This is true for normally healthy children or those with asthma or other pre-existing conditions that put them in the high-risk category. Levine said if a parent has any concerns, call to update their child's condition. Don't assume the symptoms will pass, because that's happened in the past, or that the doctor has no open appointments. The flu makes kids more susceptible to bacterial co-infections, like pneumonia, so be sure to let your doctor know if your child's condition may be worsening.
  • Practice Swine Flu prevention tips. This includes covering up if you cough, washing your hands and watching closely for symptoms and staying home if you are sick and not returning to school until the fever has subsided - without the help of aspirin - for a full 24 hours. "You can't emphasize enough how important hand-washing is," Bernstein said.
  • No assumptions, please. Flu is unpredictable. The flu you've had in the past is a different strain from Swine Flu, so don't assume that similar symptoms or fever will result in the same result as another year's case of flu. Are healthy children with no pre-existing conditions in the clear, even if they come down with Swine? While most healthy kids will recover fairly quickly, there are no guarantees. "It's expected that the great majority of kids will do just fine," Levine said. "But, every once in a while, there's a case that throws you for a loop. So it's very hard to say."  

CDC Estimates of 2009 H1N1 Cases and Related Hospitalizations and Deaths from April-October 17, 2009, By Age Group

2009 H1N1

Mid-Level Range*

Estimated Range *




0-17 years

~8 million

~5 million to ~13 million

18-64 years

~12 million

~7 million to ~18 million

65 years and older

~2 million

~1 million to ~3 million

Cases Total

~22 million

~14 million to ~34 million




0-17 years


~23,000 to ~57,000

18-64 years


~34,000 to ~83,000

65 years and older


~6,000 to ~14,000

Hospitalizations Total


~63,000 to ~153,000




0-17 years


~300 to ~800

18-64 years


~1,900 to ~4,600

65 years and older


~300 to ~700

Deaths Total


~2,500 to ~6,100


Source: Centers for Disease Control

November 16, 2009