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The ABC of influenza and the flu for 20162017

season
A detailed review of signs symptoms treatment and prevention of
influenza virus infection
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ThoughweareoneofthemanyPediatricPrimaryCareclinicsinRoswell,Georgia,wearegoingtotellyouallyouneedtoknowabout
influenza.Thisisbecauseofhowimportantthisconditionisandhowmuchworktimeandschooltimeislosttotheepidemicevery
year.Influenzaactuallyconsumesusinthefallespeciallyifwehaveabadvaccineyear.
InfluenzaremainsacommonacutechildhoodillnessintheUnitedStatesandthemainreasonisbecauseitisacontagiousviral
illness,isspreadbycontactanddroplet.Therearetwospeciesofinfluenza,InfluenzaA,andInfluenzaBhoweverforourpurposesand
forthemostpartbotareoftenmanagedthesameway.
EveryyearscientiststypethestrainsofinfluenzacirculatingandyouwillhearstrainsdescribedasA/H1N1,A/H3N2,B.Thesearethe
mainonesthatcausemostepidemicshoweverwithantigenicdrift,humansarerarelyabletobuildenoughimmunitybeforethestrain
changesslightlyandonceagaininfectsus.
Childrenaremostaffectedbecauseoftheirimmunologicalimmaturity.Theirimmunesystemisrelativelyinexperiencedwithinfluenza
virusesthustheyareunabletoneutralizethevirusintime.
Howdoesfluspread?
Itinfectstheentireairwayfromthenosethroughthethroatallthewaydowntothelungs.Thesearehightrafficwindtunnelsandas
suchtheinfectedpersonisabletoshootviruscarryingdropletsfarawayfromthem,infectingothersthatinhalethedroplets.
Therecouldalsobespreadwhenthesedropletsgetintoourmouthwhenwetouchasurfacethathastheinfectionandthentouchour
mouth,eyesornose.
Whataretheusualsymptomsandsignsofinfluenza
Intheolderchildrenandadults,onsetisrathersudden.Achesandpainsinthemusclesandbonesisanearlyheraldofinfection.This
isusuallyaccompaniedbysevereheadaches,fever,andchills.Affectedpersonsoftenfeelverytired.
Therearetheothersymptomswhichwemayseeinotherviralrespiratoryillnesssuchasacough,sorethroat,andrunnynose,butthe
mostintensesymptomsusuallyovershadowandkeepthepatientverysick.
Ihaveseenasmallnumberofchildrendevelopvomiting,tummypain,andwaterystoolsbutthisisnotseeninadults.
Intheveryyoung,under2yearsold,theymaygetverysickveryfastandmaylookliketheyhavealifethreateningbacterialinfection
calledsepsis.

Visit the influenza section to read about influenza on the

Omega Pediatrics blog
Whataretheunusualsymptomsandsignsofinfluenza
Theseclinicalsignsandsymptomsmaybeseensometimesininfluenza.
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1. Croup:aconditionwherethepatienthasswellingoftheinnerlining/surfaceofthe
throat,causingacertainhoarsenessofthevoicequality.Thiswilloftenleadtoa

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Theseclinicalsignsandsymptomsmaybeseensometimesininfluenza.
1. Croup:aconditionwherethepatienthasswellingoftheinnerlining/surfaceofthe
throat,causingacertainhoarsenessofthevoicequality.Thiswilloftenleadtoa
barkinglikesoundiftheindividualcoughs.ItismorecommoninInfluenzaA.
2. Asthmaexacerbation(increasedsymptoms):Inknownasthmatics,theymay
developanincreasedneedfortheuseoftheirinhalerorotherasthmamedications
beyondwhatwouldnormallyworkforthem.
3. Myositis:Muscleachesespeciallywiththecalfmuscles.
4. Myocarditis:Inflammationoftheheartmuscles.Doctorssuspectthisiftheperson
hasunusualphysicalexaminationfindingsinthecardiovascularsystem.Itisnot
commonbutcanhappen.
5. Parotitis:Inflammationandpainoftheparotidgland.Theparotidglandliesonbothsidesoftheface,kindofoverthemusclearea
thatweseemovingwhenwechew.Itmayswellandbewarmandthedoctorscanusuallytellthatsomethingisamiss.
6. Encephalopathy:asomewhatabnormalfunctioningofthebrainduetometabolicfactorswhichmayhavebeentriggeredbyan
infectiousagentwithinoroutsidethebrain.
7. Transientskinrash:theseareflatwithafewraisedareas(maculopapularrash).Maybemissedindarkskinnedindividualsbut
looksredderinlighterpersons.
Whendothesymptomsofinfluenzastart?
Thesymptomscanstartbetweenoneand4daysafterthepersonhascomeincontactwiththeviralagent.Theaverageistwodays.
Howlongdothesymptomsofinfluenzalast?
Theacutesymptomslast2to5days,butacoughandtiredness(fatigue)canlastseveralweeks.
Whenisthepersoninfectedwithinfluenzacontagious?
This is really bizzare and I want you parents to pay attention here. A healthy person may start spreading influenza up to 1
day before they themselves develop symptoms.
Yes,youcannotgivewhatyoudonothave,butyoucangivewhatyoudonotknowthatyouhave!
Peopletendtospreadthevirusupto5to7daysafteronsetofsymptoms.
Whatarethecomplicationsofinfluenza?
According to the CDC Young children, adults aged 65 years and older, pregnant women, and people with certain chronic
medical conditions are among those groups of people who are at high risk of serious flu complications, possibly requiring
hospitalization and sometimes resulting in death. For example, people with chronic lung disease are at higher risk of
developing severe pneumonia.
Othercomplicationsthataremorecommonincludeearinfectionsandsinusinfections.
Howdothedoctorsdiagnoseflu?
Influenzaischallengingtodiagnosewithoutlaboratorytestingbecausetherearemanyotherillnessesthathavesimilarsymptoms.This
ismoresoinchildren.
AsIhaveoutlinedabove,therearesomanysymptomssothedoctorscarryoutlaboratoryteststodiagnoseflu.Thesetestsvaryin
theirnatureaswellastheiraccuracy.Thusapersonmayhavetheflubutthetestswillcomebacknegative.
TherapidinfluenzadetectiontestsRIDTssometimeshavefalsenegative,soanegativetestisnotsinequanonefactthatthereisno
influenzainfectionpresent.Manydoctorsuseacombinationofclinicaljudgmentbasedonthesymptomsandsignselicited,thehistory
(surroundingstory)andthetestresultstomakeadecisionondiagnosis.

Wedonothavethischallengeifthetestcomesbackpositive.

Inthetesting,thenurseordoctorwouldstickaswabintothethroatordeepinthenasopharynx.Itisveryveryuncomfortable.Nonot
painful,justplainicky.

Therapidtesttakesabout30minuteswhilethespecimenmayalsobesentofftothelaboratoryandcomesbackafterabout2daysa
PCRisdone.Insomecenters,theywoulddotheculturewhichisgrowingtheorganisminthelab.Insuchcases,itmaytakeanywhere
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from3to7daysbeforeyougetaresult.

Therapidtesttakesabout30minuteswhilethespecimenmayalsobesentofftothelaboratoryandcomesbackafterabout2daysa
PCRisdone.Insomecenters,theywoulddotheculturewhichisgrowingtheorganisminthelab.Insuchcases,itmaytakeanywhere
from3to7daysbeforeyougetaresult.
Howisinfluenzatreated?
Okay,youhavebeendiagnosedwithinfluenzaandyouarehappy.Timefortreatment?
Erhm.Itisstillcomplicated(noyoudonothaveacomplication,itisjustcomplicated).
Therearetwogroups:astheCDCsayshere,
Antiviraltreatmentisrecommendedassoonaspossibleforpatientswithconfirmedorsuspectedinfluenzawhohaveasevere,
complicated,orprogressiveillnessorwhorequirehospitalization.
Antiviraltreatmentisrecommendedassoonaspossibleforoutpatientswithconfirmedorsuspectedinfluenzawhoareathigher
riskforinfluenzacomplicationsonthebasisoftheirageorunderlyingmedicalconditionsclinicaljudgmentshouldbean
importantcomponentofoutpatienttreatmentdecisions.
Themedicationsknowntobeeffectiveinmorethan99%ofcasesaccordingtotheCDCareoseltamivir(Tamiflu)andzanamivir
(Relenza).AmantadineandRimantadinearenolongerrecommendedbecauseofresistanceandalsobecausethefirsttwo
medicationsaboveareeffectiveupto99%ofthetime.
Howdowepreventinfluenzainfection?
Wow.Iamgladyouasked.Iwilltellyou.Itisveryeasy.HereatOmegaPediatricswedoengageinPreventivePediatrics(whenweare
notbattlingacuteillness).
Goandgettheflushot.
Firstoff,everybodygetsashot.Thereasonisthatthenasalspraywhichsomepeoplelikehasbeenfoundnottobeeffectiveenough
recentlytokeepongivingit.TheCDCAdvisoryCommitteeonImmunizationPracticesmadethatdeterminationandpublishedthe
guidancethispastJune2016.
TheyfoundthatthenasalsprayLiveattenuatedinfluenzavaccineLAIVwas3%effectivecomparedtotheshotinactivatedinfluenza
vaccineIIVwhichwasupto63%effective.
YoumaybewonderingwhyIsaideverybodygetsashot.Well,ifyoudonotgetashotthisseason,youareapotentialrisktoyour
community.Youcouldgettheinfluenzavirus,spreadittoachildwhoisunder6monthstherebyputtingthechildinmortaldanger.
WhatweexpectbasedonCDCplansfortheinfluenzashotsthisyearcanbeseenhere.
CDCInfluenza(Flu)|WeeklyReport:InfluenzaActivityInteractiveMap
What is the appropriate dosing age for young children? (copied from www.cdc.gov)

[I expect this to be the same for 20162017]

I: The following children will require 2 doses of influenza vaccine, administered at least 4 weeks apart, for 201516:

1. Children aged 6 months to 8 years who have never been vaccinated against influenza or for whom vaccination history is
unknown;

2. Children who have not received at least two doses of seasonal influenza vaccine (trivalent or quadrivalent) before July 1,
2015.

II: The following children will require only one dose of influenza vaccine for 201516:

1. Children 6 months through 8 years who have received at least two doses of seasonal influenza vaccine (trivalent or
quadrivalent) before July 1, 2015.

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1. Children 6 months through 8 years who have received at least two doses of seasonal influenza vaccine (trivalent or
quadrivalent) before July 1, 2015.

2. Children 9 years of age and older.

For inactivated (injectable) vaccine (IIV), the dose for children aged 635 months is 0.25 mL and the dose for children aged
36 months-9 years is 0.5 mL.
VisittheinfluenzasectiontoreadaboutinfluenzaontheOmegaPediatricsblog.

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