Pediatric Associates of Richmond

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Flu (influenza)

As fall settles in on us, we as pediatricians begin to prepare for the coming of influenza season. Worldwide influenza circulates from October to May with peaks in the United States between December and February. It is difficult to predict what to expect from each flu season, or when we may expect to see the virus circulate in Richmond. What is certain is that protection against influenza is essential for all infants, young children, adolescents and caregivers of children. Below, we’ll review the symptoms of influenza, common myths about the flu and strategies for prevention.

It is common to hear someone with a runny nose and cough to say they have ‘the flu’. In addition, persons with vomiting and diarrhea are sometimes referred to as having ‘the stomach flu’.   The influenza virus is a respiratory virus that may include these symptoms, but also typically includes:

A sudden high fever, usually above 101°F and chills

Body aches, headache and tiredness

Sore throat

Dry, hacking cough and stuffy or runny nose.

Some children will complain of nausea, vomiting and diarrhea. Others may complain of ear pain.

The onset of flu is usually very quick. Most adults are infectious one day before symptoms develop and up to 5 to 7 days after becoming sick. It is possible to have influenza more than once in a season if different strains circulate in the community. Generally, patients with influenza will be ill for about 5 to 7 days. Rest, fluids and fever reducer can relieve many of the symptoms of the flu. There are also medicines that are given by prescription that we will address later. Your child should remain home from school or childcare until they have been fever-free for 24 hours and the cough is decreased.

Young infants and children with special health conditions are at particular risk of developing a severe case of influenza or complications from the illness. Patients at highest risk for developing complications were those with neurologic or neuromuscular conditions. Other children at particular risk are those with asthma, diabetes, sickle cell disease and children younger than 6 months who cannot receive the vaccine due to age. However, up to 40 percent of children who developed severe complications in past flu seasons did not have underlying medical conditions, so it is important to monitor your child’s symptoms closely for worsening or changes.

The influenza virus is spread by droplets that are tossed into the air by an infected person when he or she coughs or sneezes. The virus can become airborne and infect persons within about a 6 foot radius. The flu virus infects another when it lands in the mouth or nose or is inhaled into the lungs. The virus also lives on surfaces and may be transmitted by touching an infected surface and then touching the face.

Given the miserable nature and duration of the influenza illness, the high probability of spread and the risk for complications, protection against the virus is the very best defense. However, some parents decide to decline the vaccine for themselves and their families.

One common myth is that the flu shot somehow causes the flu. This is not at all the case. The flu virus infects a person by making copies of itself in the body, called ‘viral replication’.   The injectable vaccine is an entirely killed virus, thus it cannot make copies of itself or make you ill. The nasal spray vaccine, which has not been offered since the 2015-2016 flu season, is a weakened “attenuated” form of the virus that is rendered incapable of making copies of itself. Think of a copy machine with no paper and no toner—not very good at producing copies!

Some parents feel that their families “don’t get the flu”, so they don’t vaccinate. It is estimated that 5-20% of adults and 10-40% of children get the flu every year. It is also possible that the infection is very mild, so it is not recognized as influenza. Some argue that they are ‘healthy’ and thus do not need to be vaccinated. Again, nearly half the children who develop complications from influenza were previously healthy.

Finally, parents may feel that the flu shot ‘just doesn’t work’. Like any immunization, protection from the influenza virus is imperfect. Strains of the virus circulating in the community and across the globe change from year to year, and even within a season. The CDC picks the strains to be included in the seasonal vaccine based on the virus patterns from previous years and predictions for the upcoming season. Sometimes the vaccine is an imperfect match for the virus circulating in a community. The most recent reports for this 2017-2018’s vaccine site a 30% effectiveness rate overall, but 59% effectiveness for children under 9. While it is possible to contract the flu after receiving the immunization, the illness is typically less severe and shorter in an immunized person. This is because there is some cross protection between the vaccine and the circulating strains, even if they are not a ‘perfect match’. Additionally, it takes approximately 2 weeks for the vaccine to be effective, so it is possible to contract the flu virus before the vaccine is working.

Our practice will provide only 1 type of flu vaccine during the 2019-2020 season — the intramuscular shot of inactivated influenza vaccine (IIV) (Fluzone™), which is for children 6 months and older.  A large study came out in early 2016 showing ineffectiveness of Flumist at preventing influenza illness over the prior 3 years. Consequently, we are not recommending or offereing Flumist until effectiveness data improve.

The vaccine is given every year because the protection lasts for only about 6 to 12 months and because the strains in the vaccine often change year to year. In the first year that your child is vaccinated, he may need two doses if:

He is aged 6 months to 8 years

He received fewer than 2 does of the vaccine before July 1, 2015.

The vaccines available in our office this year are quadrivalent vaccines, meaning that they protect against 4 strains of the influenza virus. This year’s vaccine contains two “A” strains of the virus and two “B” strains. The vaccines are single dose vials and do not contain the preservative thimerisol.

Generally, all persons are recommended to receive a flu vaccine. However, some groups should not. The IIV is not recommended for those with a history Gillian-Barre syndrome.  Egg allergic patients may receive the flu vaccine. The influenza vaccine can safely be given with all other vaccinations.

The influenza vaccine generally produces very few side effects. Mild fever or achiness at the injection site may follow the IIV. Generally, most persons don’t notice side effects.

Our office will administer the influenza vaccine at scheduled well child appointments and by separate vaccine appointments that may be scheduled with our office. At these appointments, a nurse will administer the vaccination and you will be on your way! With minor illnesses, your child may receive the vaccine at a sick visit. However, some with some illnesses, it is best to wait until your child is healthy to receive the vaccine. Our providers will let you know when your child should receive the vaccine.

As pediatricians, we want to provide that every protection that we can provide your family against illness. Thus, we strongly encourage all of our patients to be vaccinated.

In addition to vaccination, there are many other steps you can take to keep your family from contracting the flu. Handwashing is the best line of defense. Encourage your children to wash with soap and water frequently. Make a habit of periodically cleaning high touch surfaces such as handles, switches, phones and remotes. Encourage your children not to touch their noses or mouths. Stay home when you are sick, to avoid infecting others.

Should your family members become ill despite all of your best precautions, symptom care will certainly help. This includes fever and pain reducers such as acetaminophen, drinking lots of liquids and rest. A prescription anti-viral medication called oseltamivir will be helpful for certain patients. This medicine is most effective if it is given within 48 hours of the onset of symptoms. This medicine sometimes has unpleasant side effects such as nausea and vomiting or behavior changes. These subside once the medicine is stopped. It is available in liquid or capsule form. The capsules may be opened and sprinkled, if necessary. Contact our office regarding whether this prescription is indicated for your child.

We hope this information helps you better understand the influenza virus and why influenza vaccine should be on your mind (and your calendar) this fall. As always, contact our office with questions or to schedule your child’s flu vaccine appointment.