Flu Season
Dr. Mark Weissman
Chief of Pediatrics, Children's National Medical Center
Friday, December 12, 2003; 2:00 p.m ET
Reports of flu outbreak are increasing among 24 states, including Virginia and the District, according to federal health officials. Health officials are predicting that this could be one of the worst flu seasons in years, particularly dangerous for children. At least nine children have died of influenza in Colorado and vaccines are in short supply.
Dr. Mark Weissman, chief of Pediatrics at Children's National Medical
Center, was online Friday, Dec. 12 at 2 p.m. ET to discuss the flu, shortages of the vaccine and the vulnerability of children to influenza.
The transcript follows.
Editor's Note: washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Rockville, Md.:
What is the difference between a cold and the flu?
Dr. Mark Weissman: Winter is cold & flu season. Both are virus infections. Most colds produce a runny nose, cough and occasional fever.
Influenza is also a virus- but one that usually produces more severe illness symptoms. People with the flu usually develop higher fevers (up to 104), headache, sorethroat, cough and often body & muscle aches. These symptoms can continue for several days (much longer than typical cold symptoms).
For most people, both virus colds and the flu run their course and improve on their own. However, sometimes the flu can produce more severe illness, secondary complications, or make pre-existing medical conditions worse.
_______________________
Bethesda, Md.:
There's been some question about the effectiveness of the vaccine to one of the strains of virus in the current flu season. Is there any new information about this?
Dr. Mark Weissman: Every year the flu vaccine is developed based on flu virus strains circulating in the previous 6-12 months. It takes 6 months to produce the supply for the anticipated flu season. Sometimes during this interval- the flu virus "drifts" or mutates slightly. This year's Fujian strain is such a case. According to the CDC, this year's vaccine is close enough to offer some protection against this year's virus. While it may not keep you from getting the flu- it should lessen the severity of illness.
_______________________
Faifax, Va.:
Dr. Weissman, could you please provide a short "what to look for" in ones child to determine if they are simply fighting a cold or this nasty flu strain?
I have a 10month old. Say he's cranky, sleepless and has a fever, I'd give baby-tylenol and re-check the fever after 6hrs or so, at what point should I take him to the Dr's? 24hrs later if fever still high?
Thanks for your time!
Dr. Mark Weissman: While the flu can be a serious illness, most children don't get seriously ill. Certainly, several days of fever and feeling sick is no fun- but most children get better with home treatment. We recommend encouraging fluid intake and treating fever & discomfort with age-appropriate does of fever medications like acetominophen ("Tylenol") or ibuprofen.
A few children get more ill. If your child seems very weak, poorly responsive or very irritable, has labored or trouble breathing, is not taking fluids well and looks dehydrated- he should be seen promptly. A few children develop fevers and worsening cough after apparent improvement- they, too , should be seen promptly.
_______________________
Fairfax, Va.:
How dangerous is the flu to children with asthma? Is it OK to mix cold medicines with asthma medicines (like albuterol?)
Dr. Mark Weissman: The flu can aggravate special health problems in kids or adults- including asthma. It's important to be following your child's asthma management plan- particularly if she or he is taking daily controller medications to prevent asthma symptoms. Most cough & cold medicines treat symptoms- but don't really make the flu go away. I'd use them as needed- but remember that they may not be all that effective. It is safe & appropriate to take medicines to reduce fever or achiness.
_______________________
Rockville, Md.:
What can you say about the reported deaths of children from the flu so far? Have these all been children with special risk factors,or have they been children who were otherwise healthy?
Dr. Mark Weissman: While certainly tragic & upsetting for parents & pediatricians- this is still, thankfully, a rare- albeit widely publicized- event. Many of the flu deaths occur in children & adults with at-risk health conditions. A few have occured in apparently well-children-- sadly, they seem to have developed just more severe illness. Younger children- under 2 years- seem to be a bit more likely to develop severe illness. That's why the CDC has begun recommending flu shots for well children in this age group.
_______________________
Fairfax, Va.:
I have a seven-year-old daughter. When I received my flu vaccination at work in November, I was told that vaccinations are not recommneded for children under 10, so I did not get my daughter vaccinated. Now I'm seeing in media reports that children under 10 are being vaccinated. What is the correct course of action here?
Dr. Mark Weissman: Demand for flu vaccine has far out-stripped national & local supplies. At this time- the few remaining doses are being targeted for children & adults who have special risk factors: chronic heart or lung problems, like asthma; metabolic conditions like diabetes, chronic kidney conditions, immunosuppression, or children taking chronic aspirin therapy (Reye's syndrome risk). Also, healthy kids between 6 -23 months where supply permits.
The best approach for healthy children is as follows:
1.) stay calm- severe flu illness is rare.
2.) basic hygiene- handwashing, covered nose/mouth with sneeze & cough to reduce spread
3.) avoid unnecessary exposure to large crowds who might be sick- particularly younger children or kids with at-risk concerns
4.) stay home if you have the flu
Special anti-viral medications can be prescribed for children who are unusually sick with flu or who have at-risk conditions. These medications have side effects, shorten the illness by a day or so and should be used on a limited basis.
_______________________
North Potomac, Md.:
My 1-year old son received a flue shot in mid-November. Young children receiving their first flue vaccination are supposed to receive two flu shots one month apart. He is supposed to receive a second shot later this month. If no vaccine is available, will the single shot in November produce enough immunity to give him some protection?
Dr. Mark Weissman: For children under 8 years who've never received a flu shot before- a 2nd booster shot is recommended a month later to achieve full protection. The high demand for vaccine has exhausted thesupply and many of these children may not get their 2nd dose. There's limited data to predict the significance here. Certainly, these children will have some protection to reduce flu illness.
Healthy children over 5 years could use FluMist for their 2nd dose.
_______________________
Alexandria, Va.:
Thank you for taking my question: How safe is the flu mist for young children (ages 5 and 7)? Is it a good alternative for children who did not get the flu shot this season?
Dr. Mark Weissman: FluMIst is a new vaccine. Unlike the shot which contains inactive virus- FluMist is a weakened (attenuated) live flu virus vaccine that's squirted into the nose passage.
It's only recommended for healthy children & adults between 5-49 years.
It has not been approved yet for younger children.It is also not recommended for children over 5 years with asthma/reactive airway disease or for individuals who are pregnant or immunosuppressed or who might come in contact with such individuals.
It may be an ok alternative for healthy kids/families who want to reduce their possibility of getting severe flu illness.
_______________________
Alexandria, VA:
I have a four month old daughter. The pediatrician said that she is too young to receive the immunization. Is she not high risk? Is a nursing baby protected by the mother's antibodies?
Dr. Mark Weissman: Flu shots are only recommended for 6 months and older.
Nursing may offer some of mom's transferred immunity- as might avoiding unnecessary exposure.
_______________________
Annandale, Va.:
How does infection with the virus causing influenza lead to death? Is the fatal progression avoidable?
MM
Dr. Mark Weissman: Most flu illness does not progress to dangerous illness. Deaths have been attributed to severe respiratory irritation, brain irritation or encephalitis or aggravating of at-risk health conditions.
The best approach is recognizing severe illness early and seeking immediate medical treatment.
Mild illness is best treated at home- not waiting in a doctor's office or emergency room filled with sick individuals.
_______________________
Frederick, Md.:
I have a 2 1/2 year old boy who has had colds move into asthma and then pneumonia in Apr & Sep of this year. (He was hospitalized the 1st time for 4 days.) He had a pneumonia shot a month or so ago and a flu shot a week ago. (Both parents have had their flu shots - one has asthma and one has chronic sinusitus.) He seems to get every cold in preschool, but is otherwise in good health. After 2nd bout w/ pneumonia, he is on a daily nebulizer treatment for prevention/control of asthma. Fortunately, he drinks lots liquids even when he is sick, so we haven't ever been worried about dehydration when he's sick.
How long does it take for the flu shot to offer some vs. maximum protection?
How long does it take for the pneumonia shot to offer some vs. maximum protection?
It's pretty scary hearing about little children dying of the flu. What are the early symptoms should we watch for?
Dr. Mark Weissman: It may take up to 2 weeks for immunity from the flu & pneomococcal shot to take effect. In the meantime, follow your asthma management plan and avoid unnecessary exposure to sick individuals.
_______________________
Manassas, Va.:
What are the antiviral medications available that can prevent and treat the flu, and where are they available? Are there any age restrictions, i.e. children under 5?
Dr. Mark Weissman: Regular antibiotics won't treat the flu- although sometimes they are used for secondary illnesses, like pneumonia or ear infections.
There are special medicines that can be given to reduce the severity of flu illness or shorten the course by a day. They are: amantadine, rimantadine, zanamivir, & oseltamivir. Some can be used in as young as 1 year olds. There are side effects (agitation, nausea, vomiting). Their use is limited to children who are especially sick or especially at-risk. For most children, home treatment with fluids and fever medicines and TLC is all that's needed to get better from the flu.
_______________________
Dr. Mark Weissman: Thanks for so many great questions- we don't have time to answer them all. I hope we've covered most of the basics in our responses.
Additional information can be obtained at: CDC (www.cdc.gov)& the American Academy of Pediatrics (www.aap.org).
_______________________
Automatically Update Page
Get New Responses
Submit Question
| 
