Influenza (Flu) Dr. Shilpa Aroskar.

Influenza or Flu is one of the most common disease affecting children. Though a self-limited illness in most, it may at times cause serious complications in an infected child. Due to its ability to mutate and antigenic drift it is often called “chameleon” of all viruses and despite medical advances it still remains the “last great plague of man.”

Influenza viruses are divided into types-A,B, C and D. Type A and B are known to cause seasonal epidemics in humans. Two subtypes of type A- H1N1 & H3N2 and influenza B currently circulates worldwide.

The highly virulent H5N1 is a potential threat to humans.

FAQs

  1. Why are children more susceptible to Flu?
  2. Children are more prone to getting infected by the flu viruses as they have tendency to touch everything around them and put hands in the mouth. Also toddlers going to school, day care centers catch cross infections from other children, as kids don’t cover their nose and mouth while sneezing and coughing. Bottle fed babies are more prone for respiratory infections.
  • How to differentiate between seasonal Flu and Swine Flu?

What are the symptoms?
Seasonal flu child will have sore throat, runny nose, cough, mild fever and congestion. Fever is often biphasic, whichmeans fever for two days followed by no fever for a day or two and then again fever for next two days. It is usually a self-limited disease and improves by fifth to sixth day.

Swine flu will have all of these above mentioned symptoms along with excessive fatigue, lethargy, reduced activity in a small child, headache, muscle pain, high fever at times with chills, sometimes vomiting and diarrhea also. At times it may lead to Pneumonia or ARDS and child may have breathlessness and respiratory distress.

3) Which time of the year flu disease is more common?
In tropical country like ours usually influenza peaks during monsoon June   to Aug, unlike western countries where it peaks in winter months- Oct to Jan.However   because of the antigenic drift in the virus we have been seeing changing peak seasons in the past few years, which has baffled many health care researchers.

4) What investigations are needed to confirm swine flu?
It is practically not feasible to test all patients with flu like symptoms for swine flu.Besides in most of the children it is a mild self-limiting disease. On your doctor’s recommendation  these tests  can be done at government centers and govt. specified laboratories. The tests done  are RT-PCR tests on throat and nasal swabs

5) What is the treatment of flu- Seasonal flu and Swine flu?
A child who has flu should be confined at home and refrained from going to school. Treatment is symptomatic with rest and good hydration. Paracetamol for fever, mild decongestants, steam inhalation and gargles helps. Antibiotics are not required in viral flu disease unless there is secondary bacterial infection.

Children with clinical signs suggestive of swine flu or a positive swab test need to be treated with anti virals like oseltamivir. However the drug is most effective if started within 48 to 72 hours of the infection. Children with complications like ARDS or pneumonia may need hospitalization and supportive treatment IV fluids, oxygen/ ventilator support, Antibiotics.

PROHYLAXIS with anti-viral drugs is no longer recommended for household contacts.

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6)What food should I give to my child?
Children are bound to have loss of appetite during flu illness so force feeding should not be done. Semisolids like khichdi, porridge, warm soups which are soothing to the throat can be offered.  However it’s more important to keep good hydration and replenish fluids with ORS, fresh juices, soups and water. Parents should be informed to count the number of times the child passes urine atleast 3 to 4 times minimum in a day.

7) What are the other precautions to be taken?

No single action will provide protection but a combination of steps can prove to be effective-

  1. Wash hands frequently with soap and water or use an alcohol based rub.
  2. Cover mouth and nose with a tissue while coughing and sneezing
  3. Avoid touching your eyes,nose and mouth
  4. Children infected with flu should be refrained from going to school or day care but confined to home, avoid travel, keep away from other children for at least 24 hours after the fever subsides.
  5. Avoid close contact with persons- six feet distance with persons with influenza like illness
  6. During outbreaks of swine flu health care personnel should wear facemasks or N95 respirators.
  7. Flu Vaccines should be taken annually.

PREVENTION

8) Should I give flu vaccine to my child?
Yes. Indian Academy of Pediatrics recommends Flu Vaccines to children above six months of age. Also children with high-risk conditions like   chronic cardiac diseases, pulmonary (asthma excluded), diabetes mellitus, hematological and renal diseases must receive the vaccine.

9) What are the types of flu vaccine available and recommended for this season?
The flu vaccine available in India is trivalent injectable ones though quadrivalent will soon be launched. The dose recommended is two doses one month apart for children 6months to 9 years and after that one single dose to be administered intramuscularly once a year.

10) What is the best time to give flu vaccine to my child?
The best time to administer flu vaccine is just before the peak season starts in the particular community. So usually in tropical country like ours we see peak in monsoon so it can be given in April or if peak season in that community in winter then the vaccine can be given in September. It takes two weeks for the vaccine to be effective after administering.

11) How effective it is?Can my child still get flu after taking the vaccine?
Flu vaccines are most effective when the circulating viruses are well matched with the vaccine virus. However as per studies it still shows 79 to 86% efficacy which is good to prevent children from getting recurrent infections.

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