Influenza in Children

Influenza in Children

Of all vaccine preventable diseases, influenza is the leading cause of hospitalisation amongAustralian children under five years of age. When compared to other diseases, influenza inthe zero-four year age group causes:
* Four times more hospitalisations than meningococcal disease
* More than three times more hospitalisations than pneumococcal disease
* Double the number of hospitalisations than chickenpox

While the vast majority of children will recover from influenza in a couple of weeks, othersmay become seriously ill and need appropriate treatment.
"The thing about influenza is that it may come on quite suddenly. Parents should be on thelook-out for symptoms including irritability and a high temperature - or in more severe casessymptoms like very fast breathing or febrile convulsions," said Professor Robert Booy,Professor of Paediatrics, University of Sydney.

"Some young children with influenza can look so unwell when they arrive at hospital that aspinal tap - otherwise known as a lumbar puncture - is performed to rule-out meningitis,"Professor Booy added. "Much of this might be prevented if children were vaccinated againstinfluenza each year."

Australian studies confirm influenza hospitalisation rates are highest among children aged under five years. In fact, local and international data indicates children under five are more likely than any other age group to present to Emergency Departments, GPs and need hospitalisation due to influenza. Young children hospitalised with influenza can spend anywhere between a few days to a couple of weeks in hospital recovering. Not only are influenza infection rates generally highest among children, children are also a main transmitter of influenza in the community.
"Children are one of the main spreaders of influenza, particularly within households. Therefore vaccination is not only important to protect the health of the child, but also because of the key role they play in transmission, particularly if they are in contact with at-risk people or older adults," Professor Robert Booy explained.

Current Australian immunisation guidelines recommend annual influenza vaccination for anyone who wishes to protect themselves. In particular, Australians over the age of six months who are at risk of severe complications from influenza should get a vaccinated, including those with heart conditions, asthma and other lung conditions, diabetes (type 1 and type 2), kidney problems or impaired immunity.

Influenza infections typically start to increase in June, peaking between July and September.Children under nine years of age who have not been vaccinated previously are recommendedto receive two doses the first year they get vaccinated. In subsequent years, they only requireone dose. As it takes two weeks for full immunity to develop after vaccination, now is thetime to get vaccinated against influenza.

Influenza is a serious, often debilitating illness which the affects the whole body. Influenza symptoms include fever, headaches, muscle aches and pains. Children's symptoms may also include nausea, vomiting and diarrhoea. Influenza can cause serious illness, particularly in young children, older adults and people with underlying medical conditions. Many people confuse the common cold with influenza; however, colds are much less severe.

Each year an estimated 2,500 Australians die from influenza and its complications. The World Health Organization (WHO) estimates that worldwide 5-15% of the population are affected by influenza each year, there are between three and five million cases of serious illness and between 250,000 and 500,000 deaths. In Australia it is estimated that influenza annually causes 18,000 hospitalisations and over 300,000 GP consultations.

Influenza is highly contagious, with children being a major transmitter of the virus.7 Studies have shown that influenza can survive for:
* An hour or more in the air in enclosed environments
* More than eight hours on hard surfaces such as stainless steel and plastic
* Up to five minutes on hands after transfer from other surfaces

People at particular risk of severe complications from influenza are those with:
Heart conditions
Asthma and other lung conditions
Diabetes (type 1 and type 2)
Kidney problems
Impaired immunity
People - 65 years of age, residents of nursing homes and other long-term care facilities, and Aboriginal and Torres Strait Island adults aged ? 15 years are also at increased risk of severe complications from influenza.
People who care for or are in close contact with at-risk individuals, are also advised to protect themselves against influenza to avoid passing on the disease.
Many otherwise healthy Australians who can not afford to get influenza, such as single parents, carers, those who are self-employed or people who can't afford to take any time off work.

There are a number of things people can do to protect themselves against influenza, vaccination is the single most effective way of protecting yourself against influenza infection. Hand washing and personal hygiene, such as trying not to touch your mouth or nose are also important preventative measures. Also where possible, avoid crowds when influenza is prevalent It is important to note that in controlled clinical trials remedies such as vitamin C and Echinacea have failed to show any benefit in preventing influenza.

A new influenza vaccine with an updated formulation is produced every year, to ensure that Australians are given the best possible protection. The vaccine protects people against three strains of influenza which the WHO identifies as the most likely to cause outbreaks for that season.

For most parts of Australia influenza vaccination is best carried out in the autumn, before serious outbreaks begin to occur. The majority of infections occur between July-September. In the far north of Australia influenza outbreaks can occur early in the year and vaccination should be practiced as early as possible. No vaccine is 100% effective. However, clinical trials have shown that influenza vaccination is very effective in protecting against the severe consequences of infection. In healthy adults the vaccine has been shown to be 70-90% effective in protecting against infection.

Influenza is highly contagious and can be spread for up to a day before symptoms appear and for five days afterwards. Ways to avoid spreading influenza include:
Wash your hands regularly
Cover your nose and mouth when coughing or sneezing
Avoid physical contact with others
-Avoid mixing with other people, particularly those in a high-risk category, while contagious
Don't return to work early, you could still be contagious
Antiviral medications that can limit the effect of influenza if they are taken early after onset of symptoms (within the first two days of the illness) are available on prescription. Therefore, it is important that you see your GP immediately if you believe that you are suffering influenza and wish to reduce the duration of your illness.

We spoke with Professor Robert Booy a Paediatrician about the severity of influenza:

Is Influenza is more than a flu-virus?

Professor Robert Booy : There are a host of different virus that make us unwell, most people just call it the flu, that is really unfair on Influenza because it tends to be much more severe than most other virus. A standard variety virus will give you a snotty nose, a sore throat and a cough and a little bit of a temperature, you are more likely to get a high temperature with Influenza and feel very unwell, so unwell that it is hard to get out of bed. You will also have muscle aches and pains and headaches, whilst feeling generally unwell.


How long does the average case of Influenza last for?

Professor Robert Booy : In children they are often having the infection for the very first time it can last for a whole fortnight where they are unwell and able to spread the virus to other people. Where as adults are generally only unwell for a few days or a week because we tend to have some cross-immunity having had a previous flu infection. You could be unable to get out of bed for a couple of days or for a whole week.


Are you surprised by the recent results?

Professor Robert Booy : Well no, I'm not surprised because the vaccine is not a routinely recommended vaccine, it is halfway there as it is recommended but it is not paid for. When it becomes paid for, probably in a couple of years, we will receive much better vaccine update. At the moment almost all the vaccines that children have are paid for by the government, but influenza is not in that category yet, they have to do a bit more research, which may take another year or so. Then it may go into a paid for category, then we will see a much high vaccinated rate.


How important is the vaccination?

Professor Robert Booy : It is very affective. It is the most affective way of preventing influenza. Healthy lifestyle and all of that is good for you, but it is not very affective in regards ot the flu because it is something that is passed between humans very easily, it is very infectious.

At the moment the people who are strongly recommended to have the vaccination is everyone over the age of 65, people of Aboriginal background over the age of 50. As well as anyone else who has a chronic medical problem, perhaps they have severe asthma, or a problem with their heart or diabetes or kidney failure. If you have chronic health problems, at any age, you should have the vaccination. Children are at increased risk so there may be a recommendation for children within the next two years.


Is Influenza most common in the season of winter?

Professor Robert Booy : That is correct.


Can this be prevented, if so how?

Professor Robert Booy : A good diet and healthy lifestyle as well as the vaccination. Another thing you can do is if you are aware of someone who has symptoms such as a cough, a fever and a runny nose, you don't expose them to children. Isolate those with the symptoms. Also effective is washing your hands often and this will prevent all types of infection. If you have to be exposed to someone who is coughing and sneezing, wearing a mask will help you. It may be difficult for a child if their parent wears a mask but if they can still cuddle them with a mask that will be effective.


Where you surprised that remedies such as vitamin C and Echinacea failed to show any benefit in preventing influenza?

Professor Robert Booy : They don't make much of a difference.


Brooke Hunter