“The Flu” refers to any illness caused by influenza viruses. These illnesses typically circulate through Utah during the winter months every year. Each year we will see a slightly different influenza virus. We call these illnesses “Seasonal Influenza”. Every so often, influenza viruses can change dramatically, causing new versions of influenza virus to circulate. This year, one of these new viruses called H1N1 Influenza is circulating as well.
Typical influenza symptoms include fever, dry cough, muscle aches, headache, and sore throat. Sometimes runny nose, upset stomach, and diarrhea may occur. The “stomach flu” is actually not influenza at all, and is more accurately called gastroenteritis. The severity of influenza symptoms is variable. Most children and healthy adults will experience mild to moderate symptoms with the main symptoms of fever, muscle pains, and sore throat lasting 3-7 days. Cough and fatigue will often last for 2 weeks. Patients at high risk for more serious symptoms and complications include those with underlying lung disease (such as asthma), infants under 6 months old, and individuals with immunological disorders. Influenza symptoms are very similar to those of the common cold. The current cold viruses that are circulating tend to cause more mild symptoms, more runny nose and sore throat, and lower fever of shorter duration.
Symptoms that you should let us know about include persistent fever over 103, breathing difficulty, decreased urination, persistent vomiting, fever that returns after it has been gone for more than a day, chest pain, ear pain, or fever lasting more than 7 days. If your child has any underlying medical issues, or is under 6 months of age and has influenza symptoms, you should contact us for more information.
Treatment – Supportive Care
The majority of children with mild to moderate influenza only require symptomatic care. Symptomatic care includes the use of acetaminophen for children over the age of 2 months and/or ibuprofen for those 6 months and over to help control fever, body aches, and headache. Sore throat can be treated with these medications as well. Throat lozenges for those over 4 years old may help. Cold drinks and popsicles help with sore throat and help to keep the child well-hydrated. It’s also very important to push a lot of clear fluids and make sure the child is getting enough rest. If your child is having more severe symptoms, or has underlying medical issues, you should have them seen by one of our providers for further advice.
Treatment – Antiviral Medication
For certain patients, a medication called an antiviral may be used to help fight influenza infection. The main antivirals in use currently include Tamiflu, Relenza, Flumadine, and Amantadine. Most influenza viruses will only be sensitive to some of these medications. The H1N1 virus that is presently circulating is sensitive only to Tamiflu and Relenza. These medications are effective at reducing the severity and duration of influenza infection, but tend to only work well if started in the first 24-48 hours of symptoms. These medications also have some serious potential side effects including nausea, vomiting, stomach pain, agitation, insomnia, worsening of asthma, and potential psychiatric side effects such as hallucinations and anxiety. These side effects make it so that the medications may actually be more harmful than the influenza itself for many children. Children with mild to moderate symptoms and no underlying health issues are not recommended to take these medications. For some influenza outbreaks, these medications are used to prevent transmission of the virus through a family. This “prophylactic” use is not recommended for the H1N1 virus.
The best method for prevention of influenza is vaccination. We recommend influenza vaccination for all children over the age of 6 months old, and all family members of children of any age. The current “flu shot” has been in use for over 15 years and has one of the best safety records of any intervention in medicine today. Since the influenza virus changes each year, the vaccination is also modified each year to match the circulating strains of virus. For 2009, we will have both seasonal influenza and H1N1 influenza circulating. The H1N1 virus was not identified early enough to include in the regular influenza vaccine, so this year there are two influenza vaccinations. Influenza vaccine can be given as a shot to kids over the age of 6 months, or as a nasal mist to kids over the age of 2 years. The shot should not be given to kids who are allergic to it. The mist should not be given to kids with chronic health problems such as asthma, diabetes, or immunological disorders. The mist vaccine is a live-virus vaccine and should not be given within 30 days of any other live-virus vaccine (MMR, Varivax, or other Flumist).
Hand-washing is also important to prevent all respiratory viruses, including influenza. Teaching your kids to wash their hands for 30 seconds, use hand sanitizer frequently, cough into their elbow, and keep their fingers/hands out of their noses, mouths, and eyes makes a HUGE difference.
If your child is sick, keep them home and away from other kids. If your child has influenza, they should stay home from school/daycare/church until their fever has been gone (and they aren’t needing any ibuprofen or Tylenol) for at least 24-48 hours. With influenza, this is likely to take up to a week, so plan childcare ahead. If your child has influenza and must go into public (like to our office), have them wear a mask. Masks work best to keep the infected person from spreading the virus, however, masks aren’t the most effective at preventing healthy people from getting the virus.