Healing Arts Center for Children

Common Illness
flu | RSV

INFLUENZA

You know the flu has arrived when the pediatrician’s office looks crazy busy and you are in the waiting room trying to make sure your little one does not have anything serious because his fever is so high and he or she looks like the saddest little poodle in town! The following may help inform about what you can do to help your little one.

Introduction:

For many people, cold and flu have become an inseparable pair, like salt and pepper or New Year's and gym memberships. Walking down the "cold and flu" aisle of any drugstore, you will find stacks of bright boxes with bold claims of help for those suffering from a cold or the flu. Since the two illnesses share some similar symptoms, and both come during "cold and flu season," the two often run together in people's minds. We have a vague idea that they are different, but if pressed, have a hard time saying exactly how. The cold is much more common. The flu is much more serious.

What is it?

A single family of viruses – the influenza viruses – causes the flu. Unlike with the common cold, both adults and children with the flu generally have a fever and feel sick all over. For the great majority of people, the illness is quite unpleasant but not dangerous.

However, the flu can be quite a serious illness. The most deadly recent worldwide outbreak was the flu epidemic at the beginning of the 20th century, which killed more than 20 million people.

Even today, more than 20,000 people in the United Sates die from the flu each year. This number is a small percentage of those who get the flu (much less than one percent). They are primarily those who are weak from advanced age or a major illness.

Still, about one percent of otherwise healthy children get sick enough from the flu to be hospitalized.

Who gets it?

Most people get the flu once every year or two or three – unless they are vaccinated. It can happen at any age, but is most common among school-aged children.

The flu is most common during the winter months.

What are the symptoms?

The flu can take many forms. Classically, the flu begins abruptly, with a fever in the 102 to 106 degree range, a flushed face, body aches, and marked lack of energy. Some people have other systemic symptoms such as dizziness or vomiting. The fever usually lasts for a day or two, but can last five days.

Somewhere between day 2 and day 4 of the illness, the "whole body" symptoms begin to subside, and respiratory symptoms begin to increase. The virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, and/or pneumonia.

The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore (red) throat and a headache. Nasal discharge and sneezing are not uncommon.

Is it contagious?

The flu is very contagious. It can be spread by airborne, droplet, or contact transmission and by fomites ( toys, furniture etc).

How long does it last?

Inhaling droplets from coughs or sneezes is the most common way to catch the flu. Symptoms appear 1 to 7 days later (usually 2 to 3 days). Symptoms (except the cough) usually disappear within 4 to 7 days. Sometimes there is a second wave of fever at this time. The cough and tiredness usually lasts for weeks after the rest of the illness is over.

The flu is airborne and quite contagious, and with its short incubation period, it often slams into a community all at once, creating a noticeable cluster of school and work absences. Within 2 or 3 weeks of its arrival, most of the classroom has had it.

How is it diagnosed?

The diagnosis is often based on the history and physical examination. Viral studies on nasal or throat swabs obtained during the first 72 hours of symptoms can verify the diagnosis if there is a question. Blood tests can make the diagnosis after the fact.

The initial symptoms of inhalational anthrax can be difficult to distinguish from the flu.

How is it treated?

Specific antiviral medications such as tamiflu are available for older children, and recommended for those with severe illness, those at high risk for complications, and children with social situations that would make treatment benefits outweigh the risks. If specific treatment is to be used, it should be started as early in the illness as possible for it to help. Alternative remedies such as Oscillococcinum have been found to be useful anecdotally, unfortunately these lack clinical studies.

Rest, fluids, and fever control are useful for most children . Other treatments are aimed at reducing specific symptoms.

Aspirin use in children with influenza increases the risk of Reye syndrome and should not be used. Tylenol or motrin may be used as needed to keep the fever down.

How can it be prevented?

People are most contagious beginning 24 hours before they develop symptoms (and up to 7 days afterwards), making it difficult to prevent the flu by avoiding sick individuals.

Influenza shots can be started one month prior to the official flu season. The Center for Disease Control typically will do a news bullitan in October every year about when your child should receive the flu shot. Please check our website or call the office to schedule your child's flu shot.

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RESPIRATORY SYVCYTIAL VIRUS (RSV)

RSV, or Respiratory Syncytial Virus, is the most important respiratory organism of early childhood. RSV occurs throughout the world, and in each location it tends to occur in yearly winter outbreaks. In the northern hemisphere the peak of the epidemic is usually in January, February, or March, although in some years it may begin earlier and/or end later. Each year almost 125,000 infants are hospitalized with RSV in the United States alone. Michigan is particularly bad for RSV infections because of its severe weather.

The virus lives and replicates inside the cells lining the respiratory system, causing swelling of this lining coupled with the production of large amounts of excess mucus. In adults, this shows up as a bad, lingering cold with thick nasal congestion and a deep, productive cough. In infants, especially premature infants who have tiny tiny airways to start with or infants with congenital heart disease, the excess mucus can be enough to plug their small airways or bronchioles, resulting in a severe illness that requires hospitalization.

Almost all children have had RSV by the time they are two years old. Children who first get it under 6 months of age (or who have serious underlying illnesses) are at the highest risk for severe disease. Severe RSV infection is very uncommon in the first 6 weeks of life, since these babies still have antibodies from their mothers.

The time period from exposure to illness is usually about 4 days. Typically a parent, or more likely an older sibling, comes down with a bad cold first. The disease spreads when infected droplets in the air or on the hands comes into contact with the baby's mouth or nose. (It has never been shown to be passed from someone standing as far as 6 feet away). Then, the infant develops a runny nose and a red throat. Over the next 3 days or so the infant gets sicker. Symptoms include cough, wheezing, and sometimes a fever or an ear infection. In most infants, this is as severe as RSV gets. Some, though, will get progressively sicker with fast respirations (>60 per minute), difficulty breathing, and listlessness. About 3% of infected infants get sick enough to require hospitalization. The disease usually lasts 5 to 12 days.

Prevention is very important. The best way to prevent RSV is good hand washing, particularly just before handling susceptible infants. Use a tissue when you cough or sneeze. If possible, avoid exposure to sick individuals during the peak of RSV season.

Although those who have been infected develop some antibodies to RSV, most individuals are susceptible again by the next annual outbreak. Subsequent infections, though, are usually both less common and much less severe. Only about 15% of children over the age of 2 will have a case of RSV in each epidemic.

Children who are sick enough to come to medical attention and be diagnosed with RSV have an increased chance of having recurrent wheezing later in life. This is even more likely if the child has eczema or if there is asthma in the family. The older a child is (over the age of 1) with severe RSV, the higher the likelihood that the child eventually will be diagnosed with asthma.

Latest Developments in the fight against RSV: Two products are now available to prevent RSV infection in children at high risk for serious disease. RSV-IGIV (RespiGam) and palivizumab (Synagis) have been approved for children younger than 24 months with chronic lung disease/bronchopulmonary dysplasia or a history of premature birth (< 35 weeks).

DETAILED RISK FACTORS FOR RSV AND AAP RECCOMENDATIONS FOR RSV PROPHYLAXIS.

Documented RSV Risk Factors School-age siblings

• Daycare attendance (CDC definition: ≥ 4 hrs/wk)
• Exposure to environmental air pollutants
• Severe neuromuscular disease
• Congenital abnormalities of the airways
• Low birth weight (<2500 g)
• Crowded living conditions
• Multiple birth

For further information you may link to the site below: http://www.synagis.org/hcp/rsv/rsv.aspx

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