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Parental Anxiety Continues Over Swine Flu

by Sue Hubbard, M.D.

As the H1N1 virus (swine flu) continues to cause flu throughout the country, with 26 states reporting widespread illness, parental anxiety continues to be prevalent in our office. Tragically, there have been recent deaths in the pediatric population, and it seems that the H1N1 virus is infecting many children between the ages of two to 24 years. Fortunately, the vast majority of children who have developed “swine flu” really are not any sicker than with other influenza viruses we see each year. It is unusual to see influenza in the summer and early fall, and that is one reason we are expecting a longer flu season with greater numbers of sick people than in previous years.

The issue continues to be that the media reports the tragedies rather than the reassurance that MOST children, including my own, are handling this virus with a three to seven day stay at home, in bed with plenty of parental TLC, fluids, and fever reducing medications. It is definitely tragic, and certainly scary for parents to hear about a pediatric death secondary to H1N1 illness, but we all must be reminded of the fact that there have been pediatric deaths secondary to flu each year. There has just not been as much publicity.

For perspective, I decided to look back at the statistics from the Centers for Disease Control and Prevent (CDC) for the last several flu seasons. For the 2006- 2007 flu season there were 78 pediatric deaths in the U.S., 2007 – 2008 flu season, 88 pediatric deaths, and for the 2008-2009 flu season through Sept 19, 2009 there were 117 pediatric deaths, with 49 of the deaths in children with H1N1 illness (recorded since April, 2009). The difference is that the flu season this year is longer so there are more people being affected. Remember math facts, the denominator is bigger, so while the numerator (deaths) may seem higher, the actual ratio is no different from year to year.

I guess the point of all of this is that panic and fear is not going to help anyone get through the flu season. It is better to be educated about H1N1 and to know when to call the doctor, visit the pediatrician or go to the ER, than be one of the thousands of worried parents who are seeking medical care for their children simply out of fear. For physicians and hospitals to be able to care for the sickest patients it is imperative that parents try to remain calm. The majority of kids I have seen would rather be at home in their bed watching TV and playing games than sitting in my office, only to be told to go back home to bed, drink lots of fluids, to cover their mouths when coughing and to wash their hands. REST is still the best medicine for most of us when sick (the mother in me comes out a lot).

The CDC, state and local health departments are no longer recommending routine testing for influenza, as the in office test is often inaccurate anyway. The in office test also only tells you that you have Influenza A or B, it does not tell you the subtype. It will not tell you if it is H1N1, so think of it as just flu. Clinical symptoms are really the best diagnostic clue to the “flu” and the more patients doctors see with the same symptoms of fever, sore throat, headache, and cough the more you “know” how epidemic this flu is. There is no need to test ever patient, but testing for the sickest patients or those with an underlying chronic medical condition is appropriate. Your doctor will decide if it is necessary.

As I have written before, routine use of anti-viral medication is NOT being recommended, so don’t expect your otherwise healthy child to be placed on antiviral medications. Tamiflu and Relenza are good drugs when used appropriately, and overuse of these medications could lead to resistance in their effectiveness when they are really needed. I understand that there are school tests, field trips, homecoming dances, birthday parties, and sporting events that all of our children “need to attend”, but these are not really reasons to begin antiviral medications. If you look at the data, these drugs typically only shorten the course of the illness by one day, and Tamiflu may even cause side effects of nausea and vomiting, which could be worse than the fever and body aches! Is there ever a “convenient” time to be sick?

So, I am hopeful that these posts are helpful in providing information and education to alleviate some of the anxiety and panic during this “swine flu” outbreak. Stay abreast of the latest information and get your seasonal flu vaccines and when available (hopefully in the next month) get the “Swine flu” vaccine.  I will continue to be in my office otherwise known as the “swine zoo” to see those children who need us.

That’s your daily dose, we’ll chat again soon.

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