Home
About Us
Our Services
New Patients
Forms & Policies
Medical Resources
   Emergencies
   Medical Conditions
      Abdominal Pain, Recurrent
      Acne
      Acute Ear Infections and Your Child
      Acute Lymphoblastic Leukemia
      Acute Otitis Media
      Acute Strep Throat
      Addison
      ADHD and Your School-aged Child
      AIDS/HIV
      Allergies in Children
      Anaphylaxis
      Anemia and Your Young Child
      Anesthesia and Your Child
      Ankle Sprain Treatment (Care of the Young Athlete)
      Antibiotics and Your Child
      Anxiety
      Appendicitis
      Asthma
      Asthma and Exercise (Care of the Young Athlete)
      Asthma and Your Child
      Asthma Triggers
      Atopic Dermatitis (Eczema)
      Attention-Deficit Hyperactivity Disorder
      Attention-Deficit Hyperactivity Disorder (ADHD)
      Breast Enlargement, Premature
      Breath-Holding Spells
      Bronchiolitis
      Bronchiolitis and Your Young Child
      Care of the Premature Infant
      Celiac Disease
      Chickenpox
      Chickenpox Immunization
      Chickenpox Vaccine, The
      Coarctation of the Aorta
      Colds
      Common Childhood Infections
      Congenital Hip Dysplasia
      Constipation
      Constipation and Your Child
      Coxsackie A16
      Croup
      Croup and Your Young Child
      Croup: When Your Child Needs Hospital Care
      Crying and Your Baby: How to Calm a Fussy or Colicky Baby
      Cyclic Vomiting Syndrome (CVS)
      Depression
      Developmental Dysplasia of the Hip
      Diabetic Mother, Infant of
      Diaper Rash
      Diarrhea and Dehydration
      Diarrhea, Vomiting, and Water Loss (Dehydration)
      Ear Infection
      Ear Infections
      Eating Disorders
      Eczema
      Eczema (Atopic Dermatitis)
      Enlarged Lymph Nodes
      Erythema Multiforme
      Eye Problems Related to Headache
      Febrile Seizure
      Febrile Seizures
      Fetal Alcohol Syndrome
      Fever
      Fever and Your Child
      Fifth Disease
      Fifth Disease (Erythema Infectiosum)
      Flu
      Flu, The
      Food Allergies and Your Child
      Food Born Illnesses
      Fragile X Syndrome
      Gastroenteritis, Viral
      Gastroesophageal Reflux
      Giardiasis
      Guide to Children's Dental Health, A
      Hand Foot and Mouth
      Hand-Foot-and-Mouth Disease
      Head Lice
      Headache Related to Eye Problems
      Hemangioma
      Hepatitis A
      Hepatitis A Immunization
      Hepatitis B
      Hepatitis B Immunization
      Hepatitis C
      Hib Immunization
      High Blood Pressure
      Hip Dysplasia (Developmental Dysplasia of the Hip)
      HIV/AIDS
      How to Take Your Child's Temperature?
      Hyperactivity
      Hypertension
      Hypothyroidism
      Immunization
      Infant of a Diabetic Mother
      Infectious Mononucleosis
      Influenza Immunization
      Influenza-Seasonal
      Inhaled and Intranasal Corticosteroids and Your Child
      Kawasaki Syndrome
      Language Development in Young Children
      Lead Poisoning
      Leukemia
      Lung Hypoplasia
      Lyme Disease
      Lymphadenopathy
      Measles
      Mental Health
      Middle Ear Fluid and Your Child
      MMR Immunization
      Molluscum Contagiosum
      Mumps
      Obesity in Childhood
      Osgood-Schlatter Disease
      Otitis Media, Acute
      Pneumococcal Conjugate Immunization
      Pneumonia and Your Child
      Polio Immunization
      Premature Thelarche
      Prematurity
      Prematurity, Retinopathy of
      Pulmonary Hypertension
      Pulmonary Hypertension (PPH & SPH)
      Retinopathy of Prematurity
      Rheumatic Fever, Acute
      Ringworm (Tinea)
      Roseola
      Rotavirus
      Rubella (German Measles)
      Safety of Blood Transfusions
      Scabies
      Seasonal Influenza (Flu) 2014–2015
      Separation Anxiety
      Sinusitis
      Sinusitis and Your Child
      Sleep Apnea and Your Child
      Smoking
      Speech Development in Young Children
      Stevens-Johnson Syndrome
      Strep Throat
      Strep Throat-Acute
      Strep Throat-Recurrent
      Stuttering and the Young Child
      Swine Flu
      Swine Flu (H1N1) FAQ
      Swine Flu (H1N1) Vaccine
      Swollen Glands
      Tattoos
      Tear Duct, Blocked
      Tetralogy of Fallot
      Thyroid Problems
      Tinea (ringworm infection)
      Tonsils and the Adenoid
      Toxic Shock Syndrome
      Toxoplasmosis
      Turner Syndrome
      Type 2 Diabetes: Tips for Healthy Living
      Underdeveloped Lungs
      Urinary Tract Infection
      Urinary Tract Infections in Young Children
      Varicella or Chickenpox
      Varivax Immunization
      Vesicoureteral Reflux
      Wheezing-Infant
      Whooping Cough (Pertussis)
      Wilson Disease
   What's Going Around?
   Pediatrics
Contact Us

Practice News

Anywhere Family Practice is thrilled to announce the addition of Dr. Julie Johnson to our team.
We will be transitioning to a new patient portal in April. Watch for new updates on this website!

Is Your Child Sick?TM

 

Are You Sick?

Flu

W. Paul Glezen, M.D.
Department of Molecular Virology and Microbiology
Baylor College of Medicine
Houston, Texas

What is influenza?

Influenza, commonly referred to as the "flu," is an acute, contagious respiratory infection. The first of the human respiratory viruses to be isolated and characterized, influenza viruses have been studied the most extensively and are the best understood. The term itself, "influenza," may have come from the Latin word influo, meaning "to flow in," perhaps indicating its airborne transmission, or it may be of Italian origin, relating to an "influence," such as the weather, or mystical astrologic causes.

top

What causes influenza?

Influenza is caused by strains of the orthomyxoviruses. The influenza viruses are comprised of three major types-A, B, and C-and multiple subtypes. Influenza A and B are the two types of influenza viruses that most often cause disease in humans. Influenza A and B viruses have been studied more extensively than influenza C viruses.

top

How does it cause disease?

Influenza is most prevalent in the winter and the spring. It occurs following close contact with a person who has the illness. Spread by discharges from the mouth and nose of an infected person, the virus is then inhaled and multiplies in the newly infected person. Influenza may occur on a sporadic basis, or it may occur as epidemic influenza (i.e., involving a large, regional population) or as pandemic influenza (i.e., involving a worldwide population).

top

Who gets influenza?

All persons may contract influenza; however, younger children (under 2 years), pregnant women, American Indians, Alaskan Natives and older adults (over 65 years) are the most susceptible to its effects. Persons at high risk for the complications associated with influenza include those with preexisting medical conditions, such as:

  • Asthma
  • Neurological and neurodevelopmental conditions
  • Chronic lung disease
  • Heart disease
  • Blood disorders (such as sickle cell disease)
  • Endocrine disorders (such as diabetes mellitus)
  • Kidney disorders
  • Liver disorders
  • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
  • Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)
  • People younger than 19 years of age who are receiving long-term aspirin therapy
  • People who are morbidly obese (Body Mass Index [BMI] of 40 or greater)

top

What are the common findings?

In young children, the most common findings of type A influenza include its sudden onset and its associated symptoms of high fever, headache, lack of appetite, fatigue, chills, and muscle aches. Common respiratory findings include a cough, a runny nose, and a sore throat. Other symptoms may include abdominal pain, swollen lymph nodes in the neck area, nausea, vomiting, and diarrhea.

In older children and adolescents with type A influenza, the onset of the illness is abrupt, and is associated with high fever, flushed face, chills, headache, muscle aches, and fatigue.

In type B influenza, children often will have typical "flu-like" symptoms with fever; however, adults frequently will have only respiratory tract symptoms without significant fever.

Influenza C viruses cause illnesses similar to type A influenza; however, the severity of the disease is usually less, and the duration of it is shorter.

top

How is influenza diagnosed?

Infection with the influenza virus is diagnosed more accurately from groups of patients exhibiting the classic symptoms of influenza, rather than an individual patient. Epidemics occur each winter, and usually begin with a sudden increase in its appearance in the primary care facilities of school-age children with febrile (associated with fever) respiratory tract illnesses.

A diagnostic test called a "Rapid Flu Test" is now available in most physician's offices. Unfortunately, the reliability of these tests is variable and a person with a negative test may still have the flu. Your health care provider will often make the diagnosis of flu based on your symptoms and physical exam. In certain circumstances, your provider may decide to send a nasal swab to a specialized laboratory for a more definitive diagnosis.

top

How is influenza treated?

For types A and B influenza viruses, the illness usually resolves itself after several days; however, fatigue and persistent coughing can last for two or more weeks. Bed rest, adequate hydration with oral fluids, control of fever and muscle aches with acetaminophen, and maintenance of comfortable breathing with nasal decongestants and humidifiers are the best courses of treatment in uncomplicated cases of influenza. A persistent cough may be treated with cough suppressants.

Preventative administration of antibiotics should be discouraged. For complicated cases of influenza, a physician should evaluate the patient, and may recommend antibiotic treatment for possible secondary bacterial infections. The neuraminidase inhibitor oseltamivir (Tamiflu) is FDA-approved for the treatment of uncomplicated acute influenza in patients 1 year and older who have been symptomatic for no more than 2 days. The neuraminidase inhibitor zanamivir formulated for oral inhalation (Relenza) is FDA-approved for the treatment of influenza in patients 7 years of age and older who, similar to approved uses for oseltamivir, have uncomplicated illness and have been symptomatic for no more than 2 days.  These treatments have limited benefit and are recommended only for those HIGH RISK patients (see list above) or patients with severe symptoms.

top

What are the complications?

A patient's recovery from a case of uncomplicated influenza generally is considered to be excellent.

Complications that may occur as a result of influenza include bacterial infections of the respiratory tract (particularly pneumonia), acute otitis media (ear infections), and sinusitis. Acute myositis, (i.e., severe pain and tenderness in the calves of both legs that occurs suddenly, often with a refusal to walk) may also occur.

Reye's syndrome may occur as a result of influenza, most commonly when aspirin or aspirin-containing compounds are used in children with influenza. Reye's syndrome is a constellation of symptoms that can result in degeneration of the liver and/or swelling of the brain.

Rare complications of influenza include encephalitis and other neurologic illnesses (e.g., transverse myelitis, Guillain-Barr syndrome, Parkinson disease), cardiac inflammation (e.g., pericarditis, myocarditis), and kidney failure following myositis (acute inflammation of the muscle).

Despite improvements in living standards and the introduction of antibiotics, an average of 30,000 deaths still are attributed to influenza each year. Most deaths occur in those patients with preexisting chronic medical conditions involving the pulmonary or the cardiovascular systems, in very young patients (less than two years of age), or in elderly patients (older than 65 years of age).

top

How can influenza be prevented?

The influenza vaccine is the primary method for preventing influenza and its more severe complications. To be effective, the vaccine must contain antigens similar to those of the most likely current strain of the virus. In years when a new strain arises and causes widespread outbreaks, the available vaccine may contain a previous strain of the virus, which may give only modest protection from the flu.

Worth noting, the influenza vaccine does not affect the safety of mothers who are breastfeeding or their infants.

For those previously unvaccinated children who are 6 months to 8 years of age, two doses of the vaccine should be administered at least one month apart in order for it to be effective. For those children who are older than nine years, only one dose of the vaccine is necessary.

A live, attenuated (weakened) influenza virus vaccine (FluMist") administered by nasal spray is now available for healthy children over 2 years of age.  Recent studies have suggested that this flu nasal spray provides better protection to children and all children between 2 and 8 years of age should receive this nasal spray vaccine. If it is not available, these children should still receive a flu shot.

The live flu nasal spray should not be used in the following populations:

  • Persons aged <2 years or >49 years;
  • Those with contraindications listed in the package insert:
    • Children aged 2 through 17 years who are receiving aspirin or aspirin-containing products;
  • Persons who have experienced severe allergic reactions to the vaccine or any of its components, or to a previous dose of any influenza vaccine;
  • Pregnant women;
  • Immunosuppressed persons;
  • Persons with a history of egg allergy;
  • Children aged 2 through 4 years who have asthma or who have had a wheezing episode noted in the medical record within the past 12 months, or for whom parents report that a health care provider stated that they had wheezing or asthma within the last 12 months (Table [footnote]). [For those aged ≥5 years with asthma, recommendations are described in item 4 of this list];
  • Children with High Risk conditions (see list above) should consult their healthcare provider for studies are limited.
  • Children who are severely immunosuppressed
  • Persons who have taken influenza antiviral medications within the previous 48 hours.
    • Side effects to the vaccine may occur, and they include fever, "flu-like" symptoms of fatigue and muscle aches, and tenderness at the site of the inoculation (if given by injection). The occurrence of febrile convulsions, which have been associated with the vaccine in very young patients, is rare, and studies have shown no association of an increased frequency of Guillain-Barr syndrome and the influenza vaccine.

      top

      Can the influenza vaccine prevent acute otitis media?

      Acute otitis media (i.e., ear infection) is the most common cause for illness visits to the pediatrician in the United States, most often occurring in children between the ages of 6 months and 3 years, with the highest incidence in the 6- to 12-month age group.

      Studies suggest that the influenza vaccine can decrease the incidence of acute otitis media in children, especially those children between the ages of 6 and 30 months, during the influenza season. These same studies also suggest that other vaccines against respiratory viruses may be an effective way to reduce the incidence of acute otitis media in children.

      top

      What research is being done?

      Whereas the currently available antiviral drugs, oseltamivir and zanamivir, are effective against influenza A and B viruses, recent resistance has been reported. In intravenous medication, panamivir has been approved for administration to severely ill hospitalized patients with influenza.

      top

      Links to other information

      Information regarding influenza is available through the Centers for Disease Control and Prevention (CDC) Web site at CDC FLU FACTS.

      State and local health departments can be contacted for information regarding the availability of the influenza vaccine, access to vaccination programs, and information about state or local influenza activity.

      top

      References

      Belshe RB, Mendelman PM, Treanor J, King J, et al. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenza virus vaccine in children. N Engl J Med 1998;338:1405-12.

      Buchman CA, Doyle WJ, Skoner DP, Post JC, et al. Influenza A virus-induced acute otitis media. J Infect Dis 1995;172:1348-51.

      Clements DA, Langdon L, Bland C, Walter E. Influenza A vaccine decreases the incidence of otitis media in 6- to 30-month-old children in day care. Arch Pediatr Adolesc Med 1995;149:1113-7.

      Glezen WP. Emerging infections: pandemic influenza. Epidemiol Rev 1996;18(1):64-76.

      Glezen WP. Influenza control-unfinished business. JAMA 1999; 281:994-5.

      Glezen WP. Influenza viruses. In: Feigin RD, Cherry JD, eds. Textbook of pediatric infectious diseases. 4th ed. Philadelphia: WB Saunders, 1998:2024-37.

      Glezen WP, Taber LH, Frank AL, Gruber WC, et al. Influenza virus infections in infants. Pediatr Infect Dis J 1997;16:1065-8.

      Heikkinen T, Ruuskanen O, Waris M, Ziegler T, et al. Influenza vaccination in the prevention of acute otitis media in children. AJDC 1991;145:445-8.

      U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (CDC). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). Mor Mortal Wkly Rep 1999;48(RR-4):1-28.

      About the Author

      Dr. Glezen is professor of microbiology and pediatrics at Baylor College of Medicine in Houston, Texas. His research has focused on the consequences and the prevention of respiratory viruses in children.

      Dr. Glezen has published more than 125 papers and chapters related to his research. His three grandchildren, Claire, Tyler, and Meghan Gahm, have flourished under the pediatric care of Dr. Dan Feiten.

      Reviewed 11/3/2010

      Revised 11/3/2010

      Copyright 2012 W. Paul Glezen, M.D., All Rights Reserved