Dr. David Gifford, the director of the R.I. Department of Health, returns to projo.com on Friday, Oct. 30, from 10 to 11 a.m., for his second chat on swine flu. With the H1N1 virus becoming widespread in Rhode Island, Dr. Gifford volunteered to take questions even as he experienced flu-like symptoms himself.

See a transcript of his first chat in August here

Andrea: Good morning, everyone. We've already got several of your questions lined up for Dr. Gifford, who is indeed with us today. We'll be starting the chat with him shortly. Andrea Panciera, projo.com

Dr. Gifford: Good morning. I am looking forward to answering as many of your questions as possible. Pardon my typing and spelling errors.

Chris: My daughter has a flu clinic at her school on November 13th. How certain are you that the vaccine will be here that day? What happens if it is not?

Dr. Gifford: We are certain that we have enough vaccine for the first week of school clinics starting monday Nov 2nd. We are pretty confident that we will have enough for the second week but will not know for sure until next week. After the second week, we are less confident. If the amount of vaccine projected holds, we should be ok.

Lisa: My 3 year old daughter received the first of her 2 doses of the h1n1 flu mist last week. The second dose won't be administered until the end of November...does she have any protection now? Or is it only effective after the second dose?

Dr. Gifford: For children nine years and under, they should get 2 shots. Many but not all will have some protection after the first shot but we can not predict which ones. Therefore, just like for seasonal flu shots that must be given twice to children 9 and under, the H1N1 vaccine needs to be given twice. The second shot needs to be given at least 4 weeks later. We will have to delay the second shots in schools until January given the amount of vaccine available.

coco: Are you going to close down schools especially those that are not scheduled for their vaccines until the end of December/January? These children will be sitting ducks in schools just waiting to become infected with H1N1 or worse because these schools are the last to be given the vaccine there may possibly be none to give at that time! It is especially unfair to those children that are in the high risk group... no priority were given to these children such as asthmatics that rightfully NEED it more. Though ALL children need their vaccines... it clearly states on the Dept of Health's website those of high risk are more susceptible to this virus... why label such groups high risk if they're not being treated like one? A bit hypocritical on your part... don't you think Dept of Health?

Dr. Gifford: Closing schools does not help as much as you would think in preventing spread of influenza given how effective the virus is in spreading and how children interact with each other outside of school. We also are see H1N1 throughout the state in all sectors, so closing schools will not have the effect you want. The best steps or the use of frequent hand washing, particulary after shaking hands or coming in contact with frequenty touched surfaces. None of the infectious disease experts in RI or nationally that we have consulted think that we should recommend closing schools.

wondering: Why are school age children with extremely with extremely serious medical conditions such as hypoplastic left heart being made to wait to receive a vaccine when a vaccine will be available in RI starting Monday? Wht put these children at further risk by increasing their wait time?

Dr. Gifford: We are working closely with Hasbro speciality clinics for these types of children. We were able to deliver some vaccine to start vaccinating children with transplants starting next week. We are hopeful that we will be able to get some more for the other high risk children including those with congenital heart disease. However, Some may still be able to get it sooner in their school clinic.

Andrea: Dr. Gifford, I just went to let people know that you are, as we planned, doing this chat from home today after not feeling well earlier this week. When we chatted on the phone, you said you were feeling better after getting a good night's sleep. Can you tell us if you think you had the flu, which kind, and how will you know for sure?

phyllis: my daughter had the flu last week and was sick for almost a week. It was not confirmed swine flu but i'm pretty sure with her symtoms thats what she had it. Can she and should she get the swine flu vaccine and how long would she have to wait before she gets it. thank you

Dr. Gifford: Yes. Up until about two weeks ago 90% of people with influenza like illness did NOT have influenza or H1N1 based on our testing. Now we are seeing about 75% of people with influenza like illness (defined as Fever plus cough or sore throat) are having H1N1. So there still is a 25% chance that your child did not have it. We also expect to see another wave of outbreaks in the spring so getting the vaccine in December or January is good idea.

Concerned health care worker: Hello all! My question for Dr. Gifford concerns the first responders. The vaccination of these individuals is currently set for Decemember or January. My feeling is that that may be too late considering H1N1 is already here! Any alternatives being suggested??

Dr. Gifford: We have agnozed over this decision as we have for all the compelling cases and groups. Since most of the illness is in children and pregnant women do not do well when they get this virus, we elected to start with children and pregnant women first. We look at the amount and type of vaccine we get on a daily basis and if we have enough we are adding in other groups. There just is not enough to give out to everyone who should get it first let alone who wants it. We will have enough later on for everyone who wants it.

julie: If a patient is suspected of having H1N1 - shouldn't they STILL receive the vaccine when available, since tests to confirm are not being done routinely. There are alot of parents who are assuming not to get the vaccine even if symtoms are mild and unconfirmed.

Dr. Gifford: Yes, there are no complications from getting the vaccine if you already have been infected by H1N1.

Renee: I was told the seasonal flu vaccine and the H1N1 vaccine have to be administered 3 to 4 weeks apart. How can you control that with all the school vaccination clinics? Thank you, Renee

Dr. Gifford: The nasal spray version of seasonal and H1N1 needs to be given 4 weeks apart. The injection versions can be given together. You can also get the injection version of H1N1 if you got the seasonal nasal spray version. We are only giving injections in school clinics so we do not have to worry about the issue you raise of nasal spray seasonal having to wait 4 weeks before getting the nasal H1N1 version

narr99: Dr. Gifford, I hope you are feeling better. I am 39 and almost a life long diabetic on the insulin pump. I haven't had the flu in years, but have had the flu shot. I use anti bateria wipes at work and hand sanatiser. I am worried about getting H1N1 is there anything I need to do extra or watch out for until I can get the shot.

Dr. Gifford: Thank you. I am feeling much better. If I had followed your practices (and my own advice) more carefully I may not have gotten sick. We know how the virus spreads. Using alcohol hand gels frequently, especially after shakinghands and touching frequently touched surfaces is very effective.

Karen: If my child comes down with flu symptons, do i immediately take him to the pediatrician, or Hasbro, or a walk in clinic? My child will not be vaccinated until the end of November. Is there anything that can be done at a hospital? It just scares me that a healthy 12 year old girl took "a turn for the worse" and died. Could that have been prevented if she was in a hospital?

Dr. Gifford: I understand your concern. You should first contact your physician (unless you have shortness of breath or other signs that you would normally go to the emergency room). For healthy children who just have a fever and cough (the typical symptoms of flu) teh emergency room or your physician will likely send you home for rest and fluids. For children (or adults) with high risk conditions, you should contact your physician to strat antiviral medication early (withi first 24 to 48 hours from symptom onset) as this may help you. We have much more information about when to call your doctor or go to the emergency room on our web site www.health.ri.gov which I cannot cover here.

julie: if someone is vaccinated, can they still spread H1N1 to someone who is not vaccinated?

Dr. Gifford: You do not develop antibodies (the main way your bodies immune system protects you against infections) against H1N1 until about 8 to 10 days after the vaccine. So you could get infected and then spread to someone else. However, you can NOT spread the virus to others by geting the vaccine including the nasal spray.

Andrea: Dear chatters: Lots of questions still coming in here! We're aiming to post the ones first that may apply to many people. If you've submitted a question that is very specific to your circumstances, and we don't get to it today, we'll e-mail them to Dr. Gifford, who says he'll try to answer as many as he can. Thanks!

Ramona: How can the health department and the media continue to state the "the H1N1 virus is becoming widespread in RI" when we know that doctors are NOT routinely performing tests on individuals with "flu-like" symptoms (including you, Dr. Gifford). What information will the Health Department's tracking of Tamiflu prescriptions yeild if Tamiflu is NOT being routinely prescribed (including to you, Dr. Gifford). To me, the lack of hard evidence is ridiculous - medicine is a science, after all. The urgency and near panic that has been created around getting our children vacinated is completely out of control; when are you actually going to have the ability to provide the public with actual FACTS regarding this virus?

Dr. Gifford: We select a sample (say 5 out of 100 poeople sick) and test for H1N1. We do this from some schools, university clinics and physician offices as well as hospitalized individuals. This way we know what percentage of peopel who have influenza like illness have H1N1 (currently about 50 to 75%). We also track all emergency room visit for inlfuenza like illness and we track all visits to 24 different physician offices around the state. Lastly we also track school absenteeism. This give us good estimates of what is happening in the state.

brackish: Thanks for taking time to talk to us. I was wondering how long a person is contagious for after getting the flu (before and after).

Dr. Gifford: People are mainly contagious while they have a fever, hence the recommendation to stay home until you have been feer free for 24 hours. People shed (e.g. spread virus from their nose or mouth) the largest amount of virus when they have a fever. They can also shed smaller amounts of virus starting about 24 hours before they develop symptoms to up to 10 days after symptoms go away.

Physical Therapist: Thanks for doing this Dr. Gifford. PLease - what can we do as health care workers - as teachers and administrators - to ENFORCE handwashing and basic hygiene with these kids. Can we get some hand santaziers and clorex wipes out to the schools? Basic procedsures have been missed. These kids don't respond to a nurse over the loud speaker saying ..."wash your hands" They just don't.

Dr. Gifford: We did install alcohol hand gel dispensors in all schools a couple of years ago. Frequent reminders will work. When asking kids to develop a new habit, it takes time and frequent reminders. Be patient but diligent just as you are with your own children.

ConcernedParent: Dr. Gifford, our 6 year old daughter is allergic to eggs so has been unable to get the seasonal flu shot since her diagnosis. Today she is scheduled to have a scratch test to see if she can handle the shot. If she can, she will be given the seasonal flu shot while in the allergist's office. Her school is offering an H1N1 flu shot clinic next Friday evening. Assuming she handles the seasonal shot today, can she be givin the H1N1 shot next week? Will there be enough time between shots?

Dr. Gifford: The severity of egg allergies varies by child. You are doing the correct thing by having your physician or allergist determine the egg allergy. The decision about getting in school should be made by your physician & allergist. Often they can give the vaccine but in gradually increasing dose and in a controlled setting like the physicians office. We are hesitant to give the vaccine in school to children with egg allergies since we do not know the severity of the allergy.

tony: In light of the possibilty that the swine flu leads pneumonia complications, wouldn't it be wise to give anti-biotics as a preventive measure to those with swine flu?

Dr. Gifford: No. most poeple do not get complications such as bacterial pnuemonia. Giving out antibiotics to a large number of people not only puts some people at unnecessary risk of complications from antibiotics (all be it small) it also can lead to drug resistance. the overuse of antibiotics is one of the reasons we have so much drug resistant strains of bacteria currently.

Chris L: I am a public library director. We have several story hours for young children weekly and I am wondering if we should cancel them for the next two months to reduce the chance of spreading the flu virus.

Dr. Gifford: I would not cancel them. I would ask that children who are sick not attend. I would also make available alcohol hand gel and have the children use it when they arrive and leave.

colleen: I am still undecided on getting the h1ni shot for my 6 yr old daughter. She seems to pick up eveything. Yet her Dr. is only recommending the shot for high risk children. I am very nervous about all of this. Another mother told me yesterday that a healthy 7 year old gilr stayed home Friday with flu symptoms and was dead on Monday from h1n1. I have not seen this on the news. Is it just a rumor. These are the stories that make us as parents worry whether or not we are doing the right thing. Thank you

Dr. Gifford: We have only had one death this fall from H1N1. This was in a 12 year old healthy girl. We are recommending the vaccine for all children regardless of their health between the ages of 6 months and 24 years of age. However, given the type and amount of vaccine we have recieved so far, pediatricians/family physicians only have the nasal spray which can only be used in children from 2 years and up who do not have an underlying high risk condition.

mom: Are there researchers looking into why healthy people are dying? Is it possible they are predisopsed to Rheumatoid Arthirtis or some other immune compromising disease? What is the general though on the disease process when it turns into bacterial pneumonia?

Dr. Gifford: Scientist are looking into these questions and have been doing so for seasonal flu for several years. While we will hopefully get answers to these questions, I doubt we will during this outbreak. When Influenza (or many other viruses for that matter) infects the cells lining your nose, throat and trachea/bronchi and even lung cells in more severe cases (this last one inlfuenza pneumonia). These cells when infected loose some of their ability to protect you from bacteria which in some people can cause a bronchitis or pneumonia (infection in the lungs). The influenza virus does not turn into pneumonia, it makes you susceptable to getting a second bacterial infection. That is why we recommend that people who get worse after getting better contact their physician as it MAY be due to a bacterial infection.

Frankie811: I heard that once you've received the vac you cannot get H1N1? Is that true?

Dr. Gifford: No. Vaccines including the H1N1 are not 100% protective. The large majority of people are protected after the vaccine. Those that are not, still when they get infected have a head start on fighiting the illness and usually have a much milder version. I think many parents have seen this with the chicken pox vaccine where some kids who got the vaccine have developed chicken pox but much much milder version and for shorter duration.

Al: Do you need the H1N1 shot if you have or had the swine flu?

Dr. Gifford: Forthesame reason y0u need to get the seasonal influenza vaccine each year we are recommending that you still get the vaccine. The influenza virus likes to change over time. We expect to see another outbreak of H1N1 in the spring. This pattern was seen in previous pandemics in the 1950s.

Chat: I am pregnant and my doctor doesn't have any flu vaccine. Where can I go?

Dr. Gifford: We are making more available. I assume your OB ran out as we have given vaccine out for the OBs to use but only 3,000 doses. Ask your OB to call their hospital for vaccine.

mom: ANy idea when the vaccines for under 2 will be in? I hate to keep calling my pediatrican's office!

Dr. Gifford: Hopefully in the next two weeks. We will make an annoucement so you do not need to keep calling your pediatrician. They are all swamped right now with calls from parents with kids who are sick or 2 to 5 years olds to schedule their shots.

Chris: ... This is a follow-up to my earlier question. When will your office know for sure if the vaccine will be in the State for the November 13th clinic? And, is there a way for me to check on its status? I would also like to thank you for making yourself avaiable during this very busy time, especially considering you are ill your self.

Dr. Gifford: If we have to change the schedule we will make an announcement. You can also check our website and look at the school schedule for any changes.

Andrea: We're getting near to the end of our scheduled time for this chat. Dr. Gifford has a few more questions he's working on, and has agreed to keep going a little while longer. But we still won't get to all your questions today. Repeating, we'll e-mail those that haven't been answered to the director, and he'll try to answer as many as he can.

dmr217: What should be looking for as far as secondary bacterial infections? My son has asthma- I am very worried especially since we have to wait until the school clinics. Also, should I try to get a pneumonia shot for him?

Dr. Gifford: Pneumonia following influenza usually presents wtih a productive cough (eg. coughing up thick green sputum; not the clear whitish stuff), shortness of breath (hard to distinguish from his asthma getting worse) and sometimes pain in chest when taking a deap breath. The most common is a return of a fever after it has gone away for 24 hours. All of these would lead me to call my pediatrician. It does not mean that he has bacterial pnuemonia but you would want to talk to your physician.

mom: Any idea when the vaccine for under 2 will be here? - my niece in MA is getting hers today.

Dr. Gifford: We have not yet received vaccine that can be used in kids under 2. I will have to check with MA to see. They have a differnt distribution schedule where they have given physicians, public health clinics and hospitals vaccine and let them decide how to distrbute. They are encourage kids and pregnant women first but not all providers are honoring that request. We should have some hopefully in next two weeks for kids under 2.

mom: thank you

mom: feeling less stressed.

CC: Good morning Dr. Gifford. First thank you and the Gov's office for being very proactive and communicative. It is helpful and info is so important. Do you reccomend that schools be proactive in the communications department as well. Would you reccommend a sort of 2 or 3 times a week briefing from the school adminstrations to the parental community regarding the school's monitoring operations and continue to repeat the messages about staying home and being viglitant ino bserving any sick children? Thank you for your time and service.

Dr. Gifford: I would leave that decision up to the school district as it probably depends on the community. We are trying to address everyone's concerns and get information out there anyway we can. You can visit our website www.health.ri.gov, call our information line 222-8022 monday through friday between 8:30 and 4:30. We also send out a twice a week "partner briefing" updating on new information. These are also posted on our website.

donna: I completely understand that our children are very important and need the H1N1 flu vaccine but my question is.....where can I find the regular flu vaccine for myself? Everyone and everywhere has been canceled. I live in the N. Kingstown area....I am also a diabetic and need a flu shot. Thank you

Dr. Gifford: Uptake of the seasonal flu vaccine was much higher than expected when orders were placed in the spring before H1N1. The manufactures of seasonal flu are the same ones making H1N1 so when they switched over to making H1N1 they stopped making seasonal. we recieved more than we used last year but most clinics and doctors office have run out of seasonal flu and cancelled clinics. The only good news is that 95% or more of all influenza has been due to H1N1 not seasonal influenza.This was also seen in the southern hemisphere that just completed their seasonal flu season. We are trying to get some more seasonal flu shots for high risk individuals like your self. We will give it to the primary care physicians. We expect that in next couple of weeks.

beth: Where can you get a seasonal flu shot? Every clinic has been cancelled. I checked the dept of health website, and NOTHING is scheduled.

Dr. Gifford: Share your frustration. See answer I just gave above. You can check our web site for seasonal flu clinics. We try to update it but we do not always get notified of cancellations so it is not perfect.

Guest: Dr. Gifford, can you comment on multiple children in a household? If one has flu symptoms, should the second (even if he/she has no symptoms) also stay home from school as a precaution? What's the protocol?

Dr. Gifford: No need to stay at home unless they get sick and have fever. I would try as best you can to keep the sick child (or adult for that matter) apart (e.g. bout 6 feet) from the other household members, especially if they are coughing. I would use alcohol hand gels frequently. I would also try to have the sick individual limit contact of frequently shared surfaces and wipe those down periodically. We have some guidance on our website for caring for sick house hold member (which also applies for college or apt room mates).

Dr. Gifford: That appears to be all the questions. Thank you for sending them in. I hope I was able to answer them satisfactorily. For more information visit www.flu.gov (US Federal site), our website www.health.ri.gov or call our Flu hotline at 401-222-8022 monday through friday from 8:30 am to 4:30 pm.

Andrea: Dr. Gifford, thank you for chatting with us today, and to all our visitors, thank you for participating. We'll be posting a transcript of this chat on projo.com as soon as possible today. To keep up with the latest local and national news on swine flu, please check back with projo.com and The Providence Journal. Both are publishing updates on flu clinics around the state, and resources about the flu. On projo.com, you may go to projo.com/health for more information.

Note to chat participants: Due to a technical error, unanswered questions could not be sent to Dr. Gifford. He suggests you call the department's flu hotline, at 401-222-8022 with your questions.