Category: Cold and flu
Posted by Dr. Molly OShea on Tue, Oct 27, 2009 at 12:41 PMH1N1 update: Michigan is being hit hard now
Iinfluenza has really started to hit our area hard. The following Q&A will help you understand who needs to be seen, when testing should be done and who needs Tamiflu treatment:
Q: When do I suspect my child has influenza? What are the symptoms?
A: Fever higher than 101.5 degrees along with sore throat and body aches is the first sign followed by headache, congestion and cough. The kids look very sick, down and out and are not interested in playing, eating or even really watching TV.
Q: What's the difference between H1N1 and seasonal influenza?
A: The symptoms are the same and both can give illness that ranges from mild to severe. Deaths in healthy and high-risk children occur with both, but early information indicates because none of us has immunity to the new H1N1 virus, lots more kids are getting sick with it.
Q: What if there's a case at my child's school - should I keep him home or what should I do?
A: I would not keep your healthy child at home. This situation will be the case every day for the next few months and unless you plan to homeschool your child this year, he should go. We will not be putting high-risk kids on Tamiflu when the only exposure is a classmate. Only 20 percent to 30 percent of household contacts will get the flu when exposed within the family, so the risk is even smaller for contact with classmates.
Q: When do I need to take my child to the doctor's office?
A: If your child is at high risk for complications from influenza you should take your child in within 48 hours of the start of symptoms. If your child is low risk, you should bring him in if the fever lasts more than three days to make sure there is not a secondary bacterial infection, or if the fever goes away for a full day and then returns at 101 degrees or higher.
Q: How do I know if my child is high risk?
A: High risk kids are those younger than 5 or any child with asthma, diabetes, heart conditions requiring daily medication, cystic fibrosis or any condition that affects ability to breathe easily (cystic fibrosis, very low muscle tone, etc.).
Q: What if I have a child who is high risk but it is the sibling of that child who is sick?
A: In that case, take the sick child to the doctor for assessment. High-risk siblings of likely influenza cases will need medication to try to minimize their chance of getting the illness or lessening the symptoms.
Q: Are you going to test for influenza in the office?
A: Most offices have a rapid test for influenza available. All high-risk kids (or siblings of high-risk kids) should be tested, but the test is not foolproof. About 30 percent of the time the test will be negative even with influenza present. So even if the test is negative, your high-risk child should be treated with Tamiflu to be on the safe side if the clinical presentation is consistent with influenza.
Q: Should all kids who have a positive test be treated with Tamiflu?
A: No. Only those children at high risk for complications should be treated. For the vast majority of children, the illness will be uncomfortable but not dangerous. To discourage the H1N1 virus from morphing and becoming resistant to Tamiflu, it is not recommended that otherwise healthy children receive it.
Q: How do you know that the influenza cases you are seeing now are H1N1? Can you do the test to know for sure?
A: Only hospitalized cases are being tested specifically for the H1N1 strain. Across the nation, more than 98 percent of all of the influenza seen and typed is H1N1 so it is safe to assume every case seen now is the swine flu. This will get tricky in late December or January when the seasonal flu will start to get mixed in, especially because the seasonal flu is not made better with Tamiflu because it is resistant to it.
Q: What if my child was exposed to another child with influenza during a sleepover or other intense and prolonged contact? Should he receive the medication to help minimize the chance he will get sick?
A: Only if he is high risk.
Q: We stood in line to get the H1N1 vaccine at the health department clinics last weekend. When can we get the seasonal vaccine?
A: When your child can get the seasonal vaccine depends on the type of H1N1 vaccine he received. If he received the live virus intranasal vaccine and you want to get the intranasal seasonal vaccine, you will need to wait two weeks. If you got the intranasal vaccine but are willing to get the seasonal flu shot, you can get that at any time. If you got the H1N1 vaccine as a shot, you can get either the intranasal or the shot for the seasonal flu vaccine at any time. Remember, the intranasal vaccine can only be given to children older than 2 without a history of wheezing or asthma and cannot be given when an infant younger than 6 months or anyone with an immune-compromising illness is in the household.
Q: Should we be taking our kids to CVS or Wal-Mart to get the seasonal vaccine?
A: Retail-based pharmacies will not administer the vaccine to anyone younger than 4 years of age and because the seasonal flu is still a ways off, I think it is more than safe to wait and get the vaccine at your doctor's office when it comes in.
More information is available on the CDC flu site as well as the Michigan Department of Community Health site. You can also read my other blog posts on seasonal and H1N1 flu, too.
