Flu season has arrived early, and we are seeing increasing numbers of children with the flu. As of December 2019, there are three actively circulating strains of the flu. Influenza type B is most common right now, in December, but Influenza type A, which tends to make people sicker, is expected to overtake Flu B soon.
Does the Flu Vaccine Work?
Experts say it’s too early to judge how effective this year’s vaccine will be. Even if the effectiveness in preventing infection is low, the vaccine can still help prevent complications such as pneumonia and reduce the seriousness of symptoms in vaccinated individuals that get the flu. Last year, 130 children with influenza in the U.S. died. About 80% of those children had not been vaccinated for the flu.
The American Academy of Pediatrics recommends that all children 6 months and older get the flu vaccine annually. All adults should also get the vaccine. Getting the flu vaccine not only helps prevent flu in the person getting the vaccine; it also helps keep those around them from catching the flu.
Special Considerations for the Flu Vaccine
New recommendations state that patients with egg allergies should get the flu vaccine, but it should be administered in a doctor’s office setting where the child can be watched for at least 30 minutes and be treated immediately for any allergic reaction.
First-time flu vaccine
The first time a child gets the vaccine, two shots are given at least one month apart. The vaccine, which is slightly different every year, is recommended to be given once every year, just before the flu season starts, and may also be given during the season. Catching one type of flu does NOT prevent infection with another type of flu, so even those who catch one type of flu should be vaccinated once they are free of symptoms.
Nasal flu mist
The nasal flu mist vaccine is a valid option for the 2019-2020 flu season, but it can’t be given to people with some medical problems, such as asthma. It takes about two weeks for all types of the vaccine to become effective.
Is it the Flu?
The symptoms of influenza may include fever that’s difficult to control and can last up to seven days of fever, cold symptoms and cough, sore throat, red painful eyes, headache and muscle aches. Influenza B in particular can cause stomach pain, nausea, vomiting and diarrhea. There are many other viral infections that can cause similar symptoms, but usually not all at once.
The flu is very contagious and is particularly potentially dangerous to the very young and very old, anyone with a chronic disease such as asthma/reactive airways disease and anyone with a weakened immune system. People with the flu can be contagious for up to a week, meaning that children may miss a lot of school or daycare and parents may miss work while staying home with their sick children.
A flu test is NOT necessary for your child to be diagnosed with influenza. Physicians and other providers have been encouraged by the Centers for Disease Control to make the diagnosis and treat based on the child’s history of illness and physical exam. The rapid influenza test (as opposed to the test that can take several hours or overnight for results) has a history of being negative in significant numbers of patients who had the flu, as diagnosed by other more sophisticated tests. A negative rapid flu test does NOT mean your child doesn’t have the flu. On the other hand, if the test is positive, your child DOES have the flu. If your child has flu-like symptoms, discuss with your provider whether or not he or she should be treated with oseltamivir (Tamiflu™) for the diagnosis of “influenza-like illness.”
How Can I Treat My Child for the Flu?
Oseltamivir (Tamiflu™), a medication given by mouth, is sometimes helpful in reducing the amount of sick time, the length of the contagious period, and the intensity of some of the symptoms; however, it is most effective when given within the first 48 hours of symptoms. In some people with the flu, oseltamivir significantly reduces sick time. In others, it may seem to have no effect at all. Stomach pain and vomiting are frequent side effects.
Baloxavir (Xofluza™) is available as a one-dose tablet for children over 12 years of age and weighing 40 kg (88 lbs.) or more. It is not available in liquid, capsule or crushable forms. It is also most effective when given within 48 hours of the start of symptoms. It should not be given with milk or milk products. Xofluza is not available in a generic form, so it may be quite expensive. Check with your insurance company to see if they cover Xofluza.
There’s no guarantee that any antiviral medication will work. They are expensive and can have significant side effects; therefore, your provider may not recommend the medication unless your child is at risk of complications of the flu or if there are others in your household who are at risk of complications if they catch the flu from your child.
At its worst, influenza can be a fatal disease, especially for the very young, the very old, pregnant women and people with chronic health problems. At best, it causes days of misery and school and work absences. Please consider vaccinating your entire family on a yearly basis, not only for their health, but also for the health of those around them. If you have questions or concerns, please talk to your primary care provider (PCP). Although After Hours Pediatrics Urgent Care does not offer flu vaccinations, we will be happy to see your child if you think they may have the flu and you can’t get in to see your PCP.
Lou Romig, MD, FAAP, FACEP, Medical Director
After Hours Pediatrics Urgent Care