By Judith Graham, Chicago Tribune

Swine flu has surfaced in the United States, and people are bound to have many questions as the illness arrives a step closer to home. Dr. Mark Dworkin, an associate professor of epidemiology at the University of Illinois Chicago School of Public Health, discussed some common queries.

Dworkin is the author of a new and timely book, “Outbreak Investigations Around the World: Case Studies in Infectious Disease Epidemiology.” An edited version of our conversation:

Q. What symptoms are associated with swine flu?

A. The classic symptoms are the same as with any flu: muscle aches, a fever of 101 or higher and a dry cough. Other symptoms may include nausea, vomiting, a sore throat, a running nose, and diarrhea. These symptoms tend to have an abrupt onset. Suddenly, you’ll notice that you’re feeling very bad. But this isn’t true for everyone. If you’ve been exposed to a similar virus strain in the past or you’ve been vaccinated against the flu, you may feel only mildly ill.

Q. What should I do if I or a family member has these symptoms?

A. The first thing you want to consider is whether you’ve been near someone who may have swine flu. If you think you have been exposed, get in touch with your doctor.

If you weren’t exposed, you’re probably dealing with a different illness that can cause flu-like symptoms. Since the flu season is pretty much over, it’s probably not influenza. It may be adenovirus or a parainfluenza virus. In any case, call your doctor.

If you have mild symptoms only, you don’t need to call a physician or go to the emergency room. Drink plenty of fluids, get rest, eat properly, and avoid going to work or school. Wait and see if you get better. If you don’t, be in touch with your doctor.

Q. What treatments are there for swine flu?

A. The recommended antiviral medications are the same as what we’ve been using recently for regular influenza: Tamiflu and Relenza. The drugs tend to shorter the duration of the illness — typically a week or two weeks — by a day or two. It’s preferred that treatment start within 48 hours of the onset of the illness. That’s when you get the most benefit.

Q. What about side effects?

A. These are generally safe medications. Infrequently, people report having stomach discomfort or headaches, dizziness or diarrhea. Several other possible side effects have been reported — including sore throat or asthma — but it’s hard to know what caused them, the underlying illness or the medications.

Q. Should I take anti-viral drugs as a preventive measure?

A. If you’ve had contact with someone who may have swine flu, yes. But otherwise, it doesn’t make much sense to take these medications at this time. The risk is that you’ll waste your money. And if you have a large population of people taking these medications out of fear, you could get a resistant virus as a result.

Q. What would justify a trip to the emergency room?

A. It might be a good idea if the sick person has delirium or a high fever (104 or more) that doesn’t come down in response to a medication like Tylenol, or if the person is very sick and also at higher risk of flu-related complications — children, the elderly, people with chronic lung disease or heart disease.

If someone looks really sick and you know something isn’t right, get it checked out. A lot of advice assumes a person has a regular doctor: If you don’t, go to the ER as your backup.

Q. What kind of protection does a mask provide?

A. A mask is a barrier that can protect your nose and mouth from droplets that fly in the air when someone coughs. But it will not protect the conjunctiva of your eyes, which is another entry point. A mask doesn’t protect your hands from picking up the virus in the environment. The bottom line with masks is that they’re reassuring to those who wear them but they evoke fear in those who see them. They are not foolproof for blocking transmission of the flu.

Q. What should I do if I have travel plans?

It depends on where you’re traveling. If you had a Mexican vacation planned next week, I’d cancel it. But there are no travel restrictions for other places at this point. I’d base a decision on how widespread the flu is in that area. In New York, for instance, the swine flu isn’t really widespread although a number of cases have been reported. I wouldn’t stop myself from going there based on current data.

Q. Should I take my child out of day care?

A. There are no broad recommendations of this kind. But this is an opportunity to remind parents not to bring sick children to day care centers, whether or not swine flu is circulating. It’s also an opportunity to remind people of what they should do anyway to prevent themselves from getting sick. Wash your hands more. Do it for an appropriate length of time — about the amount of time needed to sing the “Happy Birthday” song. Lather up. And keep away from someone who has flu-like symptoms unless absolutely necessary.

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(c) 2009, Chicago Tribune.

Visit the Chicago Tribune on the Internet at http://www.chicagotribune.com/

Distributed by McClatchy-Tribune Information Services.

BOCA RATON, Fla. (AP) — The parents of a 13-year-old South Florida boy are stunned he went unnoticed when he got on a plane to California.

Kenton Weaver took his father’s car Tuesday morning, drove 30 miles to the Fort Lauderdale airport and caught a flight to San Jose near where his mother lives.

The boy was found at a ticket counter at the California airport and taken to an uncle’s house. No word yet on whether the boy will return to Florida.

His parents say the teen has a form of autism and was fascinated with planes.

He used one of his father’s credit cards to buy the ticket, but had no ID on him. Airport and transportation officials say anyone under 18 only needs a boarding pass to get on a plane.

Copyright 2009 The Associated Press.

CRISTIAN SALAZAR, Associated Press Writers

WASHINGTON (AP) — Students aren’t the only ones staying home as swine flu spreads through schools across the country. Parents are nursing their ailing kids while trying not to get sick themselves.

Raquel Mooradian and her husband, Greg, have been holed up in their apartment in the New York borough of Queens since their daughter Felicia, 17, fell ill on Friday. Felicia is a senior at St. Francis Preparatory School, where hundreds of students got sick after a group returned from spring break in Mexico.

Raquel has been skipping her classes at a local college, and Greg has called in sick at work. Raquel Mooradian said she covers her face when she goes into her daughter’s bedroom to bring her soup, water or Gatorade.

“She’s able to talk but says, ‘Let me sleep, let me sleep,’” Raquel said.

As of midday Wednesday, the latest national accounting available, about 100 of the nation’s 132,000 schools had closed and Texas authorities had suspended high school sports. But the number of closed schools more than doubled overnight, when the Fort Worth Independent School District in Texas announced it was closing its 140 schools, affecting about 80,000 students.

Preparation by schools is crucial because children every year play a major role in spreading influenza, and experts have said that would be no different during a pandemic. The nation’s pandemic preparation plans assume child infection rates approaching about 40 percent.

In a worldwide epidemic — which the swine flu outbreak is not — government planning documents say schools could be closed for up to 12 weeks.

The consequences of having kids at home reach far beyond school walls.

President Barack Obama said Wednesday parents everywhere should start preparing for the possibility that their kids may be sent home.

“Our public health officials have recommended that schools with confirmed or suspected cases of this flu strongly consider temporarily closing,” Obama said as he began a news conference Wednesday night. “And if more schools are forced to close, we’ve recommended that both parents and businesses think about contingency plans if their children do have to stay home.”

Homeland Security Secretary Janet Napolitano said employers need to plan too.

“All of us should be dusting off our business contingency plans, looking at things such as telecommuting and the like so that operations keep on going,” she said.

“There is a large ripple effect,” acknowledged Kathleen Sebelius, Obama’s newly approved health secretary. “What happens to the parents? Where do those children go? Do you close the day care center if a younger sibling is there?”

Local officials make the decisions on schools, after weighing conditions in their cities, towns and counties.

So far, closings have affected at least 140,000 students, among the 56 million enrolled nationwide in K-12 education in public and private schools. Most of the closings are individual schools, not entire systems. Most are expected to be short-term, a week or so. Some of the children who got sick are already recovering.

If the outbreak turns into a killer flu, classes could continue even if schools are shut.

If they’ve planned for it, teachers could give their lessons by Internet, television, radio, telephone, mail or through their community newspapers.

If a flu case is confirmed at a school, local district officials may close down that school alone. Clusters of cases at different schools could prompt the closing of an entire system. Closings in many communities may lead to a statewide shutdown.

The decision to close a school is not to be taken lightly.

“It’s not just about the schools,” explained Kim Elliott, deputy director of Trust for America’s Health, an independent public health organization. “If a community is thinking about closing schools, they’re also probably thinking about closing day care centers. And children also depend on schools for a lot of services other than education, including lunch programs and after-school care.”

In Mexico, where the illnesses have been more severe, the government closed schools nationwide. In the U.S., authorities will deal with the problem from the ground up, not from the top down.

“It is the state and local role to plan what’s going to happen, as far as day-to-day or hour-to-hour,” said Brenda Greene, director of school health programs for the National School Boards Association.

The federal government has taken a leading role in helping states and local communities plan for a public health disaster. Washington’s concern grew from the anthrax attacks of 2001 and the 2005 bird flu scare that sparked fears of global infection.

In Congress, the chairman of the House Education and Labor Committee, Democrat George Miller of California, said Wednesday he will hold a hearing next week on how schools and businesses are prepared to handle the swine flu virus.

On a conference call Monday, officials from the Education Department and the Centers for Disease Control and Prevention answered questions from more than 1,400 people from school districts, state education offices and education groups.

Education officials said many asked what circumstances should prompt schools to close. They were encouraged to follow the CDC’s recommendation that schools close if they have a confirmed case or if they have a suspected case that is linked to a confirmed case.

In the end, making the decision is a balancing act, not an on-off switch, said Robert M. Pestronk, a former public health officer who heads the National Association of County and City Health Officials.

“Because there is one case in one school, or 10 cases, doesn’t lead to a decision to close a whole district,” said Pestronk. “It’s a case of balancing the risk that is potentially present against the need for communities to operate normally on a day-to-day basis. You’re trying to protect people’s health and not completely shut down communities.”

There may be alternatives to closing schools.

Researchers at Georgia Tech modeled the effects of two options: a voluntary quarantine of affected households in a severe flu, and school closures. They found that both would work about as well.

“It’s information that boards of education should consider,” said Julie Swann, a professor of industrial engineering who collaborated in the study. “In some cases, you might want to do both kinds of interventions.”

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Salazar reported from New York. Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

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On the Net:

www.pandemicflu.gov

Copyright 2009 The Associated Press.

This morning my daughter, Danni, was singing “Rudolph the Red Nose Reindeer.” I can’t blame her, the weather is a little confusing right now and it is a catchy tune. She was running through the classic lines naming the reindeer when she got to a reindeer I didn’t recognize – his name was “Comic” and boy did it make me laugh. I quickly realized she meant “Comet” and gently corrected her when she was done, but I like “Comic” better.

By Lisa Moore, McClatchy Newspapers

Children and dogs: ideal combination or complete disaster?

The answer depends on whom you ask.

Check with the mother whose children, all younger than 8, have lost interest in the family pet, and she’ll tell you that the last thing she needs is another “child” to take care of.

Ask the kid being dragged around the neighborhood by his dog, and he’ll grumble that he’d rather be playing video games.

There are, however, many homes that combine dogs and children, with an outcome that is satisfying for all. What makes the difference is careful planning and education — human and canine.

As a dog trainer, I frequently encounter common troubles with clients who have both children and a dog.

Here are my top four suggestions for ensuring a winning combination:

1. PUPPY IS BITING DURING PLAY — This occurs because young children run, squeal and play in a way that elicits mouth action from the puppy, whose teeth are very sharp.

The more wild the play, the more likely a child will end up scratched, bleeding and in tears. No one is at fault here; it’s just a miscommunication between species. Correcting youngsters for playing inappropriately is about as effective as correcting a puppy for using his mouth — a complete waste of time. Structured interaction is the best approach. I teach parents the games kids can play safely with a dog — hide and seek and tag team recall, for starters. These games give puppy much-needed activity that also teaches him the value of responding to cues given by the child.

The child is delighted to have ways to play with the puppy that don’t involve injury. I also introduce a “chase it” stick — this allows the child to engage the puppy in running, jumping and playful biting of a toy at the end of a long pole.

2. PUPPY JUMPS ON CHILDREN — Puppies jump on adults, too. They jump up to get attention and action. A child’s response should be to immediately stand still and quiet — often referred to as “being a tree.”

The puppy should not receive attention — negative or positive — for behaving in this way, and all family members should commit to ignoring the puppy when it jumps up, and lavishing it with attention when it chooses to stand or sit on the floor instead. For more information on this approach, visit www.be-a-tree.com.

3. PUPPY CHEWS UP CHILDREN’S TOYS — A bit of simple training can remedy this problem. Under the guidance of a trainer, puppy can be taught an off-limits cue that can be used to help him identify items in his environment that are to be left alone. Creating boundaries in the home is also of value. Puppy can’t get into a child’s room and chew up her favorite doll if he’s been taught that her room is off-limits and never to be entered.

4. LEASHED PUPPY PULLS CHILDREN — Polite leash manners must be taught in a consistent and productive manner. I usually recommend that the parent teach the dog the basics, before letting the children get involved. And I do not recommend that any child walk a gregarious puppy that outweighs him, as this sets up a scenario for puppy to learn many incorrect things, like habitual leash pulling.

A child and his dog can be a winning combination. With attention paid to breed and size selection, and parents willing to concede that some of the responsibility for the care and training of the puppy will fall to them, the outcome can be positive for all.

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(Lisa Moore’s pet-behavior column appears once a month. Write to her in care of LifeStyles, The Modesto Bee, P.O. Box 5256, Modesto CA 95352.)

___

(c) 2009, The Modesto Bee (Modesto, Calif.).

Distributed by McClatchy-Tribune Information Services.

BRIAN BAKST, Associated Press Writer

ST. PAUL, Minn. (AP) — Minnesota health officials reported the first probable case of swine flu in the state Wednesday, a person at Rocori Middle School in the central Minnesota town of Cold Spring, and local officials closed that school and one other there as a precaution.

A lab sample was flown on a state plane to the Centers for Disease Control and Prevention in Atlanta to be tested definitively, and state officials hoped to know by day’s end whether it was the unusual new strain of influenza that has made people sick in Mexico, several U.S. states and other countries.

The person who became ill was not identified. Health Commissioner Sanne Magnan said the person was not hospitalized and was expected to make a full recovery.

Magnan said the person did not travel to Mexico, but was believed to have had contact with someone who did.

State officials had said in recent days they expected swine flu to appear in Minnesota, and they urged people to remain calm.

“We will have cases,” State Epidemiologist Ruth Lynfield said. “But that’s OK. We deal with seasonal influenza outbreaks every year. This is going to be different. It may become more virulent, less virulent, we have to keep up with it and see what there is to do.”

Added Lynfield: “We have been preparing for this for almost 10 years.”

School officials said they voluntarily closed Rocori Middle School and St. Boniface School in Cold Spring, about 60 miles northwest of Minneapolis.

In an e-mail to parents, Rocori Superintendent Scott Staska said he became aware of the case late Tuesday night. He said “an individual from the ROCORI Middle School site” had experienced flu-like symptoms that were “not alarming,” and that the individual was “recovering without complications.”

Staska said his decision to close the Rocori Middle School was “purely as an effort to be very cautious and proactive.” He said classes would go on as usual at Rocori High School, Cold Spring Elementary, Richmond Elementary, and John Clark Elementary.

“There is not, at this time, cause for alarm. The symptoms experienced by the individual, in this case, are not unusual nor severe. In fact, the information shared with me is that the individual appears in much better condition as each day passes,” the superintendent wrote.

Sister Sharon Waldoch, the principal at St. Boniface, a Catholic elementary school across the parking lot with about 275 students, said they closed as a precaution because they send students to the public middle school for music, physical education and lunch.

Pawlenty said the schools would reopen quickly if the CDC test is negative, but a confirmation of swine flu would keep them closed for as long as a week.

Magnan said risk to students and staff at the schools was low. But she urged people to “take care of themselves, eat right, get the sleep they need, be physically active” and wash their hands thoroughly and often.

“No one has immunity to this new virus,” she said.

Though there is no vaccine for this strain of the flu, Magnan said antiviral drugs have been effective and Minnesota is expecting additional stockpiles of those from the CDC.

Michael Osterholm, a pandemic flu expert at the University of Minnesota, told AP Radio early detection efforts across the country seem to be working.

“I think the public health system has done a lot of work to prepare itself for the early detection of a potential pandemic flu virus in this country and I think that work is paying off,” he said.

Osterholm said he wasn’t surprised that the U.S. reported its first confirmed swine flu death Wednesday, a 23-month-old boy in Texas.

“I think over the next several days we’re going to see a number of severe cases in the United States, and that doesn’t fundamentally change anything about this disease at all,” he said.

___

On the Net:

Minnesota Department of Health: http://www.health.state.mn.us

Copyright 2009 The Associated Press.

WASHINGTON (AP) — Health officials on Wednesday confirmed the first death outside of Mexico in the swine flu outbreak, a nearly two-year-old Mexican boy whose family had traveled to Texas.

President Barack Obama offered his thoughts and prayers for the family of the child and said that schools with cases of swine flu should consider closing.

Speaking at the White House, Obama said he wants Americans to know the government is doing “whatever is necessary” to contain the emerging health threat.

“This is obviously a serious situation,” Obama said, that “we are closely and continuously monitoring.” He urged local authorities to be vigilant in reporting any suspected flu cases.

Homeland Security chief Janet Napolitano said Wednesday there are now 91 confirmed cases of swine flu in the United States. Swine flu is suspected of killing more than 150 people in Mexico and sickening over 2,400 there.

The Mexican boy arrived in the Texas border city of Brownsville with “underlying health issues” on April 4 and developed flu symptoms four days later, the Texas Department of State Health Services said. He was taken to a Brownsville hospital April 13 and transferred to the following day to a hospital in Houston, where he died Monday night.

The cause of death was pneumonia caused by the flu virus, Cameron County Judge Carlos Cascos said. Officials did not specify what underlying health issues the boy had before arriving in the U.S.

State health officials declined to identify the boy or his family, citing privacy concerns, medical confidentiality and “the absence of an obvious health threat from the boy to the public at large.”

State health officials said the boy would not have been infectious when he flew from Mexico City to Matamoras, across the border from Brownsville. None of his close contacts have developed symptoms.

The boy’s family members “are healthy and well,” Houston’s health director, Dr. David Persse, said at a Wednesday news conference.

The toddler was about 2 years old. Houston officials said he was 23 months old, but state officials said he was 22 months old and could not immediately explain the discrepancy.

The Centers For Disease Control and Prevention confirmed the death earlier Wednesday.

Meanwhile, the commandant of the Marine Corps said a Marine in southern California might have the illness and 39 Marines were being confined until tests come back. General James Conway told a Pentagon briefing an initial test indicated the sick Marine — who was not identified — might have swine flu but his illness did not appear life-threatening.

Obama said the federal government is “prepared to do whatever is necessary to control the impact of this virus.” He noted his request for $1.5 billion in emergency funding to ensure adequate supplies of vaccines.

And he advised individuals to take their own precautions — washing hands, staying home if they are sick, and keeping sick kids home.

Obama said public health officials recommend that authorities at schools with confirmed or suspected cases of swine flu “should strongly consider temporarily closing so that we can be as safe as possible.”

He advised parents to get ready for such disruptions.

“If the situation becomes more serious and we have to take more extensive steps, then parents should also think about contingencies if schools in their areas do temporarily shut down, figuring out and planning what their child care situation would be,” Obama advised.

Napolitano said that dealing with the swine flu virus will be “a marathon, not a sprint” and individual citizens have a responsibility to help.

Appearing before the Senate Homeland Security Committee, Napolitano, who is the Obama administration’s lead official on the federal disaster response, said that in important respects, state and local authorities represent the “first responder” role in the widening health emergency. She said some 40 states, for instance, are involved in close coordination and consultation with the federal establishment.

“There is a lot we don’t yet know about this outbreak. But at the same time we have been preparing as if we are facing a true pandemic, even though we don’t know the ultimate scope of what will occur,” Napolitano said.

CDC head Dr. Richard Besser said in an interview with NBC’s “Today” show that health authorities had anticipated that the virus would cause deaths, and said that “as a pediatrician and a parent, my heart goes out to the family.”

But he said it’s too soon to say if the death in Texas suggests the virus is spreading to more states. Nor would he say whether officials think it will become a nationwide problem.

He also said he does not believe the flu strain has become more dangerous and noted that even with seasonal flu, there are always some people who can’t resist it very well.

Children, especially those younger than age 5, are particularly vulnerable to flu and its complications, and every year children die from seasonal flu.

According to the CDC, more than 20,000 children younger than age 5 are hospitalized every year in the United States because of seasonal flu. In the 2007-08 flu season, the CDC received reports that 86 children nationwide died from flu complications.

Copyright 2009 The Associated Press.

 North Dakota has 18 Moving More Eating Smarter (MMES) communities. In February 2009, Bismarck became MMES   recognized. The recognition means BBPH and other community partners will develop, implement, and evaluate policies and interventions that address behaviors related to the following six principal target areas:

• Increase consumption of fruits and vegetables
• Decrease consumption of sugar-sweetened beverages
• Reduce consumption of high-energy-dense foods
• Increase breastfeeding initiation and duration
• Increase physical activity
• Decrease television viewing

Each of the above target areas are important in preventing obesity and improving health status. MMES recognition prompts BBPH to support community gardening, offer adolescent healthy-weight classes, encourage use of Farmers Markets, work with school wellness plans and health council, offer counsel to individuals and presentations to employees as part of comprehensive worksite wellness, and provide guidance to adults and kids of all ages how they can Move More and Eat Smarter. No matter if you are a parent, business owner, government leader, tax-payer, professional, unemployed individual, skilled laborer, white collar worker, or retired – everyone needs to ask, “What is my role in supporting each of the six target areas?” You can do something in every area to improve the health of yourself and others. Have questions or need information? Call Wanda Agnew, PhD, LRD. wagnew@nd.gov or 355-1555.

 For years we have been urged to “get ready” and to prepare for emergencies—from natural disasters to terrorist attacks. As a result of recent flooding in our state, we have incentive and opportunity to assess our preparedness, recognize our successes, and identify gaps where more work needs to be done.

You can take specific steps to better prepare yourself and your family, as well as encourage your community, schools, and workplace to be better prepared. Assess what worked or did not work as you prepared for, or responded to the recent floods by answering the following questions:

• Did/do you know how to obtain emergency information via the emergency broadcasting channel on the radio or TV?
• Did you call, or would you know how to call the toll free hotline seeking important information, such as; Is it safe to go back into my home? What cleaning supplies will I need?
• Did you see or hear any messages that encouraged people to take steps to be prepared in your community (stockpile supplies, prepare to evacuate, sand bag property, etc)?
• Did you prepare a Disaster Supply Kit with emergency supplies for your home, your car or where you work to take with you if you had to leave quickly (battery operated radio,  flashlight, water, food, medicine and important documents)? 
• Did you prepare a Disaster Supply Kit with items needed if you were evacuated to a city shelter or the home of a friend or family member (medicine, important documents and comfort items)?
• Did you made a specific plan for how you and your family would communicate if you were separated?
• Did you establish a specific meeting place in the event you and your family were not able to return home if you were evacuated?
• Did you discuss, practice or drill what you would do in an emergency at home (shelter in place or evacuate)?
• Did you volunteer to help prepare for or respond to a major emergency (sandbagging, serving meals, etc)? Did you know who to contact to offer your services?

Contact your Local Emergency Manager, American Red Cross Chapter, or Bismarck-Burleigh Public Health for more information…or…check the following websites:

www.ready.gov   www.redcross.org

My daughter Danni has a strange habit of always smelling hand soap before she begins lathering her hands. After a few sniffs she offers the normal kid critique of the soap. Generally it’s a comparison to some type of berries or other fruit.

It used to annoy me a little because she has to do it every time she washes – including in the men’s public restroom at the local department store. As much as it irritated me I find myself doing it occasionally. I’m learning bad habits from my child.

Just for the record, I can’t identify the hand soap fragrance in the second-floor men’s bathroom outside the newsroom at the Tribune.