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A Pediatrician's Advice on Dealing with H1N1 "Swine" Influenza

by Dr. Douglas Barton, M.D., Pediatrician 10/13/2009



Ah, the influenza season is here with a vengeance. Wentzville schools are running 20-30% absence rates, and some St. Louis area schools have actually shut down due to illness. Almost every sick child I’m seeing in the office right now is there due to influenza. With so much going on, I thought I would pass on a couple of thoughts from a pediatrician, especially with the media producing fear and some inaccuracies.

The current flu that’s “going around” is almost all H1N1 “Swine” influenza, which is a type A influenza. We have also had a couple of children in our office test positive for seasonal influenza B. Symptoms have mostly been mild with many of my patients coming in with only mild fevers and cold symptoms. A few children have been quite ill with breathing trouble, severe muscle aches, headaches, or dehydration.

The current influenza test that most physicians have in the office tests primarily for seasonal influenza A and seasonal influenza B. The test is about 70% sensitive for H1N1 influenza. That means if I have 10 children in front of me that I KNOW have H1N1 (from some better test) only seven of them will test positive using our office test. IF they test positive for influenza A, the physician can only tell with certainty that they have EITHER seasonal influenza A or H1N1 influenza A. The office test can not distinguish between the two! Remember, a negative test does not mean that the patient does not have influenza. Three of 10 patients who actually have H1N1 will test negative. Also one in 10 patients who has seasonal influenza A will test negative. With this amount of uncertainty in our office test results, I have chosen, in most patients, to diagnose based on symptoms rather than relying on a test result that has a three in ten chance of being wrong.

Secondly, H1N1 “Swine” flu is influenza, no more, no less. There is a small amount of evidence that it is more dangerous than regular seasonal influenza, but the amount of increased danger is actually not that large. Every year, seasonal influenza kills between 30 and 70-thousand patients, most of whom are either very old or very young. It would appear that, the way things are going, H1N1’s death rate is going to be a little higher. That doesn’t mean we should take it lightly, but we also shouldn’t blow it out of proportion and let fear run our lives.

The biggest issue I am getting asked about is treatment. The CDC has made very clear that Tamiflu can be useful for some patients. The current recommendations are that certain high risk groups should receive Tamiflu at the start of illness. These are children under two years old and children who are at risk of severe disease (i.e., kids with underlying diseases like asthma, heart disease, diabetes, and, in particular, neurologic diseases like muscular dystrophy, cerebral palsy or degenerative diseases). I personally don’t cover adults, but the largest group of adults that should be treated is pregnant women. The other group that should be treated are flu patients who have developed significant complications. This includes anyone who has developed respiratory difficulty or dehydration. Generally, these are patients who are likely to be admitted to the hospital for their illness. For the rest of us, Tamiflu and Relenza have only been demonstrated to shorten the course of illness by about a half a day. Too much use of these medications will lead to resistance patterns that make it difficult to treat the flu in the future.

So for everyone who does not fall into a “high risk” category, treat influenza the way you would any cold. Tylenol and Motrin can help with fevers and body aches. Increasing your fluids (not caffeinated) will help with muscle aches and fatigue and congestion. Hot showers and vaporizers can help with congestion and muscle aches. A spoonful of honey can suppress coughing for a while. Your body needs plenty of rest. Finally, there’s something in grandma’s chicken noodle soup that can be very helpful.

Watch out for evidence of dehydration (lethargy, confusion, decreased urine output, and refusal to drink), or evidence of breathing difficulty (short of breath with exertion that normally would be easy or wheezing). These symptoms indicate a problem that should be addressed immediately. Don’t hesitate to call your pediatrician if you have any concerns.

 

 

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