‘Tis Still the Season!

As a pediatrician who takes care of hospitalized children, most parents would prefer not to meet me, at least not while I am at work. If they do happen to meet me, it is likely one of the most stressful days of their lives. Having a child become sick enough to be hospitalized is something every parent dreads. One of the most common reasons that children are admitted to the hospital, especially during this time of year, is influenza.

While becoming severely ill is something that, to some degree, we cannot predict or control, there are measures that we can take to help protect our children, ourselves, and everyone that we come into contact with. The first step is to learn more about influenza and to understand how some common misperceptions may be putting kids in danger.

First, what exactly is the flu?

Influenza, commonly known as “the flu”, is a contagious respiratory illness. It is caused by a group of different influenza viruses. The two primary strains that cause illness are types A and B. Influenza viruses are constantly changing; every year the virus looks a little different can sometimes sneak around the immunity we have from previous illnesses or from vaccines. This is why, unlike some other illnesses, you can catch the flu more than once. It is also why we see epidemics (when a disease affects more people than usual) or even pandemics (when an epidemic spreads between countries).

What’s the worst that can happen?

Though influenza is a virus like those that cause the common cold, it can cause more severe symptoms and may be associated with greater risk. The flu often comes on quickly and can include symptoms such as fever, chills, cough, congestion, sore throat, headaches, fatigue, and runny or stuffy nose. Sometimes the infection may cause vomiting and diarrhea in kids, though this is less common in adults. For some, the flu is relatively mild, but it can also cause serious illness and result in thousands of deaths in the United States every year. Many of these deaths are among previously healthy children. This flu season, the CDC has estimated that about 19 million people have gotten sick; 180,000 of those people have been hospitalized and 10,000 have died.

Who is most at risk?

Anyone can catch the flu and become severely ill, but there are certain groups of people that are more at risk than others. Children are more likely to catch the flu than adults, and they can experience some of the worst complications from the flu. Young children (including all kids less than 5 years old but especially those younger than 2 years old) are at higher risk for developing severe complications. On the other end of the age spectrum, adults older than 50 and especially those older than 65 are at higher risk for complications as well. In addition to age, certain underlying medical conditions, including things like asthma and diabetes, also make an individual more susceptible to serious complications. Any person with a pulmonary, cardiovascular, renal, hematologic, immunologic, or metabolic disorder should talk to their physician about the risk of the flu and taking preventative steps.

Prevention

The Flu Shot

One of the most important things we can do to protect our children (and ourselves) is to get the flu shot annually. Each year researchers work to predict what the most common strains of influenza will be. Because the flu viruses are constantly evolving, the shot is never perfect. We have all heard stories of people who got their shot but still caught the flu later. This certainly happens. However, this should not dissuade us from getting the vaccine, as we know that immunized children and adults who catch the flu are less likely to be hospitalized and less likely to die from influenza.

Who should get the shot and when?

The flu shot is recommended for children and adults over the age of 6 months old who do not have contraindications. Children between the ages of 6 months and 8 years of age who are receiving the flu shot for the very first time should receive two doses of the vaccine, and all other kids should receive one dose. Ideally, all children should receive their shot as early as possible in the “flu season”, which starts around October and usually peaks sometime between December and February. Depending on the year, it can last as late as May. #FluBeforeBoo is a social media campaign that launched past this year to remind and encourage families to get their flu shot before Halloween. An earlier vaccination offers the most protection for the season, but the flu shot can still be protective if given at any point during flu season. When you are considering the flu shot for your children and yourself, remember the shot not only helps protect you but also all of the children you interact with. Some of those kids and adults may be at higher risk for complications and need everyone’s help to stay safe during flu season.

Who should not get the flu shot?

While the flu shot is safe for the vast majority of people, there are a few people who should talk to their doctor first. Children that have had an allergic reaction to the flu shot in the past should see an allergist to determine if they should have the vaccine. The flu shot may also not be recommended for children and adults who have had Guillain-Barre syndrome following a flu shot in the past. It is perfectly safe to give the flu shot to children who are currently experiencing minor illnesses, even those with fever. If a child has a more severe illness with a high fever, the flu shot may still be a good idea, but it is best to discuss with the child’s pediatrician to determine the best timing.

Fighting the Spread of Germs

In addition to getting the flu shot, people of all ages should be especially diligent in fighting germs during cold and flu season. Washing hands regularly with soap and water, especially after coughing or touching our mouths or noses, is incredibly important. This habit can be tough for kids to remember when they are busy playing and doing their school work, but parents and teachers can help teach young children how to wash their hands and remind them to do it regularly. It’s also important to remember to throw away used tissues and to wipe down frequently touched surfaces including, tables, toys, cabinets, cell phones, and door knobs to decrease the spread of flu viruses.

What if you still catch the flu?

Unfortunately, every year, many people will still catch the flu. While those that have had the shot are less likely to become severely ill or need to be hospitalized, they can still feel pretty terrible and spread the flu to others. In general, medications are not effective in treating the flu once you have it. In otherwise healthy individuals, Oseltamivir (better known by its brand name Tamiflu), if given early in the illness, may shorten the duration of symptoms. Unfortunately, Tamiflu can also have side effects including vomiting, diarrhea, headache, or insomnia in some patients. It is important to see your primary care doctor as soon as possible if you are experiencing flu-like symptoms to decide if Tamiflu is the right choice for you. Oseltamivir may also decrease the chances of certain complications or death in high-risk individuals, so it is always best to consult with your doctor if you have concerns. Additionally, if someone in your home is sick with the flu, it is important to also discuss giving preventative antiviral treatment to high-risk individuals in the home, as this may be recommended depending on the risk factors present.

Plenty of rest and hydration is the mainstay for recovering from the flu. Over the counter medication such as ibuprofen and acetaminophen can help decrease the discomfort of flu symptoms (such as fever and headache), but they do not treat the underlying illness. If you have flu-like symptoms, it is always best to stay home from school or work and not return until the fever has been gone for at least 24 hours. This will help protect others by minimizing the number of people who are exposed and help to slow the spread of influenza.

Resources

Healthy Children was created by pediatricians for parents and caregivers. This page provides an overview of the flu, as well as its prevention and treatment.

American Academy of Pediatrics (AAP) is an organization of over 67,000 pediatricians across the United States. Each year, they provide official recommendations on the prevention and control of influenza in children, and they have created this helpful handout on what early education and childcare programs can do to help stop the flu.

Centers for Disease Control and Prevention (CDC) not only provides an overview of the flu but has helpful features like statistics on influenza activity across the United States and a vaccine finder to locate the flu shot in your area.

Additional Contributor

Dr. Emily Dewar is a first-year pediatric resident in Austin, Texas. When she’s not in the clinic or the hospital, you can find her discussing social determinants of health (with anyone and everyone) or trying to teach her dog not to jump on strangers.