Swine Flu in Children - Should you be worried?

Yesterday, as news broke out about increasing cases of Swine Flu in neighboring New York City, I sent my pediatrician, Dr. Jen Gruen of Village Pediatrics, an email asking if they have adequate supplies of Tamiflu. She responded that they had already posted information on their web site about the disease. (See my earlier post about why I love my new pediatrician!)

 

I decided to follow up with Dr. Jen to get more information for parents on when to worry and how to think about caring for our children if the disease spreads closer to home. I’m glad I did since she was full of current, useful information including possible risks of Tamiflu in children and how to stay abreast of current cases in your state. I’ve added helpful links at the bottom so that you can stay informed.

 

 

 

 

The news reports on Swine Flu are getting a little scary. Especially since they’re discovering more and more cases in New York City. What should parents be on the lookout for?

 

The primary symptoms are a high fever (102 degrees or higher), body aches, and a cough. These typically come on right away, so contact your doctor immediately.

 

What’s your standard practice for treating a child with these symptoms?

 

If  someone calls for an appointment and we determine on the phone that it might be the flu, we first tell them that they will be put into a room right away and won’t stay in the waiting area. We are also ordering more masks for the office to care for such patients.

 

If after an initial exam, we think they may have the flu, we’ll do a rapid flu test. We swab the nose and put it into a color change test similar to a home pregnancy test. If this is positive, we’ll get a viral swab from the back of the nose and throat and put it into a special culture to be sent to the Connecticut Dept of Health testing lab in Hartford. They will send it to the CDC and we should have results in 3-5 days.

 

Would you then give the child Tamiflu?

 

If a patient came in with suspected flu and if they then tested flu A positive AND was at risk for swine flu based on travel/exposure I would offer treatment while awaiting confirmation from the state. Because the rapid flu test is not perfect - if the test were negative but the child had a chronic medical condition like diabetes or asthma I would consider treatment while waiting for the culture.

There is another drug called Relenza but you must be five years and older and we have not used that previously in a child so I would use Tamiflu.

 

 

You also need to diagnose and give Tamiflu within 48 hours. And there is a rare risk that Tamiflu can have side effects in children. A few years ago, there were reports out of Japanof serious neurological complications – seizures and delusions - in children who took Tamiflu. It’s not clear whether it had been used more in Japanor there was a predisposition in the population to the side effects. Most pediatricians around here don’t automatically treat with Tamiflu. These side effects can also present due to the flu itself.

 

Finally, another reason for judicious use of Tamiflu is to prevent the development of resistance when we really need it.

 

How should parents weight the side effects of Tamiflu against the severity of their child’s Swine Flu?

 

Based on the current numbers in Mexico, it looks like more people with Swine Flu have had severe illness and death than regular flu. So I would probably treat a child with these symptoms with Tamiflu. If it were my kid, I’d probably give them Tamiflu.

 

I’ve read that the deaths in Mexico have been in young and healthy adults, not the children or the elderly. Is it wiser to skip the Tamiflu with its risks?

 

We don’t know if that’s just because there were more adults infected and so we didn’t see deaths in children because not as many came down with it.

 

Okay, so Tamiflu is the best bet. Should I go out and get some to make sure I have it in case my child’s infected? I don’t want to risk a shortage in the supply.

 

I have already checked with local pharmacies and they have Tamiflu in stock. The government has also released additional supplies.

 

We strongly discourage stockpiling of Tamiflu for a few reasons:

1. There isn’t enough for every person in the country so we need to keep the supply for people who actually get sick.
2. If you give it to your child when they first exhibit symptoms that could be just a cold, he or she might build resistance that would prevent it from working on the real disease. Overuse of the drug will encourage resistance.

 

 

What if one of my child’s classmates went to Mexico on spring break a few weeks ago? Should he be tested?

 

Swine Flu usually shows symptoms in 2-3 days from exposure. If the child isn’t sick and hasn’t come down with already, he doesn’t need to be tested. Chances are most people in this area are in the clear from travel during our spring break earlier in April.

 

Should I stay away from New York City for the time being?

 

I wouldn’t travel to Mexico but I also wouldn’t hesitate to go into the city today. It appears that the cases right now are limited to the school where children traveled to Mexico. Maybe you want to avoid crowded subways and walk instead. If you’re sitting next to somebody who’s hacking, move your seat. Carry a hand sanitizer and wash your hands.

 

How can we stay abreast of this problem?

 

I’ve received a ton of emails today already from the American Academy of Pediatrics (AAP), the CT Dept of health, and Norwalk Hospital. We’re on a listserv through the AAP and the minute this story broke there were tons of posts and sharing of information of what other pediatricians were getting out of the CDC and local health depts.

 

What the Government and CDC are doing well is heightening the alert and making sure all physicians are getting good information. If you can isolate, diagnose and treat each person you can limit the spread. And that’s what really works.

 

Helpful Links

 

You can check Dr. Gorman’s site, Village Pediatrics What’s New section for postings on Swine Flu.

 

The CT Dept Flu Watch site has very useful information and says it will keep a tally of local cases if they arise. Check your local state Dept of Health site for similar information. The Need to Know document is very helpful.

 

A current state by state tally of Swine Flu cases is available at the Centers for Disease Control site.