By Dr.Rhonda P, Charlotte Pediatric Clinic
As our children head back to school, many parents are looking for answers to their questions about the 2009-2010 flu season. The confusion stems from the emergence of the “swine flu” which is the H1N1 subtype of Influenza A. It is difficult to give a single “answer” to many of the questions since the guidelines continue to change as more is learned about the new flu strain. Therefore, the best recommendation is to stay in communication with your child’s healthcare provider.
Influenza spreads primarily by person-to-person contact through coughing or sneezing of infected people. The contagious period starts one day prior to the onset of symptoms and continues until the fever resolves. On average, a person with the flu is contagious for one week. Some simple measures that are important for flu prevention include washing your hands, covering your mouth when you cough or sneeze, and staying home from work or school when you are ill.
Vaccines are the most effective public health tool for the prevention of influenza. This year there will be two separate immunizations against the flu. Seasonal flu vaccine protects against several strains of Influenza A and B, but it does not provide protection against the H1N1 virus. The seasonal flu vaccine is traditionally given between September and December and provides protection for one year or less. It is predicted that a vaccine against the H1N1 virus will be available in October or November.
Who should receive seasonal flu vaccine?
* All children ages 6 months-18 years
o With a special emphasis on children between the ages of 6-59 months
o And children of any age with chronic medical problems (e.g. asthma)
* Pregnant Women
* Adults over age 50 and adults of any age with certain health conditions
* Household contacts/ caregivers of children younger than 6 months of age
* Healthcare Workers
Who should receive the H1N1 vaccine?
* Pregnant Women
* People who care for children who under 6 months of age
* Healthcare Workers
* Persons ages 6 months to 24 years
* Persons ages 25-64 years with chronic health disorders or compromised immune systems
What can a parent expect this year with regards to flu vaccination?
Most pediatric and family medicine practices should have flu vaccine available in September or October. If a child is under the age of 9 years and has never received a flu vaccine in the past, the child will receive 2 seasonal flu vaccines, 1 month apart. A vaccine to protect against the H1N1 virus has not yet been released. More details regarding the administration of the H1N1 vaccine will be available when safety and efficacy trials are completed.
Diagnosis and Treatment
Symptoms of influenza include fever, chills, headache, sore throat, cough, runny nose, vomiting, and diarrhea. The fever associated with the flu can be as high as 102-105F and can last between 2-5 days. The diagnosis is typically made by a nasal swab. The rapid flu test takes about 15 minutes to process. These rapid flu tests do not, however, differentiate between H1N1 and seasonal flu. Since the H1N1 virus and the seasonal flu are treated similarly, subtyping is typically only done in hospitalized patients and for epidemiologic purposes.
Because influenza is a virus, antibiotics are not indicated for treatment. There are antiviral medications that are available for treatment of influenza; however, antiviral medications are not “miracle drugs.” In an otherwise healthy person, antiviral medication will most likely shorten the course of the flu by 1-2 days. The most commonly used are Tamiflu and Relenza. Because of the emergence of the H1N1 virus there are new guidelines regarding who should receive antiviral medication. So even if your child is diagnosed with influenza, antiviral medications may not be recommended.
Who should receive antiviral medication?
* Anyone who is “high risk” which includes the following:
o Persons who are severely ill
o Children who are less than 5 years old
o Adults who are greater than 65 years old
o Persons who are immunocompromised or who have certain health conditions
o Pregnant women
o Children who are less than 19 years old and on aspirin therapy
o Residents of nursing homes or chronic care facilities
What should you do if you suspect your child has the flu?
* Anyone in the “high risk” category (above) should seek medical treatment right away
* You should also seek medical treatment if your child exhibits any of the following
o Rapid breathing or Trouble Breathing
o Fever for longer than 3 days
o Bluish skin color
o Not drinking enough fluids
o Flu-like symptoms improve but then return with a new fever or worsening cough
o Dizziness or Confusion
o Severe or Persistent Vomiting
* For symptomatic treatment, it is important to drink a lot of fluids. It is okay to take Ibuprofen as needed for fever.
Parents of infants (whether breastfeeding or formula feeding) who are sick with influenza should try to find a person who is not ill to care for their baby while the parents are ill. When this is not possible, it is important to wash hands, wear a facemask, and avoid coughing and sneezing while caring for your infant. Ideally, a nursing mother with the flu should have a well person bottle feed her infant expressed breast milk. However, if no one is available to do this, you should wash your hands before breastfeeding and place a receiving blanket as a barrier between your face and the infant’s face during feedings.
For further questions please refer to www.cdc.gov or contact your child’s healthcare provider.