As spring is fast approaching, so is a round of influenza. The Emergency Department (ED) at Le Bonheur Children’s Hospital has been extremely busy, seeing more than 300 patients a day with flu-like symptoms. We talked to Dr. Jon McCullers who was recently appointed as Le Bonheur’s pediatrician in chief and chair of Pediatrics for The University of Tennessee Health Science Center. He answered some common questions parents have about the flu.

Is it too late to get the flu vaccine?
No. The shot can protect children to some effect as early as seven days after the vaccine, although full protection takes two to three weeks. Thus, a flu shot now can protect during this outbreak.

Is my child protected from this flu outbreak if he/she received a flu vaccine last fall?
Yes. The vaccine offered now is the same as last year's and protects against approximately 95 percent of all flu viruses. 
 
When should I seek emergency medical treatment for child?
Uncomplicated flu (fever, cough, sore throat, muscle aches, generally feeling sick) can and should be diagnosed in outpatient settings, such as pediatric offices. Treatment and advice on care for the flu are also most appropriately delivered by primary care physicians. The ED can help deal with complications of the flu, including severe dehydration, febrile seizures fom the flu and infections of the brain or lungs. Pneumonia, when the disease moves to the lungs, can either be viral or result from bacteria complicatings the flu infection.

What can parents do to protect their kids?
The flu vaccine is the best protection against the flu. Proper hand hygiene and good cough etiquette are also critical. Encourage your children to wash and sanitize their hands frequently. Cover all coughs and cough into your sleeve.

How much longer could this flu outbreak last?
It varies from year to year. Six to eight weeks would be typical, and of course a second wave from a different strain could occur later or even overlap.

To help inform our community about the flu, our infectious disease experts have compiled important information through a series of questions and answers.

What is the flu?
Flu season usually runs from late fall through mid-winter, but as everyone knows, last year was different. A novel H1N1 influenza A virus began circulating in the Memphis area in May and caused hundreds of hospitalizations in August and September.  Symptoms caused by this virus were generally very similar to those caused by the usual “seasonal flu” that appears in fall and winter

We don’t know when flu will hit the Memphis area this year. It is likely that the H1N1 virus from last year will again affect people this fall and winter -- probably with at least one of the more common types of flu virus circulating at the same time.

The flu is a contagious respiratory illness caused by influenza viruses. Symptoms usually hit hard and fast, with fever and body aches typically lasting anywhere from three to seven days.

Is there a vaccine available?
The flu vaccine is the best way to reduce your child’s risk of developing influenza, and each year the vaccine protects against three different flu viruses.  This year, the vaccine also protects against the new strain of H1N1 influenza A virus that affected so many last year.  All people ages 6 months of age and older should receive the influenza immunization this year unless they have a rare medical contra-indication, such as an allergy to chicken eggs or a history of allergic or severe adverse reaction to flu vaccine in previous years. Also note that individuals with a history of Guillain-Barre syndrome should consult their physician before receiving the influenza vaccine.

How many doses of the vaccine will my child need?
This depends on the age of the child and whether the child received flu vaccines last year.  Children 9 years of age and older need only one dose.  Children 6 months to 8 years of age will either need one or two doses, depending on whether or not they received flu vaccines in previous years and whether or not they received the H1N1 flu vaccine last year. Your pediatrician will be able to help you determine whether your child needs one or two doses of the flu vaccine this year. The American Academy of Pediatrics guidelines are available online: 
(http://www.healthychildren.org/english/news/pages/aap-issues-flu-vaccine-recommendations.aspx)

Should my child receive the shot (injection) form or the nasal spray form of the flu vaccine?
In general, healthy children and adults ages 2-49 years of age may receive either the injection or the aerosolized (nasal spray) version of the vaccine.  Children ages 6 months to 2 years (and adults 50 years of age or older) should receive the injectable vaccine, as should children and adults with underlying medical conditions (a list of these conditions is available here: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flulive.pdf).

How can you prevent the flu?
Children should be educated about the importance of hand hygiene and respiratory etiquette. These common-sense actions can help reduce the spread of influenza and many other infectious agents.

• Cover your nose and mouth with a tissue when you cough or sneeze.
• If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.
• Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose and mouth.
• Try to avoid close contact with sick people.
• If you get sick, stay home from work or school and limit your contact with others to keep from infecting them. People should stay home at least 24 hours after they are free of fever (100°F or above) or signs of a fever without the use of fever-reducing medications.

What are the flu symptoms?
Flu symptoms include:

• Fever (usually high, >101.5 or 102°F)
• Headache
• Extreme tiredness
• Dry cough
• Sore throat
• Runny or stuffy nose
• Muscle aches
• Lack of appetite
• Coughing
• Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

When do I need to seek medical care for my child if I think he or she has the flu?
Parents should use the same judgment and common sense they would have used last flu season to decide to seek treatment for their children. If you suspect your child has influenza, call your pediatrician. Le Bonheur agrees with the Tennessee Department of Health that, “in the majority of cases, testing is unnecessary” and that “initiation of treatment should be based on clinical presentation and should not be delayed for a confirmatory test.”

There are several anti-viral medications that can be prescribed by your doctor, but these medications are most effective when given early in the course of illness, especially within the first 48 hours of presenting symptoms.  Treatment is recommended for all patients with severe symptoms and for patients at high risk for complications of the flu. This includes children younger than 5 years of age and especially those younger than age 2 and children with chronic underlying medical conditions.

From the CDC website: “Children at ‘high risk’ of developing complications of influenza include the following: children with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematological or metabolic disorders (including diabetes mellitus); children who are immunosuppressed (including immunosuppression caused by medications or by HIV infection); children receiving long-term aspirin therapy who might be at risk for experiencing Reye syndrome after influenza virus infection; residents of long-term care facilities; and pregnant patients).
To relieve your child’s pain and symptoms, first administer fluids and make sure your child is getting plenty of rest. Acetaminophen (Tylenol? and other brands) helps with the aches, pains and fever reduction.  Aspirin should not be given to children with suspected influenza.

The first and most important step to prevent the flu is to get vaccinated. Vaccination stimulates an immune response using a killed or weakened virus that uses the body’s own defense mechanisms to prevent infection.

Does this year’s influenza vaccine protect against the novel H1N1 influenza A virus that caused the global pandemic in 2009?
Yes.  This year’s vaccine protects against three different influenza viruses, including the novel H1N1 influenza A virus that was first identified last year.

Can the influenza vaccine cause the flu?
No. The injectable form of the vaccine contains dead viruses.  The aerosolized version of the vaccine contains weakened viruses that cannot multiply at body temperature.  When people who have received the flu vaccine recently develop an acute respiratory illness, it is caused by other viruses.

Is the influenza vaccine safe?
Yes.  Millions of doses of flu vaccine are administered every year and serious side effects are extremely rare.  The risk of developing severe influenza is much higher.

Should everyone get the vaccine, or only those in high-risk groups?
Everyone 6 months of age or older should be immunized against influenza every year unless they are allergic to chicken eggs, have had a prior allergic or severe adverse reaction to influenza vaccine, or have a history of Guillain-Barre syndrome. 

As last year proved beyond a doubt, influenza can be unpredictable. Consequences of the 2009 H1N1 pandemic factored into CDC's Advisory Committee on Immunization Practices' (ACIP) vote earlier this year to recommend universal influenza vaccination for all persons 6 months of age and older.

How does this affect you? Because all people age 6 months and older are now recommended to receive annual influenza vaccination. Vaccination efforts should begin as soon as vaccine is available and continue throughout the influenza season.  This year's vaccine will include the 2009 H1N1 strain as part of the regular seasonal vaccine. Communication science research conducted this summer has shown us that consumers may have safety concerns about the 2009 H1N1 strain being included in the vaccine, which can be a barrier to seeking vaccination. This year's flu vaccine is made in the same way as past flu vaccines. An average of 100 million doses of influenza vaccine have been used in the United States each year and flu vaccines have an excellent safety record.

While everyone is now recommended to receive influenza vaccine, your high-risk patients—pregnant women, those with asthma, diabetes, or other chronic conditions—remain at risk for serious complications from influenza. CDC, and state and local public health agencies, will continue to reinforce efforts to emphasize the crucial importance of vaccine for these groups while simultaneously promoting annual influenza vaccination for everyone in the community.

Parents are encouraged to make sure they vaccinate themselves and their family members too, perhaps utilizing options that might be available through pharmacies, schools, workplaces or other local partners. Information on the flu vaccine is available at www.cdc.gov/flu and www.flu.gov. 

Vaccination continues to be the best protection against influenza and your efforts will be reflected in a healthier community—yours.