My husband is a pediatrician. Once a week I share this space with him so that he can give you up-to-date and pertinent information about a variety of medical topics. If there are topics that you would like to see him address, please email me at queenofhaddock(at)gmail(dot)com.
***Disclaimer – this is my personal statement regarding influenza and includes things that I tell my own patients/parents in visits to my office. This is not meant to be a substitute for a visit to or discussion with your pediatrician. For any questions regarding your child’s health you should of course discuss them with your pediatrician. This is meant only to provide information, which I hope you find helpful.***
Influenza and Swine Flu
There has been a lot of attention given to flu this year with the advent of a novel H1N1 influenza virus, aka Swine Flu. Panic seems to be widespread, and misinformation is running rampant. The first thing I would love for everyone to do is calm down. Take a deep breath. If you remember nothing else from me today remember this – swine flu has, to date, been no worse than regular seasonal flu. It has not been the great pandemic killer that it was feared to be. Your risk of a bad outcome from swine flu is no higher than your risk of a bad outcome with “regular” flu. So if normal seasonal influenza was not a cause for you to panic in years past, then neither should swine flu. The media has hyped up swine flu beyond reason, and lost in the panic of swine flu is the fact that seasonal influenza still accounts for about 30,000 deaths every year.
That being said, let’s get a basic background on flu. The usual influenza course begins with sudden-onset fever, and a combination of chills, headache, fatigue, diffuse muscle aches, and a non-productive cough. Later signs and symptoms include sore throat, congestion, runny nose, and a worsening of the cough. Most healthy children who contract the flu have an illness that lasts 3 to 7 days followed by complete recovery. Certainly there are children who are at higher risk for complications from flu (secondary pneumonia, bronchitis, etc.). The major categories of individuals who are at high risk for complications of influenza are listed here:
- Children younger than 5 years old, with the most severe complications from seasonal influenza in children younger than 2 years of age.
- Adults 65 years of age and older
- 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 Pregnant women;
o Persons younger than 19 years of age who are receiving long-term aspirin therapy;
o Residents of nursing homes and other chronic-care facilities.
Flu is spread from person to person by respiratory droplets from coughing or sneezing. It may also be contracted from a surface contaminated by droplets from another individual. There are three types of flu – A, B, and C. Type A and B are the cause of epidemic disease, with type C being only sporadic. Type A has two surface proteins which identify each strain, Hemagglutinin and Neuraminidase, and these proteins are used to type each strain of flu A (i.e. H1N1).
Swine flu is a novel H1N1 (type A) flu virus. There have been H1N1 viruses seen in prior flu seasons. The swine flu currently circulating has two genes normally found in a type of influenza virus circulating in pigs, but also has genes found in flu viruses that circulate in humans and birds as well. As noted earlier, swine flu has, to date, has not caused illness any more severe than recent seasonal influenza strains. In fact, in the state of Georgia, the Public Health Laboratory is no longer testing anyone with flu for swine flu unless they are hospitalized, as the outpatient population has not had any more severe an illness than with the usual seasonal influenza.
Treatment and prevention of seasonal influenza and swine flu are essentially identical. Prevention of the flu starts at home. Frequent hand washing, covering your coughs and sneezes into your elbow or a tissue which is then thrown away will be critical to preventing spread of the flu. You can also protect yourself by being vaccinated against the flu every year. The vaccine for swine flu is still being developed. Those currently targeted as priorities for vaccination against swine flu are pregnant women, household contacts and caregivers for infants younger than 6 months of age, health care personnel and emergency medical personnel, children and adults from 6 months through 24 years of age, and adults aged 25-64 years with health conditions that place them at greater risk for influenza-related complications.
Treatment of influenza is primarily with supportive care: Tylenol for fever, plenty of fluids to maintain hydration. Antiviral medications are available, but are not warranted in all cases of flu. For routine seasonal flu, much of the circulating influenza virus is resistant to the antivirals Tamiflu and Relenza. Swine flu has so far proven to be sensitive to Tamiflu. The current AAP recommendations (along with the Georgia Department of Community health and the CDC) do not recommend swine flu be treated any differently than seasonal influenza. Treatment is recommended for those who are at high risk for complications (see above list). In other words, if you are an otherwise healthy individual treatment is usually not needed if you do have the flu. Consider also that unless treatment is started within 48 hours of the first symptom onset, then you get no benefit from treatment. (One exception may be if you are sick enough to be hospitalized). The maximum benefit from treatment with Tamiflu is one day’s less symptoms. So instead of feeling like a Mack truck hit you for six days, you feel that way for five. Tamiflu is expensive (over $100 for a five day course of treatment), and many insurance plans do not cover it. Side effects are not insignificant, either. A recent study from the British Health Protection Agency found that over 50% of school-aged children who take Tamiflu have at least one side effect, (nausea, vomiting most commonly), and nearly 18% had at least one neuropsychiatric side effect. So unless you have a chronic health condition prior to becoming ill, you probably do not need antiviral medication. (As always, you should discuss the need for treatment with your physician).
So to summarize, the flu, be it seasonal or swine, is an illness that most individuals are able to handle with good supportive care. To be sure, there are those who are perfectly healthy and still have very bad outcomes due to influenza complications, but the numbers are not climbing with the advent of swine flu. Wash your hands, cover your coughs and sneezes, and should you get the flu anyway take Tylenol and plenty of fluids, and see your doctor if you have any concerns or questions!
Sources cited/quoted:
* http://www.cdc.gov/h1n1flu/recommendations.htm
* http://www.cdc.gov/h1n1flu/qa.htm
* www.aap.org
* American Academy of Pediatrics. Influenza. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:400-412.
* Pediatric News Aug. 2009: 8-9.
