Recently, influenza infection has become the topic of the day as a number of reported influenza illnesses continues to rise. Schools in Selangor and Penang are closed following confirmed cases of Influenza A reported in the respective areas. This has led to worries among parents. Indeed, children especially those aged less than 5 years old, are among the high-risk groups beside pregnant lady and the elderly. Hence, parental concerns are of valid ground.
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Influenza infection has long been documented back in the Hippocratic era. However, due to lack of medical advances, it wasn’t recognized until the first reported influenza pandemic or Spanish Flu dated in 1918. It was due to an unusual strain of Influenza A back then causing mortality of 40 million people. Subsequently, there are few more influenza pandemics reported throughout the decades. The last was reported in the year 2009.
INFLUENZA VIRUS
In reality, Influenza viruses actually affect all part of the world at certain seasons of the year, hence comes the name of seasonal flu. It comprised of four types of viruses, namely Influenza A, B, C and D.
Influenza A viruses further subtyped into different strains. Among the common ones are HINI and H3N2. Influenza C virus is rare and seldom causes serious illnesses in human while Influenza D virus only causes disease in cattle.
Most of the time, influenza infection is transmitted from human to human. In rare occasions, influenza viruses from birds, swine and other animals can also infect humans. For instances, the latest H7N9 Influenza outbreaks reported in China in the year 2013.
Seasonal epidemics occur mainly during winter in temperate climates while in tropical regions, influenza may occur throughout the year, causing outbreaks more irregularly. World Health Organization (WHO) has labelled Malaysia and Kenya as having activities all-year round with no distinct peaks. These are the only two countries in the world that have been labelled as such.
SYMPTOMS
If your child has been exposed to someone with a flu infection, the symptoms may not be apparent till 1 to 4 days later. We call this incubation period. So, what are the symptoms of seasonal flu? Like an adult, children will get:
- sudden onset of fever
- dry cough
- headache
- muscle and joint pain
- feeling unwell
- sore throat
- runny nose
INVESTIGATIONS
The cough can be bad and last 2 or more weeks. If your child recently exposed to someone with Influenza and develops sudden fever with cough/sore throat, you should consult a paediatrician for further assessment.
High index of suspicion should be observed especially in younger children less than 5 years old or if your child has breathing problems. A simple test called rapid Influenza test kit will be done by taking a sample from your child’s nose or throat.
The result is fast and can be available within 30 minutes. Unfortunately, the rapid test can still miss certain cases. A further test will then be needed.
COMPLICATIONS
Influenza illnesses can range from mild to severe. In a healthy population, the illness usually resolves after a week. However, in high-risk individuals including children aged 5 and below, it can be serious leading to deaths.
Apart from causing pneumonia, influenza infection is well-known to cause neurological complication in children which usually present as seizure and altered mental state. There are many reported cases worldwide, including Malaysia on influenza causing encephalopathy.
The worst scenario is Acute Necrotizing Encephalopathy (ANEC). If no prompt treatment is given, ANEC is associated with high mortality.
TREATMENT
In most instances, influenza infection in healthy bigger children is mild and require only symptomatic treatment. It is always good to know the content of medication being prescribed to your child. Paracetamol and tepid sponging are safe to be used to reduce fever but not Non-steroidal Anti-Inflammatory Drugs (NSAIDs).
Studies have shown that NSAIDs use is associated with ANEC. The common NSAIDs that are in use including syrup Ibuprofen and suppository Diclofenac. In younger children and those with respiratory symptoms like pneumonia, the doctor may prescribe antiviral called Oseltamivir for at least 5 days.
Hospitalization may be warranted in severe cases. Oseltamivir might be prescribed to high-risk children that have been exposed to Influenza contact as well.
PREVENTION
A good health habit is vital to fight against Influenza. Parents are advised to keep their children well-hydrated. Keep your child at home until the fever subsides. Avoid contact with anyone sick.
As Influenza virus spread through droplets from cough, hand washing and cough etiquette are important to reduce transmission. Encourage your child to wear mask whenever possible. Refrain your child from touching his eyes, nose and mouth after contacting with any surfaces.
You may also sanitize the surfaces at home, like toys and table with disinfectants. You are responsible to inform your child’s nursery or school regarding detection of Influenza infection for better surveillance.
INFLUENZA VACCINE
Prevention is better than cure. It is crucial to protect your child and everyone with an influenza vaccine. In Malaysia, the recommended vaccine is inactivated quadrivalent vaccines. It simply means that these vaccines composed of four subtypes of influenza viruses (2 subtypes of influenza A and 2 subtypes of Influenza B viruses) that have been inactivated to induce active immunization in the recipients.
Since Influenza activities are detected all year round in Malaysia, you may vaccinate your child at any time of the year. In other countries, vaccination is recommended either in April or October prior to the onset of flu season.
Influenza vaccination can be given to babies as early as 6 months old. In children less than 9 years old, two doses are required with a subsequent dose given 4 weeks apart.
Evidences have shown that one dose is insufficient to mount immunity in this group of children. For bigger children and adults, one dose is adequate. You then need to have yearly Influenza vaccination as the vaccine effectiveness declines over time as well as the constant changing of influenza viruses.
Can my child still get infected with Influenza virus despite vaccinated?
The answer is yes. This is because the vaccine takes 2 weeks to work. If your child has been exposed to the virus prior to or within 2 weeks from vaccination, he still has the risk of getting the infection.
Likewise, if your child exposed to an Influenza virus subtype which wasn’t included in the vaccines, he might not be protected as well. Besides, everyone has different immunity response to the vaccine. Hence, the protection towards Influenza infection varies among individual.
Nevertheless, even if your child got infected with flu virus despite vaccinated, it greatly reduces the severity of influenza complication. By vaccinating yourself and your children, it also protects people who are more vulnerable to serious Influenza infection like infants and the elderly.
All in all, the best way to keep Influenza infection at bay is by preventing it with flu vaccine and maintaining high level of good health habits. Let’s work together to fight against Influenza virus!
References:
1. World Health Organization WHO
2. Centers for Disease Control and Prevention CDC
3. Monthly Index of Medical Specialties MIMS Malaysia