"You really have to show kids how to take care of themselves early now," said Alvin McGlotten of Baltimore, who makes sure his son Kamurie, 2, washes his hands frequently.
Dr. Aaron Milstone, a pediatric infectious disease specialist at Johns Hopkins Children's Center, said hand-washing and cough etiquette remain the most important practices to prevent the spread of this and other viruses.
"You don't get sick from simply shaking someone's hand. The virus needs to be introduced into a hospitable environment like the eyes, nose or mouth," he said. "If you shake someone's hand and then pick your nose, you are introducing the virus into your nose. If someone comes to your door trick-or-treating and coughs in your face, then consider yourself unlucky and exposed."
Milstone added that unlike surgical masks, Halloween masks have holes around the mouth and won't provide any barrier for viruses.
Asked what a parent should do if a child develops flu-like symptoms the night of trick-or-treating, Milstone said, "The same thing they would do if they get it tomorrow - stay home. Kids are going to get exposed to H1N1 as the virus spreads in the community.
"Most kids will have mild illnesses and not even need to see a doctor. Some will need to seek medical attention, especially those that are very young and those with underlying medical conditions."
Amy Williams of Virginia Beach, Va., who toured the railroad museum with her son Connor, 4, said she's trying to stay out of large crowds this Halloween and added, "any time we're out in and about, we use hand sanitizing wipes and wash hands in the bathroom."
Dozens of children and parents, including some from day care classes, were on hand for the event, dressed as Batman, princesses, pirates and clowns. Many said their concerns about the spread of germs would not keep them from Halloween events altogether.
Dr. Wilbur Chen, a clinical investigator and infectious disease physician at the University of Maryland's Center for Vaccine Development, suggested that those who give candy - wrapped or unwrapped - drop it into children's hands instead of allowing them to reach into a container full of sweets. He says that candy-givers risk bringing germs into their own home by allowing kids to reach into containers.
"We don't want to be stodgy and keep people from enjoying the season, but there should be heightened awareness and decreasing contact," said Chen. "H1N1 cases have increased throughout the state of Maryland, and we've seen an increase in cases in our own hospital."
