Mrs. X. brings 18-month-old Courtney to the office because she had been suffering with a low-grade fever, runny nose and nasal congestion for the past two weeks. “She just can’t shake this darn flu,” her mom said with consternation. Mr. Y. is sitting there with his eight-year-old son, Erik, who has had two days of vomiting and diarrhea. He shakes his head and says, “Erik’s got this stomach flu—I know he got it from me. It’s made the rounds through the entire house. My wife is seeing her doctor today for the same thing.” Mrs. Z. is in with her three-year-old daughter, Amanda. They are both sharing a box of Kleenex to wipe their red noses. In a lusty, hoarse voice mom says, “Amanda brought this flu-bug home from pre-school two weeks ago and it just lingers. It won’t get better or worse!”
The one thing that all three families have in common is the fact that NONE of them actually have the flu. Although the term “flu” has been used to describe a vast array of symptoms and illnesses, it is a specific viral illness with it’s own set of classic symptoms.
There are three main types of influenza viruses; A, B, and C. Influenza A and B are the main types causing the disease that is truly referred to as the flu, and they tend to occur in epidemics. Type C influenza is more sporadic, and causes a much milder form of respiratory illness. Hence, this article will specifically be referring to types A and B when discussing the flu.
Influenza tends to occur in annual outbreaks, or epidemics, during the winter months. On a global basis, there are usually one or two strains of influenza that account for that particular winter’s epidemic each year. Therefore, the influenza that is responsible for the epidemic one winter is different from the previous year. It has an incubation period of 48- to-72 hours, which is very short for any virus. This is why the flu can wipe out an entire class of students in a matter of days. It is highly contagious.
Influenza is predominately a respiratory disease that has an abrupt onset beginning with a runny nose, red eyes (conjunctivitis), sore throat and dry hacking cough. Shortly thereafter come the systemic symptoms of high fever, chills, muscle aches, fatigue and headache. It is not uncommon for older patients to remark that they felt as if they had been "hit by a truck” when describing their flu symptoms. The fever lasts for two-to-four days, as well as the majority of systemic symptoms. The cough, however, may persist for many more days, even weeks.
The best advice in treating the flu is the time-tested conservative measures of plenty of rest, plenty of fluids, good fever control and something for the aches (ibuprofen or acetaminophen). Aspirin should not be used at all for the pediatric patient suffering with the flu, due to the suspected association with Reye’s syndrome. A cough suppressant may give symptomatic relief. Since it is viral, antibiotics are not helpful in treating the actual flu. However, a large percentage of patients, 25%, go on to develop an ear infection or pneumonia. Antibiotics would certainly be warranted in treating these complications. The decision of whether or not to use an antibiotic must be made on a patient-to-patient basis.
Much more serious complications to the flu include: encephalitis (inflammation of the brain), myocarditis (inflammation of the heart muscle), myositis (inflammation of specific muscles) and Guillain-Barre syndrome (a neuropathy that causes progressive weakness and loss of reflexes). Fortunately, these are rare occurrences.
A vaccine that is prepared each summer is available for the flu. It contains three strains of influenza. These are predicted, or anticipated strains that are expected to circulate the coming winter and be the cause of the epidemic. The vaccine that is available each winter is totally different from the preceding year. It has proven to be fairly successful over time. There was a relative shortage of flu vaccine this year because the manufacturer had problems with the preparation of one particular strain. A new type of flu vaccine has been developed and tested. It has researchers excited. It is a nasal spray that has promising results. It is safe, giving good protection and is obviously preferable to an injection. Hopefully it will soon be approved for licensure.
There are four anti-influenza drugs that are licensed for the flu. However, they have a number of side effects. They are costly and must be given within the first 48 hours of the illness. A big problem with these drugs is that the influenza virus develops resistance, frequently and rapidly. Use in pediatrics is fairly limited and must be done on an individual basis.
Thinking back to our three patients, Courtney, most likely, had a non-specific viral upper respiratory tract infection…basically a head cold. Erik had a gastro-enteritis (intestinal viral infection), NOT the flu. Technically speaking, there is no such thing as “stomach flu”. This term has worked its way into the everyday vernacular. Most people know what one is referring to when they say stomach flu. Amanda and her mom, like Courtney, had a bad cold. All three eventually got better with a little time and patience. In Long Beach, California, as of mid-December, we haven’t yet seen much of the flu. There are a number of other viruses out there, but one thing is certain. When the flu hits, there will be no question about it.