2009 Influenza Bulletin
FLU (Influenza)
What is the flu?
The flu is a viral infection of the nose, throat, trachea, and bronchi that occurs every winter. The main symptoms are a stuffy nose, sore throat, and nagging cough. There may be more muscle pain, headache, fever, and chills than colds usually cause.
For most people, influenza is just a "bad" cold.
How can you take care of your child?
The treatment of flu depends on a child's main symptoms and is no different from the treatment for other viral respiratory infections.
• Fever or aches
Use acetaminophen (Tylenol) every 6 hours or ibuprofen (Advil) every 8 hours for fever over 102°F (39°C). Children and adolescents who may have influenza should never take aspirin because it may cause Reye's syndrome.
• Cough or hoarseness
For children over age 4, give cough drops. If your child is 1 to 4 years old, warm liquids including apple juice, weak tea, or lemonade offer temporary relief as well as a warm humidifier in child’s bedroom.
• Sore throat
Use losenges for children over 4 years old. Warm chicken broth may also help children over 1 year old.
• Stuffy nose
Warm-water or saline nosedrops and suction (or nose blowing) will open most blocked noses. Use nasal washes at least four times a day or whenever your child can't breathe through the nose and is most effective in infants less than 1 year of age if performed prior to breast or bottle feeding. Saline nosedrops are made by adding 1/2 teaspoon of salt to 1 cup of warm water.
• Contagiousness
Influenza spreads rapidly because the incubation period is only 24 to 36 hours and the virus is very contagious. The illness is generally spread from person to person by coughing and sneezing with the flu virus.
Your child may return to day care or school after the fever is gone and he feels up to it.
Does your child need antiviral medicine?
Antiviral medicines must be started within 48 hours of the start of influenza symptoms to have maximum effect. They reduce the time your child is sick by 1 or 2 days. They do not cure the disease nor remove all the symptoms. The American Academy of Pediatrics recommends they be used for all high-risk children. Healthcare providers vary in their practice about the value of prescribing antiviral drugs for healthy children with influenza. Talk with your healthcare provider about this. See below the current recommendations of antiviral medications for the swine flu this season. Usually the runny nose lasts 7 to 14 days and the cough can last 2 to 3 weeks.
Does your child need a flu shot?
Yearly flu shots have always been recommended for high-risk children over 6 months of age. These children often have complications from influenza, such as pneumonia. Parents and siblings of high-risk children should also get a flu shot. Children are considered high-risk if they have the following conditions: • Lung disease, such as asthma
• Heart disease, such as a congenital heart disease
• Muscle disease, such as muscular dystrophy
• Metabolic disease, such as diabetes
• Renal disease, such as nephrotic syndrome
• Cancer or immune system conditions
• Diseases requiring long-term aspirin therapy.
In 2009, the American Academy of Pediatrics added all children age 6 months to 18 years, healthy and immunocompromised, to the list of people who should get a flu vaccine. Additionally, pregnant and breastfeeding mothers should receive the flu vaccine. Recent research has shown that healthy children younger than 24 months are at as great a risk of complications as children with the high-risk conditions listed above. The nasal spray flu vaccine (FluMist) may be given to healthy children over the age of 2 years old, with few restrictions.
Take these everyday steps to keep you and your family healthy: • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
Note: The information below is accurate as of September 10, 2009. As some recommendations may change, please check routinely for new notices from the office and the CDC.
Influenza-like-illness (ILI) is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a KNOWN cause other than influenza.
Incubation period of H1N1: The estimated incubation period could range from 1-7 days, and more likely 1-4 days.
Testing:
Currently, a rapid test, nasal swab, for influenza can be performed on all patients at your pediatrician or family physician’s office.
Who to treat wit Antiviral Therapy:
• Treatment with oseltamivir, Tamiflu, or zanamivir, Relenza, is recommended for all persons with suspected or confirmed H1N1 influenza requiring hospitalization.
• Treatment with Tamiflu or Relenza generally is recommended for persons (outpatients) with suspected or confirmed H1N1 influenza who are at higher risk for complications including:
o Children younger than 5 years old. However, the risk for severe complications from seasonal influenza is highest among children younger than 2 years old.
o Adults 65 years of age or older
o Pregnant women
Persons with the following conditions:
o Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus);
o Immunosuppression, including that caused by medications or by HIV
o Persons younger than 19 years of age who are receiving long-term aspirin therapy, because of an increased risk for Reye syndrome.
• Treatment should be initiated as early as possible because studies show that treatment initiated early (i.e., within 48 hours of illness onset) is more likely to provide benefit.
o Evidence for benefits from antiviral treatment in studies of uncomplicated seasonal influenza is strongest when treatment is started within 48 hours of illness onset. Initiating treatment as soon as possible after illness onset is also thought likely to reduce the risk of severe outcomes including severe illness or death.
• The recommended duration of treatment is five days.
Children Under 1 Year of Age
Children under one year of age are at high risk for complications from seasonal human influenza virus infections. The characteristics of human infections with swine-origin H1N1 viruses are still being studied, and it is not known whether infants are at higher risk for complications associated with swine-origin H1N1 infection compared to older children and adults.
Reference: CDC Guidelines for H1N1, September 2009
