Town and Country Pediatrics: Influenza

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INFLUENZA

What is influenza?

Influenza (or flu) is a highly contagious respiratory illness caused by viral infection of the nose, throat and lungs. The virus is spread through infected respiratory droplets; either through close contact with an infected individual or by direct contact with objects contaminated with infected nasopharyngeal secretions. Influenza is an annual event caused by a virus that can change each year (hence the need for an annual influenza vaccination). The peak seasonal flu season is December through March.

“In the United States, on average 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from seasonal flu-related complications, and; about 36,000 people die from seasonal flu-related causes. Some people, such as older people, young children, pregnant women, and people with certain health conditions, are at high risk for serious flu complications” (http://www.cdc.gov/flu/about/qa/disease.htm).

What are symptoms of influenza?

Symptoms include: abrupt onset of fever with chills, nasal congestion, sore throat, cough, muscle pain, fatigue, headache, stomachache, nausea, and/or vomiting.

If my child was exposed to the flu, how long will it take for symptoms to present?

Generally, an individual can present with influenza symptoms about 1 to 4 days after exposure to influenza (with the average being 2 days post-exposure).

How long is my child contagious?

Depending on the health and age of the infected individual, the contagious period for influenza is generally 1 day prior to presenting with symptoms to 5-7 days after the initial symptom onset.

Are there any complications from Influenza?

Yes! There are potentially very dangerous or even fatal complications due to infection with the influenza virus. Some of these include: viral or bacterial pneumonia, severe illness requiring hospitalization, dehydration, sinus infections, ear infections, or worsening of chronic medical conditions such as asthma, diabetes or heart conditions.

How can I prevent influenza infection?

Proper hand-washing is a key component to stop the spread of infection! Avoiding ill contacts as much as possible is also recommended. A yearly influenza vaccine can also prevent your child from becoming infected. Two options are available for individuals, depending on age and health. Intranasal Flumist is an option for healthy children and adults ages 2-49. Intramuscular Flu injections are also available for those that do not fit the criteria for Flumist. Children less than 9 years of age require 2 doses of the seasonal vaccine, administered one month apart, to create sufficient immunity. For H1N1 vaccination, children less than 10 years of age require 2 doses, administered one month apart to create sufficient immunity. This is only necessary the very first season the child receives the influenza vaccine. If you have any questions regarding flu vaccines and/or scheduling, please ask your child’s healthcare provider.

My child has influenza, what can I do to help him/her?

Acetaminophen or Ibuprofen use (depending on child’s age-please see dosing charts for more information) can help alleviate some of the symptoms of influenza. Encourage fluids in order to prevent dehydration and maintain adequate urine output. A humidifier in your child’s room can also help with nasal congestion and cough. An infant or toddler may benefit from the use of saline drops placed in the nose and removed with a bulb syringe. Plenty of rest is also beneficial.

When should I call the office?

Please call the office if your child’s fever has persisted past 72 hours, is less than 2 years of age, has any difficulty breathing, ear pain, a change in level of consciousness, significant vomiting, an illness that has become progressively worse or if you are not comfortable with your child’s appearance.

Will my child be tested for influenza?

We have definitive guidelines from the CDC at this point to NOT routinely test children who clearly demonstrate flu-like symptoms (fever, congestion, cough, muscle aches, sore throat). WHY? The rapid flu test is roughly 50% accurate when it gives a negative result. And more importantly, the positive or negative result should not affect our clinical management of your child. However, the final decision for testing for influenza will be up to your child’s healthcare provider at the time of the visit.

When can my child return to school?

A child should be fever-free for 24 hours before they return to school after having the influenza virus. Encourage good hand-washing behaviors at school. In addition, practice covering their nose/mouth when sneezing or coughing.

How do seasonal and HINI influenza compare/differ?

Each season, there are a wide variety of different strains of influenza. In this case, HINI is caused by a novel strain of seasonal influenza. The HINI virus was first detected in the United States this season in April 2009. They are both spread the same way and present with similar symptoms as well. Both can cause worsening of underlying medical conditions. Therefore, it is important to call the office if your child develops any of the signs/symptoms described in the “When should I call the office?” question above.

If my child had HINI influenza, can they have it again?

After being infected by an influenza virus, the body should develop adequate immunity to prevent future infections from the same strain. However, due to the fact that there are many different influenza viruses circulating, an individual may be “sick with the flu” more than once in a season if they happen to contract different influenza viruses.

Does my child need to be vaccinated if he/she had HINI?

People who had an illness confirmed by rRT-PCR to be 2009 H1N1 virus earlier in 2009 can be considered to be immune and do not need to be vaccinated this year. rRT-PCR is the only test that can confirm infection specifically with the 2009 H1N1 virus.

All persons in a recommended vaccination target group who had an influenza (flu)-like illness that was not confirmed as 2009 H1N1 virus infection by real-time reverse transcription-polymerase chain reaction (rRT-PCR) should get the 2009 H1N1 vaccine. Most people ill with a flu-like illness since this spring have not been tested with rRT-PCR. Tests such as rapid antigen detection assays and diagnoses based on symptoms alone without rRT-PCR testing cannot specifically determine if a person has 2009 H1N1 flu. Persons who were not tested, but who became ill after being exposed to a person with lab-confirmed 2009 H1N1 flu, should not assume that they also had 2009 H1N1 as many pathogens can cause a flu-like illness. These people should get the vaccine if they are in a recommended vaccination target group. (http://www.flu.gov/fluexperts.html)

People who were infected with the 2009 H1N1 virus and who are not severely immune compromised will likely have immunity to subsequent infection with 2009 H1N1 virus. However, vaccination of a person with some existing immunity to the 2009 H1N1 virus will not be harmful, and patients who are uncertain about how they were diagnosed should get the 2009 H1N1 vaccine. The 2009 H1N1 virus does not provide protection against seasonal influenza viruses. Therefore, people who get the 2009 H1N1 vaccine should also get a seasonal vaccine. (http://www.flu.gov/fluexperts.html)

Who should not receive the Live Attenuated Intranasal HINI or Seasonal Vaccine (aka “nasal mist” form)?

Those that should not receive the intranasal mist form of the vaccine include: those younger than 2, adults ages 50 and older, pregnant women, anyone with a severe egg allergy, anyone with a weakened immune system, anyone with a long term health problem such asthma, heart disease, lung disease, metabolic disorders like diabetes, or anemia and other blood disorders.

My child received the seasonal and/or H1N1 vaccination, how long after can I expect immunity?

An individual should be protected about 14 days after being vaccinated. During those 14 days, the child’s immune system creates antibodies towards the virus to protect from future infection. Depending on the age of your child and the type of vaccination (seasonal or H1N1), they may need two doses, 28 days apart, to be fully protected.

If I get the nose spray flu vaccination with the live virus (FluMist), will I be able to pass on the flu to others?

In clinical studies, live vaccine viruses were rarely passed to close contacts.
The current estimated risk of getting infected with a flu virus after close contact with a person vaccinated with the nasal-spray flu vaccine is low (0.6 to 2.4%). Because the viruses are weakened, infection is unlikely to result in flu illness symptoms. These weakened vaccine viruses have not been shown to change into typical or naturally occurring influenza viruses. (http://www.flu.gov/fluexperts.html)