Influenza (“Flu”) FAQ

FREQUENTLY ASKED QUESTIONS ABOUT “THE FLU”

What is the flu?

Influenza (“flu”) is a virus that goes around every winter between December and March. Its main symptoms are fever, sore throat, cough, and generalized body aches. These symptoms are quite similar to many other viral illnesses, including the common cold. The chief differences between a cold and the flu are: chills & body aches are usually not part of a cold, while runny nose is usually not prominent during the flu.


Which children are at greatest risk?

The most common serious complication of the flu is pneumonia. Children at risk for this are those who don’t move around as much as other children (cerebral palsy, muscular dystrophy), who have weak immune systems (AIDS, chemotherapy, post-transplant), or who have underlying lung conditions (cystic fibrosis, moderate-to severe asthma).

The second most common type of serious flu complication is the triggering of a “crisis” or exacerbation in an otherwise unrelated underlying health condition. Examples of this are epilepsy (flu could trigger convulsions), diabetes (flu could trigger diabetic acidosis& coma), and heart disease (flu could trigger heart failure). Thus children with these types of conditions are also considered to be at high risk.


What are our policies and procedures relating to the flu vaccine?

Injected Influenza Vaccine – available electively for any child >6mo old whose parent desires they get it, strongly recommended for high-risk patients. Always covered by insurance.

  • 2nd dose necessary 4wks after first if

The Flu Vaccine List:

  • Is comprised of patients with chronic illnesses that place them at high risk for Influenza complications
  • Patients on this list will be contacted by us when vaccine is available.
  • Is not perfect – only a provider can place someone on the list, but inevitably some patients who belong on the list get left off it by mistake.
  • Parents who think their child has been left off the list by mistake need to communicate with a provider – not the front desk – about this either during a visit, call-in hour, or by email.

Flu Vaccine Appointments:

  • Special “shot-only” appointments with providers for Flu vaccine should NOT be booked.
  • Flu vaccine can be given in the context of well child or followup visits which would be necessary anyway.
  • Children who need Flu vaccine but who do not have an upcoming well child or followup appointment should receive it during one of our “Flu Vaccine Clinics” which will be scheduled periodically throughout the Fall and early Winter seasons.
  • The date of our first Flu vaccine clinic will not be announced until we have supply on-hand (usually mid September).
  • Once Flu vaccine clinic dates are announced, parents of children on the Flu Vaccine List will be contacted to book one of them by our front desk staff.

When should you be concerned?

The vast majority of children (and adults) with complications get bacterial pneumonia on top of the flu. They do not get very ill suddenly or without warning. Close observation of sick children, as we have always prescribed, is your most important tool. If your child looks similar to how you imagine you would feel during a similar illness, be reassured. If he/she looks worse than you would expect, call for an appointment. Try not to panic simply because of stories in the news. Look at your child. He/she is your best guide to the seriousness of his/her illness.

SYMPTOMS TO WATCH FOR DURING INFLUENZA-LIKE ILLNESS (IFI)

NOT SO CONCERNING

MORE WORRISOME

Fevers up to 103°F

Fever 103.5°F or higher.

Perks up when fever comes down.

Lethargic even with fever control.

Doesn’t want to play or walk.

Dizzy, clumsy, confused.

Not eating much, but drinking OK.

Not drinking, dry mouth.

Urinating as often as usual, clear.

Urinating infrequently, dark, strong.

Head, stomach, muscle aches.

Vomiting, stiff neck, chest pain.

Frequent, bad cough (wet or barking).

Difficulty breathing, wheezing, stridor.

Sore Throat.

Rapid breathing, chest “caving in”.

 

Fever: Fever and serious illness are not the same. If a child looks better when the fever is lowered be reassured. If you think your child is unusually ‘out of it,’ call to be seen immediately. Remember, fevers will return when medications wear off.

Lethargy: Ill children are lethargic. Lethargy is not mere sleepiness. Rest and sleep promote healing. We all sleep more when healing, whether recovering from surgery, from an injury, or an illness. However, if you think your child’s is unusually ‘out of it,’ call to be seen immediately.

Decreased appetite: Sick children eat less. We all remember lying in bed taking only soup and toast. Food volume does not matter. Drinking is important. Encourage fluids for your ill child. If you think your child is dehydrated (decreased saliva, tears, urine and activity) call immediately to be seen.

Coughs: Children with a cold or the flu will cough. Those with non-stop coughs or those who are having a hard time breathing — rapid breathing, ribs / stomach going in and out when breathing, or children who complain about chest tightness and difficulty breathing should be seen immediately.

Vomiting: Children with the flu usually do not vomit. If they do start vomiting, it will be even harder to prevent dehydration.


Do we prescribe anti-viral medication?

Anti-viral medications for the flu have been around for years. In the past we have rarely prescribed them. They are unlike antibiotics or any other widely used medications and as pediatricians we are always reluctant to try new medications on growing children, even though they have been tested and found to be safe in the pediatric age group. We also did not use them in the past because they did not do much. At best, they reduce the duration of illness by a day or two. They have not been proven to prevent serious complications. In our view, this was not worth their regular use.

Since 2003-4 things have changed a bit. Not only did the more-severe strain of flu that year (see below) call out for treatment in certain cases, but newer anti-viral drugs have come on the market (e.g.Tamiflu, Relenza) which seem to work a bit better than the older ones did. For these drugs to work their best they must be started as early as possible in the illness, however, preferably within the first 48 hours of being sick. They are then taken twice daily for 5 days. We do not feel every child with the flu needs to be treated with these medications, but we will consider using them in children whose symptoms seem particularly severe (or in children at high risk for complications who have not gotten their flu vaccine this year).


If your child has asthma:

Regardless of whether your child got the flu vaccine this year, now is the time to review your asthma action plan and start measuring peak flow readings. If you do not have an asthma action plan, or if it is more than a year old, or if for any other reason you do not feel comfortable managing your child’s asthma make an asthma followup appointment now, before the flu season hits hard.


What is real, and what is hype?

Influenza is an illness that makes people feel really yucky for the better part of a week. It changes every year, which is why a new flu vaccine is needed yearly. Some years the flu is worse than others, and some years the vaccine works better than others. Most years the change is just a slight variation on flus that have come before, and so most people worldwide have some level of residual immunity. Occasionally a completely “novel strain” comes along which humans have no experience with. Because nobody has any immunity, such novel strains usually spread rapidly and become “pandemics”, although even a pandemic strain might be mild or severe in terms of the illness it produces. Usually this happens when a strain “makes the jump” from another species, like pigs or birds. In order to successfully make that jump the virus needs to learn how to spread human-to-human. The “avian flu” scare of several years ago was hype because all the cases in humans were caught from birds, human-to-human spread never occurred. In contrast, the spring 2009 “swine flu” scare was real, and quickly became a pandemic despite truly impressive worldwide efforts to control its spread, because that virus had gained the ability to spread directly between humans. Luckily the H1N1 strain causing the current pandemic is mild (at least so far – it could change again at any time) and does not generally cause very severe disease.

Regardless of how mild or severe a particular influenza strain may be,deaths associated with it are not usually caused by the flu itself, but rather from complications such as pneumonia, dehydration, or worsening of an underlying medical condition. Generally, the elderly (>60y), the very young (<2y), and patients who have underlying chronic illnesses such as moderate to severe asthma, cystic fibrosis, immune deficiency, diabetes, epilepsy, or cerebral palsy are considered “high-risk” because they are more than 25x more likely to develop complications from any influenza strain than other people are. One strange thing about the current H1N1 swine flu is that the elderly do not seem to be at high-risk, but instead pregnant women do seem to be.

From the time the first influenza vaccines were developed (in the 1970’s) until very recently, there was always a shortage. In the United States from 1980-2007 the total doses made available each year fluctuated between 60-100 million. That was not enough to vaccinate our entire population of about 300 million, and if one subtracted out the elderly, in bad years it didn’t even leave enough for all the other high risk individuals (in good years it just barely did). So for all those years the standard recommendation of infectious disease experts and public health officials was that only high-risk patients should be vaccinated, and this policy of “rationing”was followed by most health care providers. Low-risk patients never complained, and it was never a source of public controversy until the 2003-4 flu season. That year’s flu “burned hot & quick”– meaning that the season started a bit earlier than usual (November) and the symptoms were more severe than they are during many years. While the epidemic also lasted a shorter time than it does most years (it was over by early January), an unnecessary panic was generated by the media coverage. Demand for vaccine skyrocketed, even among low-risk individuals. The situation was made worse when flu vaccine manufacturers announced, right at the peak of the season, they had overestimated their production capacity, and promised deliveries would need to be delayed or canceled. From that point forward increasing pressure from the public, healthcare providers, and government to increase flu vaccine manufacturing capacity to the point where it could be offered to all who wanted it was brought to bear. Still it took 5 more years to finally meet that demand, 2008-9 being the first year when there was no shortage and no rationing needed. Please click here for more information about Flu Vaccine.