INFLUENZA by liaoqinmei


									THIS INFORMATION IS FOR EDUCATIONAL PURPOSES ONLY AND DOES NOT APPLY TO                                             This year’s influenza outbreak is by a virus with only small changes from the prior years
   ANY SPECIFIC PATIENT OR SITUATION. USE OF THIS WEBSITE OR MATERIALS                                              as evidenced by the relatively good protection the vaccine has afforded patients this year.
          DOES NOT ESTABLISH A PATIENT-PHYSICIAN RELATIONSHIP.                                                      Also, the mortality of this year’s strain is not significantly higher than in previous years.
Opinions and views expressed here are those of the author as of the time of the writing and may not reflect those
   of all of the physicians at Fremont County Pediatric & Allergy Clinic. As treatments change frequently in        What is “The Flu”?
          Medicine, we encourage you to see one of our Pediatricians in our office if you have concerns.            Generally speaking, it is a respiratory illness with cough, runny nose, headache, fever and
                                                                                                                    muscle aches. This year it seems to have a prominent sore throat and belly ache. These
                                                                                                                    last two symptoms have made it difficult for the doctor to separate out this illness from
                                                                                                                    other causes of belly pain and sore throat. In fact many of our patients at Fremont
                                                                                                                    County Pediatric & Allergy Clinic have had simultaneous Strep Throat infections and
                                                                                                                    Influenza infections. Influenza can also cause “Croup” or “Bronchiolitis” very similar to
                                                                                                                    RSV. Unfortunately, the yearly RSV and Influenza epidemics often occur
                                                                                                                    simultaneously, just as they have this year in Fremont County.

                                                                                                                    Complications of the Flu
                                                                                                                    In healthy children, influenza is generally an acute, self-limited and uncomplicated
                                                                                                                    disease, although an appreciable burden on account of absence from school and parental
                                                                                                                    absence from work. In addition, in certain "high-risk" groups of children, the infection
                                                                                                                    may be complicated and severe. Usual treatment for the Flu is supportive care—fluids,
                                                                                                                    rest, ibuprofen or Tylenol. Sometimes a cough suppressant is helpful (such as Robitussin
                             Offices in Lander and Riverton, Wyoming                                                DM). A vaporizer in the bedroom will keep secretions in the nose and chest thin and
                                   307-332-2185 / 800-287-2185                                                      easier to get rid of. We often recommend avoiding decongestants since they can thicken
                                                                                                                    mucous in the chest. Antibiotics provide no benefit unless you have developed a
                                                                                                                    complication of the FLU, such as ear infection or pneumonia. These complications
                                          INFLUENZA                                                                 usually occur after the person has been sick for 3 days and just doesn’t seem to come
                                                                                                                    around like their classmates. Some people are quite ill for up to a week. Frequently, a
Influenza is a virus and thus somewhat simpler in it’s structure than bacteria. Viruses                             child with influenza may have more than one visit to the doctor before the illness runs it’s
move into cells and take over functions for their own good and reproduction. Influenza                              course. Ear infection occurs in 10-50% of children with documented influenza. The
viruses in particular have the ability to undergo rapid changes in their structure making                           most common cause of a complicating bacterial pneumonia is Strep Pneumoniae—the
them a “moving target” when it comes to immune system recognition and attack--thus the                              same bacteria that we now immunize against with the infant vaccine “Prevnar” and the
regular outbreaks of influenza infection, even in the era of vaccination. These minor                               adult vaccine “Pneumovax”. Luckily these vaccines help decrease serious complications
changes that occur, result in the usual small outbreaks we see each Jan and Feb in                                  in the United States. Even so, Influenza and it’s complications cause about 100 deaths a
Wyoming. The reason these infections are mild is because the changes are so small that                              year in America among children under age 17. Reye’s syndrome is unusual since the link
there is a little remaining immune memory of the virus and the body does a pretty good                              was identified between aspirin use and influenza—do NOT give children aspirin during
job of attacking it. Occasionally Influenza viruses undergo a big change in their outer                             FLU season. Influenza is most dangerous to the elderly and to children under age 2
structure that makes it very difficult for the immune system to recognize it—these are                              years.
“antigenic shift” events and are the cause of large pandemics of infection around the
world. In the past, these big changes have resulted from a combination of the genetic                               Vaccination against the Flu
material from a common human influenza virus and an influenza virus from an animal.                                 This past fall, we attempted to immunize most of our patients under age 2 and as the
Today, in 2006, our concern is that as avian “bird” flu begins to sporadically infect                               supply of the influenza vaccine improves we will continue to follow the
humans—it has demonstrated it’s ability to quickly kill it’s victims. Should that virus                             recommendations of the CDC in immunizing increasingly larger portions of the youth in
combine with a common human influenza virus in the same person then spread to others,                               Fremont County each fall. Our vaccine supplies usually become available in October or
it will result in another severe influenza outbreak like the one in 1918.                                           November each year. Vaccination gives only partial protection for the same reasons
                                                                                                                    noted above—the virus changes so quickly that it often changes from the time the vaccine
                                                                                                                    was produced the year before.
Use of Antiviral Medications
If a patient is seen during the first 2 days of the illness and tests positive for either
Influenza A or B, then a medication can be used called “Tamiflu” which makes it
difficult for the virus to reproduce, by blocking the release of the new viruses from the
host cell they have taken over. By the time the person has been ill 3 days, there are so
many viruses already released in the body, that the medicine doesn’t have much benefit.
Therefore we recommend that if your child becomes ill during flu season (especially if
they also suffer from fever seizures or asthma), they be seen early in the illness if you
wish to give them Tamiflu. Tamiflu usually results in a rapid improvement in symptoms
within 1-2 days and can help parents stay in the work force and help prevent
complications in children who are considered at increased risk. Tamiflu can also be used
preventatively if you did not receive the flu shot. Unfortunately, Tamiflu is not approved
for use in infants under age 1 year. In years past we have used a medication called
Amantadine, but the CDC notified physicians this year that Amantadine has little
therapeutic benefit against this years particular strain of the Flu.

At Fremont County Pediatric & Allergy Clinic, we have a lab able to make a rapid
diagnosis, giving you and the doctor an answer in just 5-10 minutes. Our office is also
part of the Influenza Surveillance Network and reports regularly to the Wyoming
Department of Health with updates on number of cases diagnosed.

If your child is ill this FLU season, we recommend you have them seen at Fremont
County Pediatric & Allergy Clinic. We have convenient offices in Lander and Riverton
Wyoming and can usually see your child the same day you call. With 4 Board-Certified
Pediatricians on staff, 2 registered nurses and 1 LPN, 1 Nurses Aide and an excellent
support staff in our front office, you can be assured that only the most qualified and well
trained staff will be involved in your child’s care. We also offer 24 hour a day
availability of one of our Pediatricians for phone calls or visits if necessary—just call
Lander Valley Hospital at 307-335-6365 and ask them to page the Pediatrician on call
for Fremont County Pediatric & Allergy Clinic. During usual business hours you can
reach us at 307-332-2185 or 800-287-2185.

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