INFLUENZA UPDATE JANUARY 2013

While the flu season is in full swing in the mid-west and east coast of the USA, here in Oregon we are just getting started. I had 3 rapid-flu positive ill children yesterday from 3 separate families in one afternoon. With school in full swing, it appears this may be a worse than usual flu season.

 We are unable to get any more mercury-free flu shots and most pharmacies are also out.  If you really want to get the flu shot, it is not too late and worth doing if you can find mercury-free doses. Call around to pharmacies and if they have one and your child is not ill and does not have any contra-indications, you may be able to get one.  Most pharmacies will not give the flu shot to children under the age of 11 though. If you are able to purchase a dose of mercury-free flu shot, we would be happy to administer that to your child. We do have flu-mist (Intranasal Live Attenuated Virus influenza vaccine– LAIV).  Flu-mist can be given to anyone age 2 and above. Flu-mist should NOT be given to children with asthma, lung disease, heart disease, liver or kidney disease, diabetes or blood disorders, seizure or neurological disorders, or a weakened immune system. You should NOT get the flu-mist if pregnant, nor if you will be around someone who is immune-compromised like cancer/chemo patients or HIV.  Also, don’t get this vaccine if your child has had Guillain-Barre or a severe egg allergic reaction. 

The composition of the influenza vaccine for the 2012–2013 contains the following:

A/California/7/2009 (H1N1)-like antigen (derived from influenza A [H1N1] pdm09 [pH1N1]virus)
A/Victoria/361/2011(H3N2)-like antigen
B/Wisconsin/1/2010–like antigen

Note: the influenza A (H3N2) and B antigens differ from those contained in the 2010–2011 and 2011–2012 seasonal vaccines. The influenza A (H1N1) antigen remains the same as the 2010–2011 and 2011–2012 seasonal vaccines.

All persons 6 months of age and older should receive trivalent seasonal influenza vaccine annually, especially those at high risk of influenza complications (e.g., children under 5 years of age and children with chronic medical conditions such as asthma, diabetes mellitus, immune-suppression, or neurologic disorders) and their household contacts and out-of-home care providers.

Below is a link to the childhood deaths in the US the past few flu seasons.  This year may prove to be one of the worse.  Many times these deaths are in high risk children with underlying heart disease or other risk factors.  Death from influenza is actually very rare for healthy children.

http://pcinf.pedialink.courses.aap.org/Image%20Library/General%20Course/IPD38_small-1-.gif?code=1e6566cd-8408-4ecc-a26c-e64582269a3d 

WHEN TO TREAT
The antiviral Oseltamivir (Tamiflu) can reduce the severity of illness, or reduce the likelihood of getting the flu.  In the past I have rarely used this medication as bad side effects have been reported and include seizures and other neurological manifestations, rash and heart arrhythmias.

It is worth considering if your child is VERY ill after only a day or two of illness with the flu.  It typically is no benefit to start the Tamiflu after day 2 – 3 of illness.

We do have rapid flu tests in the office, so come in early rather than later if your child is very ill and may have the flu (severe URI symptoms and cough, high fevers over 102, and body aches). 

Be aware that most children with fever, cold symptoms and cough likely do NOT have the flu, but if they are looking very ill – it’s worth making sure they do not. 

Children with severe clinical manifestations or complications of influenza such as pneumonia, children who are hospitalized, and children with medical conditions that increase the risk for complications, should be treated with an appropriate antiviral agent. Unimmunized children at risk for complications of influenza and their unimmunized contacts should receive antiviral prophylaxis following exposure.

 Remember that the media focuses on the worst news and your child will likely be fine.  That having been said, do not ignore the symptoms your child is having, especially if very high fevers with bad cough, they are very lethargic, or they are struggling a bit to breath. 

Dr Paul.

2 comments

  • I really appreciate your through and researched updates. Would you also recommend adults get the vaccine? I have not for many years but recently went through several illnesses and surgery in October of last year and just seem to be getting stronger.

    Thanks again for your response,

    Carmen

    • admin

      Yes, the current recommendations are for all persons to get the vaccine. Particularly, children and older adults who may have a more difficult time with the flu should get the vaccine. You can ask your doctor about your personal conditions/situation to see if there are any reasons they would advise against it.

      Dr Paul

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