Influenza during the Covid-19 Pandemic: What parents need to know

Wed, Oct 13 2021

Background

Influenza, more commonly known as the flu, is a respiratory virus that infects the nose, throat and lungs. Seasonal flu epidemics typically run from late Summer/early Fall to the Spring yearly.  Children consistently have the highest infection rates of flu in the community during these seasonal epidemics and, therefore, play a pivotal role in transmission.  During the Covid-19 pandemic there have been many questions about whether a child may have covid or flu since they have multiple similarities; both being respiratory illnesses that can range in severity of symptoms from asymptomatic to severe, and both typically presenting with one or more of the following tell-tale signs: 

  • Cough
  • Runny nose
  • Sore throat
  • Fever (temperature > 100.4°F)
  • Headache
  • Fatigue
  • GI upset including vomiting and diarrhea. 

Both viruses are spread by droplets and aerosols, which means that coughs, sneezes, speaking, singing, and even breathing close to another person can spread the virus.  Transmission can also occur if one touches a contaminated surface and then touches their eyes, nose or mouth.

High-risk groups in the population are susceptible to more severe illness with both of these viruses.  It is important however to determine which virus your child has in order to best treat their illness.  If your child presents with any concerning symptoms or has had a known exposure to influenza or Covid-19, please contact the office to discuss evaluation.

Serious complications from flu infection can include:

  • Sinus problems and ear infections
  • Dehydration
  • Pneumonia
  • Worsening of long-term medical problems such as heart disease or asthma
  • Brain dysfunction such as encephalopathy
  • In rare cases flu complications can lead to death

If your child exhibits any of the following symptoms, then immediate evaluation is required and you should take them to the closest urgent care or emergency room:

  • Fast breathing/trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Chest pain
  • Severe muscle pain (child refuses to walk)
  • Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
  • Not alert or interacting when awake
  • Seizure
  • Fever > 104°F
  • Fever > 100.4°F in an infant less than 12 weeks old

Treatment

Antiviral treatment for the flu has shown to reduce flu-related complications in some pediatric patients.  It is mostly recommended for children who are hospitalized, have a severe or progressive case, or have underlying conditions that increase their risk of complications of flu.  Antiviral treatment for flu may also be considered for any previously healthy, symptomatic outpatient not at high risk for flu complications if the patient has a confirmed flu diagnosis and the antiviral treatment can be initiated within 48 hours of illness onset. Children whose siblings or household contacts are younger than 6 months or have a high-risk condition that predisposes them to complications of flu may also benefit from antiviral treatment. 

Antiviral treatment does have potential side effects though, so it is important to discuss your child’s care with your provider to determine if antiviral treatment is recommended. 

High-risk groups in the pediatric population for severe illness as well as complications of flu include:

  • Children less than 5 years and especially less than 2 years, regardless of the presence of any underlying medical conditions
  • Children with:
    • Chronic lung disease – asthma and cystic fibrosis
    • Hemodynamically significant cardiovascular disease
    • Kidney disorders
    • Liver disorders
    • Endocrine disorders – diabetes mellitus
    • Blood disorders – sickle cell disease and other hemoglobinopathies
    • Metabolic disorders – inherited metabolic disorders or mitochondrial disorders
  • Children with immunosuppression attributable to any cause including that caused by medications, cancer, or by HIV infection
  • Children with neurologic and neurodevelopmental conditions including cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury
  • Children with conditions that compromise respiratory function or handling of secretions including tracheostomy and mechanical ventilation
  • Children receiving long-term aspirin therapy

Recent Stats

According to the CDC, there was an unusually low number of cases of influenza in the 2020-2021 Flu Season when compared with previous years.  Reports of pediatrics flu-related deaths have been followed since 2004, with the lowest number being 37 during the 2011-2012 season, up until the 2020-2021 season which only had one report of a pediatric flu death.  The highest number of pediatric flu-related deaths was 199 in the 2019-2020 season.  The low number of flu cases from the 2020-2021 flu season are thought to be correlated to Covid-19 mitigations measures, as well as a record number of influenza vaccines given in the US from the Fall of 2020 until Spring of 2021.  Those mitigation measures included face masks, staying home, hand washing, school closures, reduced travel, increased ventilation of indoor spaces, and physical distancing.

Let’s keep our kids safe! 

To slow the spread, make sure to wash hands, cover your cough/sneezes with your elbow or upper sleeve, use disinfecting wipes on surfaces that are frequently touched, mask up, and get vaccinated!

Influenza vaccination is particularly important during the SARS-CoV-2 pandemic to reduce the burden of respiratory illness and hospitalizations.

The CDC and AAP recommend that everyone 6 months of age and older get a seasonal flu vaccine.  It is important to do this early during the season as it can take 2 weeks after the vaccination for immunity to develop.  If your child is younger than 6 months, the best way to protect them is by preventing flu with caretakers or household contacts.  Pediatric flu vaccines are quadrivalent vaccines meaning they will cover 4 separate strains of flu: two A strains and two B strains.  Each year the flu vaccine is updated to better match the virus strains that are expected to circulate in the US during that season, which is why it is important that you get your flu vaccine yearly. 

The first time a pediatric patient between the ages of 6 months and 8 years of age gets a flu vaccine, they will need a total of two doses of the vaccine at least 28 days apart.  Few side effects have been reported with flu vaccines including fever in the first 24 hours and soreness at the site of injection for 1-2 days.  There is now strong evidence that egg-allergic individuals can safely receive the flu vaccine without any additional precautions beyond those recommended for any vaccine.  Children who have had a previous allergic reaction to the flu vaccine should be evaluated by an allergist to determine whether future receipt of the vaccine is appropriate. 

Flu vaccines will become available to SouthernMED Patients starting the second week in October.  Please call to schedule your family’s flu vaccine appointment(s) and together we can keep them healthy!

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