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.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recently recommended that boys ages 11 and 12 should be vaccinated against human papillomavirus, or HPV, to protect them against certain cancers. It also recommended vaccination of males ages 13 through 21 who had not already had all three shots. Vaccinations may be given to boys as young as 9 and to men between the ages of 22 and 26.

The committee recommended in 2006 that girls and young women ages 11 to 26 should be vaccinated.

Dr. Keith English, Pediatrician in Chief for Le Bonheur Children’s Hospital and Interim Chair for The University of Tennessee Department of Pediatrics, gave our readers his thoughts on this recent recommendation. Dr. English is also the head of Infectious Disease programs at Le Bonheur.

“I strongly support routine immunization of both males and females with the quadrivalent HPV vaccine as the most effective strategy to prevent HPV infections, to reduce transmission of HPV to women and men, to promote widespread herd protection and to prevent HPV-associated diseases in both women and men.”

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?
The flu is a contagious respiratory illness caused by influenza viruses. The seasonal flu typically runs from late fall through mid-winter, and symptoms usually hit hard and fast. Once symptoms occur, the fever and body aches typically last anywhere from three to seven days.

Is there a vaccine available?
Flu vaccine is an important way to reduce your child’s risk of developing influenza, and each year the vaccine protects against three different flu viruses.  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 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 with their physician regarding whether or not to receive 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. 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 here.

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.

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 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 48 hours of the start of the 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 2 years of age and children with chronic underlying medical conditions.

What can I do for my child’s symptoms?
To relieve your child’s pain and flu symptoms, first, administer fluids, and make sure your child is getting plenty of rest. Acetaminophen (Tylenol and other brands) helps with aches, pains and fever reduction.  Aspirin should not be given to children with suspected influenza.

Since February, seven children in Minnesota have come down with measles. The outbreak is being blamed, in part, on parents’ refusal to have their child receive the measles, mumps and rubella (MMR) vaccine due to fears of autism.

Typically, children get the MMR vaccine at 12 months of age and another MMR shot at the ages of 4 and 6, with their kindergarten booster shots. For full immunity, both of these shots are required. 

Dr. Sandy Arnold a Le Bonheur Infectious Disease physician, says, “What usually happens is you get an imported case of measles either from a visitor or an American returning from another country. Eventually, it’s stopped because most of the parents living in this modern time of medicine do choose to vaccinate their children against the disease.”

Arnold added, “It’s never too late to vaccinate your child if you haven’t done so. Everyone who is not immune from previous infection (those born after 1957) should receive two vaccinations, at least one month apart.”

If you fear your child could have been exposed to the disease, consult your physician right away. Administering the vaccine within 72 hours of exposure could prevent illness. It is important to note that individuals with the measles are contagious one to two days before showing symptoms.”

She says these outbreaks are proof of why it is so incredibly important to vaccinate. “It saddens me that fears about this vaccine live on despite epidemiologic research from around the world that shows no link between MMR vaccine and autism. My hope is that parents will educate themselves, with help of their physicians, and will choose to protect their children from this and other vaccine-preventable diseases.”

For more information on vaccines and vaccine safety, please go to:
www.cdc.gov/vaccines.

In the Wednesday, November 3 edition of Memphis’ Commercial Appeal, Dr. Keith English, Infectious Disease Chief at Le Bonheur Children’s Hospital encouraged parents and healthcare workers to receive their flu vaccine. In the Guest Editorial piece written by English, he stresses the critical influence people can have against another dangerous flu outbreak by getting vaccinated.  Read his guest column by clicking here.

Reports of pertussis cases, also known as whooping cough, are increasing, along with recent deaths in infants from the disease. Le Bonheur Infectious Disease Chief Dr. Keith English provides information for parents who have questions and concerns regarding whooping cough. Here’s what he has to say.

Pertussis (or whooping cough) is a serious, potentially life-threatening infection that is particularly dangerous in young infants.  The best way to protect your children from pertussis is to make sure that they and everyone who lives in the home with them is immunized against it.

When does my child receive the vaccine?
The primary immunization series for children includes the DTaP infant vaccine.  The first three doses of DTaP are given at 2, 4 and 6 months of age, and then boosters are later given at 15-18 months of age and at 4-6 years of age.

When will the vaccine take effect in my child?
As with many other childhood immunizations, the pertussis vaccine provides greater protection after the second and third doses.

Should pregnant women and/or caregivers and close contacts be vaccinated?
Protection of the most vulnerable infants (those younger than 2 months of age who are not yet immunized and those 2-4 months of age who have only received one dose of pertussis vaccine) can ONLY be accomplished by also vaccinating close contacts of these young infants. This includes a first dose of the Tdap vaccine (this form is indicated for adolescents and adults) for teenagers and a booster dose of Tdap every 10 years for adults.  
It is particularly important for mothers of young infants to be immunized; ideally, pregnant women should receive Tdap before pregnancy.  Otherwise, it is strongly recommended that Tdap be given shortly after delivery, before leaving the hospital or birthing center.  In situations such as a community-wide outbreak of pertussis, the mother's physician should consider administering Tdap during pregnancy.

How is pertussis spread?
Pertussis is spread by exposure to droplets in close proximity (usually within three feet) to a patient with pertussis who is coughing or sneezing.  One problem is that pertussis may be quite mild in teenagers or adults, who may spread the bacteria to a young infant who has an increased risk of severe disease.

As with other respiratory illnesses, good hand hygiene and avoiding contact with other children or adults with acute respiratory illnesses can also help limit the spread of pertussis.

For more information, see http://www.cdc.gov/pertussis/outbreaks-faqs.html

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.

Research was released today indicating that instances of pertussis, or whooping cough are rising. We talked to Dr. Sandy Arnold, infectious disease physician at Le Bonheur Children’s Hospital and the University of Tennessee Health Science Center. Dr. Arnold’s input is below.

Pertussis, or whooping cough, is a bacterial infection characterized by a prolonged cough that can be severe, especially in very young children.  It is called whooping cough because infected people can have spells of cough during which it is difficult to breath, thus making an unusual sound called a whoop.  

Pertussis has three stages. The first stage lasts about seven - 10 days and is indistinguishable from the common cold. The next stage usually lasts several weeks and is the period where the most severe episodes of cough occur. Finally, the patient will enter a healing phase of the infection; this, too, can last several weeks.  Many serious complications can result from pertussis, particularly in young infants, including pneumonia, seizures and rib fractures.

The best way to prevent pertussis is to have your child vaccinated against the infection. In 2005, two new vaccines known as DTaP and Tdap were licensed. DTaP is for children younger than 7 years and has a higher concentration of pertussis than Tdap, which is intended for persons 10 years and older. The DTaP and Tdap vaccines are given as a shot in the muscle.

The usual schedule for infants is a series of four doses given at two, four, six and 15-18 months of age. A fifth dose, or booster, is recommended at 4-6 years of age, unless the fourth dose was given late (after the fourth birthday). All adolescents and adults younger than age 65 years should receive a one-time dose of Tdap.

In an article published in October 2009, the Associated Press discusses the possibility that new research may suggest giving babies Tylenol to prevent fever when they get childhood vaccinations may backfire and make the shots a little less effective. We asked Dr. Keith English, Chief of Infectious Disease at Le Bonheur Children’s in Memphis and the University of Tennessee Medical Group to explain.

“When a routine dosage of Tylenol is given to infants before vaccinations are administered, the research does show that there is a very small chance it may make the vaccine a little less effective. In saying 'routine dosage', that is when a health care worker would automatically give a dosage of Tylenol right before or after administering the shot.” However, he stressed the importance of recognizing that the study only looked at this type of preventive use of Tylenol – not whether it is OK to use after the vaccines are administered for the relief of mild symptoms.

“The Centers for Disease Control hasn’t published any research that would indicate giving a child Tylenol for the relief of a sore arm or a fever after vaccines presents a problem. The study only suggests against routinely giving Tylenol, and that is based on a very small percentage of instances.”

“As always, parents should talk to their pediatrician and remember to let their instincts guide them. If your child seems uncomfortable a few hours after he or she has received immunizations, there seems to be no adverse effect on the vaccine by giving them a dose of Tylenol to relieve the symptoms.”