Dr. Bob Wiskind has practiced general pediatrics in Atlanta for more than 20 years. He was a longtime board member of Kids Health First, a pediatric IPA, and currently serves as president of the Georgia chapter of the American Academy of Pediatrics.
It may seem odd to talk about influenza (“flu”) this time of year, but with vaccine already available in many doctor’s offices, many children can be vaccinated as they head back to school. Flumist is the version of the vaccine given as a spray in the nose. It can be used in children 2 and older and adults up to age 49, though it is not appropriate for children with asthma, diabetes, congenital heart disease and other significant health conditions.
In Georgia, flu usually hits in January or February, but recent years have shown us there are no longer any “typical” flu seasons. 2011-2012 produced a very mild flu season, with a majority of the cases in early spring. A few years ago there was a peak of disease around Thanksgiving, and many remember the H1N1 flu strain that ran rampant through summer camps. If children get vaccinated in late summer or early fall, they will be protected no matter when flu season arrives.
Years ago, flu vaccines were targeted for groups considered high-risk, particularly the elderly and children with asthma. Studies showed that young children were more likely to have a severe case of the flu, so children under 2 years started getting vaccinated regularly. As it became clear that it was impossible to predict who would suffer the most complications from influenza, the recommendations expanded to include all children through age 18 in 2009 and, in 2010, all children and adults. (The vaccine is not used under 6 months of age because a baby’s immature immune system does not produce a good response. The best way to protect an infant from getting the flu is for all family members and other close contacts to be vaccinated. This is known as “cocooning.”)
Typically, the vaccine for each flu season contains different strains of the flu virus than the vaccine used the previous year. The strains included in the vaccine are chosen based on predictions of which ones are likely to be prevalent in North America in the coming flu season. Sometimes there is a good match between the predicted flu strains contained in the vaccine and the flu strains that are circulating that season, and the vaccine is very effective in preventing disease. In other years, the match is not as precise and the vaccine is less effective; but in those years, due to cross-reactivity among the flu strains, the vaccine still does a good job of preventing severe disease, the most important benefit of vaccination. You need a flu vaccine every year because of the changing strains in the vaccine and because your immunity declines over the course of the year.
Children 2 and older without chronic health conditions can receive either a flu shot or the nasal vaccine. Many prefer the spray in the nose to avoid getting a shot. The nasal vaccine is at least as effective as the shot, and there is some evidence that it produces a better immune response in younger kids. Regardless of which form of vaccine they receive, children under 9 who have never been vaccinated against the flu need 2 doses of vaccine, one month or more apart. This is because they don’t mount a full response to a single dose of vaccine. In all subsequent flu seasons, they will only get a single dose, as there is enough immune memory from the previous flu season to produce a good antibody response.
High fevers and muscle aches are two of the main symptoms of influenza, but it is important to note that there plenty of other viruses that can cause similar symptoms. There is a rapid test that can be used to distinguish flu from these Influenza-Like Illnesses (ILI), though the test has its limitations. When there is a lot of flu in the community, a negative rapid flu test is more likely to be wrong (saying you don’t have the flu when you really do); conversely, when there is a low prevalence of flu, a positive test is more likely to be wrong (falsely saying you have flu when you don’t). From a pediatrician’s perspective, one of the major benefits of diagnosing flu with the rapid test is that it allows us to stop looking for other potentially more serious causes of fever, like meningitis or blood infections.
Since influenza is a virus, antibiotics are not the proper treatment. There are anti-viral medications specifically for flu, but they typically are reserved for children with underlying health conditions for whom flu can cause a significant worsening of their condition. For healthy children, a course of anti-viral medicine will only shorten the duration of the illness by a day or two, and that is only if it is started at the onset of symptoms. The anti-viral medicines are also expensive and can cause side effects, so they should not be given to most healthy children with suspected or confirmed flu.
With many childhood illnesses, prevention is much better than treatment; flu is no exception. As summer winds down and your children return to school, remember to think about flu vaccine and get them protected.