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Should Your Child See a Doctor?

Influenza Exposure

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Definition

  • Exposure (close contact) to person with influenza
  • Questions about influenza
  • Your child has no symptoms of influenza (no fever, cough, sore throat, runny nose)
  • Children with symptoms of influenza following exposure (close contact) should be managed using the influenza topic

Exposure (close contact) definition

  • Household close contact: Lives with a person with influenza.
  • Other close contact (within 3 feet, 1 meter; touching distance) with a person with influenza. Examples of such close contact include kissing or embracing, sharing eating or drinking utensils, close conversation, and any other direct contact with respiratory secretions of a person with influenza. Includes being in the same child care center room or carpool.
  • Not close contact: In same building. Activities such as walking by a person or sitting across a waiting room from a person with influenza for a brief period of time. Being in the same school, church, workplace or building also is not close contact.
  • Not close contact: In same community. Lives in a community where there are one or more confirmed cases of influenza is not an Exposure. Living in the same state or country (e.g., Mexico) carries even less risk.

High-risk children for complications from influenza (AAP)

  • Children are considered high-risk for complications if they have any of the following conditions:
    • Lung disease (such as asthma)
    • Heart disease (such as a congenital heart disease)
    • Cancer or weak immune system conditions
    • Neuromuscular disease (such as muscular dystrophy)
    • Diabetes, sickle cell disease, kidney disease or liver disease
    • Diseases requiring long-term aspirin therapy
    • Pregnancy
    • Healthy children under 2 years old are also considered high-risk (CDC: September 2009)
  • Note: All other children are referred to as low-risk.

Prescription antiviral drugs for influenza

  • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the start of flu symptoms.
  • The AAP recommends they be used for: 1) any patient with severe symptoms AND 2) for most HIGH-RISK children (see that list) with any flu symptoms.
  • The AAP doesn't recommend antiviral drugs for low-risk children with mild or moderate influenza illness.
  • Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not eliminate them.
  • Side effects: Vomiting in 10% of children.

See more appropriate topic (instead of this one) if

  • Influenza exposure (close contact) within last 7 days and fever or respiratory symptoms (cough, sore throat, or runny nose), see influenza.

When to Call Your Doctor

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • Influenza exposure (close contact) within last 7 days and your child is high-risk for complications of flu (age under 2 years or underlying heart or lung disease or weak immune system, etc) (see that list above)

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Age over 6 months and needs flu shot

Parent care at home if

  • Influenza questions and no exposure in the last 7 days
  • Influenza prevention questions
  • Tamiflu prescription questions
  • Influenza exposure within the last 7 days, but low-risk child
  • Influenza minor contact (same school or gathering, etc.) but no true exposure (close contact) and no symptoms

Home Care Advice for Influenza Exposure

Influenza Questions and No Exposure in the Last Seven Days

Influenza general information

  • For most healthy people, the symptoms of seasonal influenza are similar to those of the common cold.
  • However, with flu, the onset if more abrupt and the symptoms are more severe.
  • Feeling very sick for the first 3 days is common.
  • The treatment of influenza depends on your child's main symptoms and usually is no different from that used for other viral respiratory infections.

Influenza symptoms

  • The main symptoms are fever, cough, sore throat and runny nose.
  • Fever is usually present. (Exception: immune-compromised children)
  • Other common symptoms are muscle pain, headache and fatigue.
  • Some people also have vomiting and diarrhea, but never as the only symptom.

Influenza diagnosis and flu tests

  • If influenza is widespread in your community and your child develops flu symptoms with fever, then he or she probably has influenza.
  • Your child doesn't need any special tests.
  • You should call your doctor if your child is high-risk for complications of flu: 1) under 2 years of age or 2) has underlying health problems. (e.g., asthma or weak immune system (see the high-risk list above)
  • For low-risk children, you don't need to call or see your child's doctor, unless your child develops a possible complication of the flu.

Influenza treatment

  • Tamiflu (oseltamivir) is the main antiviral drug used to treat influenza in children.
  • Treatment is recommended for any patient with severe symptoms and for most high-risk patients (see that list above) with any flu symptoms. (AAP) It usually is reserved for hospitalized children with severe symptoms or who have underlying health problems.
  • Treatment is generally not recommended for low-risk children with mild to moderate influenza illness (per AAP).
  • Most patients recover without taking Tamiflu.

Influenza contagiousness and return to school

  • Spread is rapid because the incubation period is only about 2 days (range 1-4 days) for seasonal flu and the virus is very contagious.
  • Keep your child home and out of child care or school for at least 24 hours after the fever is gone (CDC: August 2009).
  • The influenza virus is spread by airborne droplets from sneezing and coughing.
  • It also can be transmitted by hands contaminated with secretions.

Call your doctor if

  • You have other questions or concerns

Influenza Prevention Questions

How to protect yourself from getting sick

  • Wash hands often with soap and water.
  • Alcohol-based hand cleaners are also effective.
  • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
  • Try to avoid close contact with sick people.
  • Try to avoid unnecessary visits to the ER and urgent care centers because those are the places where you are more likely to be exposed to influenza, if you don't have it.

How to protect others: stay home when sick

  • Cover the nose and mouth with a tissue when coughing or sneezing.
  • Wash hands often with soap and water, especially after coughing or sneezing.
  • Limit contact with others to keep from infecting them.
  • Stay home from school or work for at least 24 hours after the fever is gone (CDC, August 2009).

Flu shot

  • Getting a flu shot is the best way to protect you and your child from flu.
  • Yearly influenza vaccines are strongly recommended for all children over 6 months of age. (AAP)
  • When the vaccine is a good match to the circulating flu virus, it is highly effective at completely preventing the disease.
  • Even when the vaccine doesn't match the circulating flu virus, it usually reduces the severity of the symptoms.

Anti-viral medication

  • Tamiflu can be used for prevention following close contact with a person who has influenza.
  • It is only recommended for high-risk patients (CDC). (See that list above.)

Call your doctor if

  • You have other questions or concerns

Tamiflu Prescription Questions

Treating influenza: Tamiflu

  • Tamiflu is a prescription anti-viral medicine that is helpful in treating the influenza virus.
  • The benefits are limited. Tamiflu usually reduce the time your child is sick by 1 to 1.5 days. It helps reduce the symptoms, but does not eliminate them.
  • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the onset of flu symptoms.
  • Indications: Severe symptoms or underlying health problems (high-risk group)
  • For high-risk children, call your child's doctor at the start of flu symptoms.
  • Most patients have mild to moderate symptoms and Tamiflu treatment is not necessary.
  • Tamiflu also has side effects: vomiting in 10% of children.

Preventing influenza: Tamiflu

  • The drug Tamiflu may help prevent influenza.
  • Indications: Recent close contact with person with confirmed influenza and the exposed person is in high-risk group (age under 2 years, underlying heart or lung disease, weak immune system, etc.) (CDC)
  • It is effective only while your child is taking it and ceases once your child stops taking it.
  • Your child should only take Tamiflu if your child's physician recommends it.
  • High-risk adult: If a high-risk adult (e.g., adult with a chronic disease, pregnant, over 65 years old, etc.) has been exposed to influenza in the home, call that person's doctor within 24 hours. (Reason: May need anti-viral medicine)

Personal stockpiling of Tamiflu: not recommended

  • Definition: Some people request a prescription for Tamiflu for all family members just in case they come down with flu symptoms. They currently are well and have not been exposed to influenza.
  • Doctors are opposed to this practice, as are the CDC, the AAP and your state's public health department.
  • The supply of Tamiflu is limited and needs to be kept available for patients who have severe symptoms or have underlying health problems.

Call your doctor if

  • You have other questions or concerns

Influenza Exposure Within the Last Seven Days but Low-Risk Child

Reassurance

  • Although your child was exposed to influenza, your child does not have any symptoms.
  • Symptoms usually develop within 1-4 days of exposure to another person with seasonal flu (7 days is an outer limit with the H1N1 strain of flu).
  • Even if your child did develop symptoms of influenza, at this time, anti-viral treatment (Tamiflu) is not indicated for low-risk children.
  • Patients recover from influenza with supportive symptom care.

Call your doctor if

  • You have other questions or concerns

Influenza Minor Contact (Same School) But No True Exposure (Close Contact)

Reassurance

  • To catch influenza, your child would need to have close contact with an infected person.
  • Close contact includes kissing or embracing, sharing eating or drinking utensils, close conversation, interactions within 3 feet (1 meter), being in the same child care group or car pool, etc.
  • Because your child did not have close contact, it is highly unlikely that he will develop influenza.
  • Even if your child did develop symptoms of influenza, at this time, anti-viral treatment (Tamiflu) is not indicated for low-risk children.
  • Healthy children recover from influenza with supportive symptom care.

Call your doctor if

  • You have other questions or concerns

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. ACIP. Prevention and Control of Influenza.Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep. 2008 Aug 8;57(RR-7):1-60.
  2. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement: Recommendations for the prevention and treatment of influenza in children, 2009-2010. Pediatrics. 2009;124:1216-1226. 
  3. American Academy of Pediatrics. 2009-2010 Influenza Season Triage Algorithm for Children (18 or Younger) with Influenza-Like Illness. CDC H1N1 Website. October 2009. (PDF)
  4. Cheung M, Lieberman JM. Influenza: Update on strategies for management. Contemp Pediatr. 2002;19(10):82-94.
  5. Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. NEJM. 2009;361(20):1935-1944.
  6. Nayak LJ, Treanor JJ. Antiviral treatment and prophylaxis of influenza virus in children. Pediatr Ann. 2009;38(12):667-673.
  7. Piedra PA, Schulman KL, Blumentals WA. Effects of oseltamivir on influenza-related complications in children with chronic medical conditions. Pediatrics. 2009;124:170-178.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 6/1/2011

Last Revised: 7/27/2011 1:53:52 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D. 

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