Health Education

Influenza (Flu)

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What is the flu?

The flu is an infection caused by a respiratory virus called influenza that affects primarily the upper respiratory tract (nose, mouth, sinuses) but can often migrate to the lower respiratory tract (lungs). 

What are the symptoms of the flu?

  • Congestion, runny nose and cough
  • Sore throat
  • Headache
  • Fever, often as high as 104-5 degrees Fahrenheit
  • Body aches and muscle soreness
  • Vomiting and diarrhea
  • Fatigue
  • How is the flu spread?

The flu is spread primarily by respiratory droplets that have been carried from an infected person to an uninfected one when coughing, sneezing or talking.  Less often, it can be spread from touching a surface on which those respiratory droplets have been deposited (cell phones are a common culprit) and then touching the nose, mouth or eyes.

What is the period of contagiousness?

Adults are contagious from 1 day before symptoms until 5-7 days after symptoms.  Children can be contagious for a few days longer.  The greatest period of contagiousness is when a child is most symptomatic.

What are the complications of the flu?  

Most of the time, the flu passes with a lot of misery but without many complications.  Known complications in children include ear infections, pneumonias, sinus infections and dehydration.  Typically, the flu symptoms abate after 5-7 days.  If your child appears to be getting better and then takes a turn for the worse, that is usually a sign that one of the above complications is occurring and should prompt a phone call.

How serious is the flu?

The flu is the most common cause of vaccine preventable death in the world.  While most children with the flu recover uneventfully, each year about 250 children, some previously healthy, die of the flu and that is why we take it very seriously.  The seriousness is dependent on which viruses are circulating and how effective the vaccine is in preventing the disease.    

What is the treatment for the flu?

In most cases, the physicians and nurse practitioners at Senders Pediatrics do not treat the flu with anything other than supportive therapy.  Humidity and honey form the mainstay of treatment for the flu and other similar viral illnesses.  Using a humidifier will lubricate irritated breathing passages and make it more comfortable to breathe through clogged noses.  While saline nose drops and sprays are often suggested as variants on the humidity theme, it is not one of our favorite recommendations because the bulb syringe often used to remove the moisturized secretions (snot) often induces more trauma than it helps.  Honey (none under 1 year, ½ tsp 3X/day from 1-4 years and 1 tsp 3X/day from 5 years and up) has both medicinal properties (works better than corn syrup or agave) and increases lubricant secretions. 

There have been many other therapies for the flu that have been studied over the years:

  • Tamiflu – This is an oral medication that has been shown to reduce the symptoms of the flu by 24 hours. Unfortunately, the side effects seen in up to 1/3 of children include achiness and nausea and vomiting.  Because of the side effects and the very real possibility that excessive usage will cause resistance and prevent its usage in hospitals and ICUs where the disease is more critical, our policy at Senders Pediatrics is to only use Tamiflu for patients with severe disease (about to be hospitalized) and those at risk for severe disease (children under 6 months, former premature children and children with significant heart and respiratory problems).  In a recent extensive analysis of the effectiveness of Tamiflu, it was not shown to reduce hospitalization or development of pneumonia in older children. 
  • Antibiotics – Are not helpful for the flu. Antibiotics kill germs that have cell walls and viruses do not have a cell wall.  However, since the flu generally gets better over the course of 5-7 days, if your child has had flu like symptoms that improved initially and then worsened over a week, it is worth coming in to see us.  It is possible that the flu virus has caused the sinus draining tracts to have become plugged, allowing bacteria, which do have cell walls, to accumulate in the ears and sinuses and cause an ear or sinus infection.   Ear and sinus infections can be treated with antibiotics, the flu cannot.
  • ·        Menthol rubs – Vicks VaporRub and its imitators have been used for generations. Menthol actually cools nasal passages and makes stuffy noses feel less congested.  It is safe at all ages and works well for infants under a year when placed on the onesie at night.  Vicks on the soles of the feet does not appear to be helpful.  (see Snopes.com)
  • Zinc – There is mixed evidence about the efficacy of zinc. The dose used in those studies that showed benefit was 13 mg taken 4 times a day for a total daily dose of 50-60 mg.  The risk of taking zinc pills by mouth is small but any benefit that has been found occurs only if zinc pills are taken within 24 hours of the onset of the symptoms.  Taking nasal zinc has been associated with permanent damage to nasal passages and should be avoided.
  • Chicken soup – May be beneficial in two ways. It promotes white blood cell attraction to the nasal passageways to help fight the infection and it increases the movement of mucus which may help with the congestion.  One study looked at 13 different recipes and found that all provided the same effect so feel free to use your mother’s favorite recipe.
  • Echinacea – The problem with most of the studies is that they have not looked at a standardized dose. In a meta-analysis which combines all studies together for better analysis, there was evidence of improvement when using the standard dose of 2000-3000 mg of crude extract, 6-9 ml of pressed juice or 0.75-1.5 ml of tincture.  Echinacea is a member of the ragweed family and so children with ragweed allergies should be especially careful with its use.
  • Goldenseal– There have been no studies that have shown benefit in using these substances although the side effects are minimal. The NIH does not consider this a beneficial product in the treatment of the flu.
  • Garlic – There are no studies that have shown benefit in using smelly garlic or garlic with the smelly component, alicin, removed. However, garlic when taken in doses recommended by proponents, can impact on estrogens and reduce the efficacy of oral birth control pills.
  • Siberian Ginseng – When used with the herb, andrographis, there are some adult studies that have shown better efficacy than anti-viral medications when taken within 72 hours of onset of symptoms. This is not a safe product for use in children and adolescents since it can have blood clotting and sugar lowering effects.

What can be done to prevent getting the flu?

The most important message is to get your child vaccinated!  250 kids a year die of garden variety influenza every year and many are perfectly healthy children without underlying problems.  Kids with asthma, wheezing, cardiac problems or sickle cell disease are at highest risk. 

Each winter, the CDC chooses the flu vaccine components to be used the following fall/winter.  Because all flu vaccine is currently produced in eggs and it takes 6 months to grow the vaccine in egg culture, there is a great amount of guesswork in choosing the new flu vaccine.  Thanks to many patients from Senders Pediatrics who participated in recent clinical trials, the vaccine now includes 2 strains of influenza A and 2 from influenza B.  By including multiple strains, the CDC is hoping to protect a larger number of patients.  But the flu, unlike many other viruses, often mutates slightly from the time it is included in the vaccine to the time the season begins, rendering the protection from the flu vaccine less perfect.  The 2014-15 season appears to be such a season.  Flu vaccine can be up to 90% protective.  The 2014-15 season appears to have only 50-60% protection but that is still better than zero.

There are 2 formulations of flu vaccine.  Injected flu vaccine (the shot) is a killed virus vaccine whose advantage is that it is easy to administer and is tried and true.  It often gives more achiness as a side effect but cannot possibly transmit the flu.  It is also the only vaccine approved from 6 months to 2 years.  Flumist (the mist) is a live but changed vaccine.  Similar to MMR and chicken pox vaccines, it has been changed so that it cannot transmit disease.  It is given as a squirt in each nostril, tends to cause less achiness but cannot be given under age 2 and to any patient with a history of asthma or wheezing in the past 2 years.    

The other best defense is with diligent hand washing and the use of antiseptic gels.  Both work equally well and you may have noticed that many of us at Senders Pediatrics, have switched entirely from hand washing to the use of gels.  Here are a few more tips to keep you and your family healthy this winter:

  • Stay rested – Getting 8 hours of sleep makes you 3x less likely to catch a bug. (Sleep is valuable for other reasons including making you less likely to sustain a serious injury and helping preserve long term memory.) A Finnish study showed that adults who were awakened after a few hours of sleep produced fewer protective antibodies against illness.
  • Use probiotics – A recent Rutgers University trial found that adults taking probiotics recovered two days sooner from a cold while a study in Chinese children found a 30% reduction in the actual number of colds. We have long recommended these so-called, “good germs” when your child is taking an antibiotic as they help repopulate the GI tract, the ear canal, the vagina and other vital areas with healthy germs that keep the bad bugs at bay.  Our recommendation under a year is Culturelle packets which can be added to water (for breastfeeding babies) and to formula (for non-breastfeeding babies) daily throughout the winter.  Over a year, try Ultimate Flora 15 billion (the adult dose).  One capsule appears to be very protective when taken daily.  There appears to be little evidence that taking yogurt with probiotics (Activia and others) is helpful unless taken daily.
  • Try meditation – Adults who practiced mindfulness (popularized by many including Mindsight, by Daniel Siegel) which is a combination of relaxation and awareness of the world around you, reduced the incidence, intensity and recovery from colds and flu viruses by 40-50%.
  • Exercise – Another adult study found that those who had moderate exercise daily, had a 30% reduction in viral symptoms.
  • Sing – Two studies found that singing regularly reduced cortisol, the stress hormone and increased Immunoglobulin A, an infection fighting agent.
  • Get a life – Although there are many who believe that not shaking hands or hugging and kissing is the antidote to catching viral infections, a Carnegie Mellon study found that those with the most social networks (club memberships, work friendships or participation in a faith community) were less likely to develop illness compared to loners when exposed to experimental cold virus.