Influenza virus and the flu vaccine

I don't know about you guys, but when I was little I thought that "the flu" was a vomiting and diarrhea thing. It wasn't until I got to medical school that I realized that the flu vaccine wasn't going to prevent the unpleasantness of gastroenteritis.

Influenza is a respiratory disease and therefore the influenza vaccine is most beneficial to the children who suffer from respiratory illnesses.

Influenza virus is a disease that circulates this time of year and usually shows up as a fever (lasting up to 10 days), chills, headache, fatigue and muscle pain. You rarely get influenza without the headache. It can involve a non-productive cough, sore throat, runny nose and congestion. This year, the eyes seem to be more red and sore, without pus, and with gobs of tearing (a viral conjunctivitis).  We can usually recognize it in kids because they look really sick and are often refusing to walk because of severe pain in their calf muscles. In addition to that good stuff, the virus can lead to pneumonia, wheezing, croup and bronchiolitis.   Up to 1/3 of kids have vomiting.  Diarrhea is unusual.

The influenza virus is the reason that children are not supposed to have aspirin. The use of aspirin (as a way to reduce fever) in influenza has been associated with Reye syndrome. Aspirin generically is salicylic acid , and can be found in Pepto. DON'T USE ASPIRIN ever in your children without talking to me first!!

The virus is spread from person to person through inhalation of small virus particles from somebody who just sneezed on you, by direct contact with the virus particle (so wash your hands) and by touching stuff that's been recently contaminated with the virus (so wash the toys and stay out of the ball pit at your favorite fast food joint!)

It's pretty easy to get, and you feel pretty lousy during the illness. You are most infectious within 24 hours of getting the disease, during a time period that you probably don't feel that bad. You can share the virus with others for 7 days after getting it and it's usually 1-3 days after exposure that you start to feel really bad.

How we can make you feel better

It's a virus, so there are no antibiotics to make this any better. There are some new medicines for treatment but they are only studied and indicated for children over 12 years of age.

Treat the fever

But not with aspirin. And not because we have to keep the temperature down. We want to keep your child comfortable. See the acetaminophen and ibuprofen medicine charts here.

Treat the Cough

The AAP, and me, for that matter are not big fans of over the counter cough medications.  They haven't been tested for safety in children and are not usually effective.  Cough suppression in general is not a good idea.  The cough reflex is a protective airway mechanism; by suppressing it, we may be suppressing a very important defense mechanism against foreign particles in the child's airway.

Coughing always gets worse at night.  Try to keep the child's head elevated, keep the air moist (and I don't care about hot vs. cold vaporizers), and if you are tempted to use OTC medications, try Benadryl, as the side effect in most children is sleep.

I use a lot of albuterol this time of year.  Albuterol is the same medicine we use in children with asthma.  (If your child has asthma and is coughing, use the inhaler by all means.) It has been used in all age groups and is safe. It's mechanism of treating cough is to open airways, not cough suppression, so it treats the underlying problem without suppressing important airway reflexes.  And just because we use the medication does not mean necessarily that your child has asthma.

Since the cough from influenza can last for weeks after the disease is done, the albuterol can be used as a cough medicine for the rest of the winter.

related pages:

• RSV
• asthma questionnaire
• green snot
• Kids and bronchitis
• over the counter medications

Stay hydrated

call us if your child

• Hasn't wet their diaper in more than 6 hours (mind you, diapers can suck up a lot of liquid without it being too obvious. Put a cotton ball or a piece of tissue paper in the front of the diaper, and if that gets wet, then you know when your child has urinated).
• If potty trained, hasn't urinated in 8- 12 hours
• Doesn't cry tears when crying
• Has a dry, sticky mouth ( kids will often have dry lips and a coating on their tongue when they are sick. Those things don't help us as much in determining who is dehydrated).

Prevent getting the disease in the first place.

• Wash your hands.
• Wash the toys.
• Get vaccinated. This is not the same vaccine as the one for hemophilus influenzae that your child got at 2,4,6 and 18 months of age.

Highest vaccine priority (seasonal vaccine) in the pediatric age group

• Kids who have chronic disorders of the respiratory system: asthma and cystic fibrosis
• Kids who have chronic disorders of the cardiovascular system, congestive heart failure or congenital heart disease
• Kids with sickle cell disease
• Kids with diabetes
• Kids with kidney disease
• Kids with an immunodeficiency or HIV
• Children aged 6 months to 18 years who are receiving chronic aspirin therapy
• Anyone in the second or third trimester of pregnancy
• Otherwise healthy kids over 6 months of age who wish not to feel like garbage because of influenza virus.

Side effects of the seasonal vaccine:

My grandfather swears he didn't have asthma until he got the vaccine, but there are no infectious particles in this vaccine, so you can't (sorry grandpa) get sick from this vaccine

• Fever: in children over 13 years, the chance of a fever as a reaction is pretty low. The risk of fever in the first 24 hours after the vaccine is highest in children younger than 2 years of age.
• People who have egg allergy should let us know before receiving the vaccine.
• It doesn't interfere with breastfeeding.

Seasonal Influenza Vaccine Schedule

Children 6 months to 8 years who have never had the vaccine get 2 doses given at least one month apart. Children over 8 years need only one vaccine a season. All age groups need to get a vaccine every year, as the sneaky little influenza virus changes just enough each year to make previous vaccines not work.

or your child can get FluMist