Why didn’t the doctor test or treat my child for flu?

Summary:     

1. Most children who have a flu-like illness do not require antiviral medications  for flu. Children and adults who have a flu-like illness and who have high risk medical conditions should be treated with antiviral medications. For high risk patients who are not hospitalized, these medications should be started within 48 hours of the onset of the illness if they are going to have any significant effect .

2. Current rapid tests for flu are inaccurate and are generally not recommended in outpatients. More accurate tests are available for patients who are sick enough to be admitted to a hospital, but results may take several days to return .

 

Many parents are concerned about their child’s health and safety during the curent H1N1 pandemic. Not surprisingly, some have taken their child to a clinic or emergency department for evaluation of  fever, fearing that it could be due to Swine Flu. Here are a few points to help parents understand why some children are treated for Swine flu but most are not.

When H1N1 “Swine Flu” appeared in May 2009, the first sketchy information received by flu experts and public health authorities caused them to believe Swine Flu was going to be very deadly, much worse than the yearly seasonal flu. In response, there were a number of recommendations made regarding testing for flu, closure of schools, and treatment of anyone who had confirmed or suspected Swine Flu. It was appropriate to make those recommendations until we had more information about this brand new virus.

Since those early days of the pandemic, we have learned a lot more about swine flu. We now know that it is not as deadly as was initially feared. It is true that a large number of people have died throughout the United States, but no more than during seasonal flu outbreaks that we have every winter. In fact, this form of flu may be less deadly than our yearly seasonal flu.

The antiviral medications that are effective against Swine Flu are oseltamivir (Tamiflu) and Zanamivir (Relenza). As is true for all antibiotics and antiviral medications, if we use them too much the bacteria and viruses figure out how to defeat them. If that happens with Swine Flu, we will have no medications left to treat patients with flu. In addition, studies in children have shown that for the average child with flu who is not hospitalized, the antiviral medications do very little to help. The studies have shown that these medications only reduce the duration of the illness by 12-36 hours. So, instead of being sick for 5 or 6 days without antiviral medications, the child is sick for 4 or 5 days with antiviral medications.

This additional information has caused the national experts on flu to change the recommendations in an effort to preserve the effectiveness of the antiviral medications and to reduce unnecessary use of these expensive medications. The current recommendation is to treat non-hospitalized patients for flu if the patient has flu symptoms (fever PLUS cough or sore throat), has had symptoms for less than 48 hours, and has a high risk medical condition. Patients who do not have fever or who have symptoms of other infections also should not be treated for flu.

These recommendations are based on symptoms, not on the result of a flu test. If a patient has flu symptoms during a time when flu is known to be circulating and has a high risk medical condition, he or she should be treated with antiviral medications. The result of a flu test doesn’t  change that. If the child has flu symptoms but does not have a high risk medical condition, he or she should not be treated, even if a flu test is positive. Since the flu test does not change the recommendation, the flu test is unnecessary in most cases. In addition, studies have shown that the currently available rapid tests for flu are highly inaccurate and tend to miss many cases of H1N1.

During times when flu is not circulating, such as during most summers, patients with flu-like illness are highly unlikely to have influenza infection, so neither tests for flu nor treatment for flu are warranted.

Patients who are sick enough to be admitted to a hospital for flu complications are treated differently. They are tested as a way to keep tabs on the pandemic. That test is very complex and results often take several days to be available. Patients admitted to a hospital for flu are also treated with antiviral medications even if they have been sick for more than 48 hours.

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2 Responses to “Why didn’t the doctor test or treat my child for flu?”

  1. Don

    Just a couple of questions: 1) Why is it, more people actually get sicker in Winter vs. Summer. A report last year said that it’s not based on temperature so what’s it based on. 2) The study that was conducted of H1N1 cases of people that have died, I think, was not based on the number of people that contracted the disease, but actually the total population. I think that doctors and hospitals (no offense) are actually down-playing the severity of the issue. The people don’t trust the vaccines, they don’t trust the information that’s being published (because to us the virus is new), and they don’t trust the goverment drug companies because they see it as a way to keep them in business. So should we be afraid of this virus?

    #7
  2. admin

    It is unclear why flu is more common in the winter. However, seasonality is not unusual for infectious diseases. For instance, enteroviruses tend to circulate in the summer (vomiting, diarrhea), and Croup tends to occur in the fall. Nobody knows exactly why.

    The new CDC model is a way to estimate the true number of infections, hospitalizations, and deaths due to H1N1. Most people who are infected are not tested, since the test is so difficult to obtain. Even if the test is done, many may escape detection becasuse the tests we use require that virus is still shedding from the patient. The tests detect the virus directly. However, in many cases viral shedding stops at about day 5-7 of infection. If you test after viral shedding stops, the test will be falsely negative; it will fail to detect the infection. If someone has H1N1 and then develops a complication such as bacterial pneumonia, the complications often don’t show up until day 5, 10, or later. If they aren’t tested until after shedding has stopped, the tests will “miss” them. The CDC model is an attempt to estimate how many we have “missed” in each category so we can get a better idea of the true impact of the pandemic.

    It’s ironic to hear that you believe doctors and hospitals are downplaying the pandemic. Most of the criticism leveled at public health authorities and the medical professionals is that we have been too aggressive in alerting the public to the dangers of a pandemic. It is truly a balancing act. If this bug had turned out to be as bad as in 1918 we would have been roundly criticized for not “doing more” to alert the public. We at G-LINE, as well as the people in state public health and the CDC itself are trying to give accurate, balanced information without sounding hysterical.

    There are some who don’t “trust” the vaccines. That’s a carryover from the 1977 Swine Flu debacle, when a vaccine was rushed to the public in an effort to avert a major pandemic. That pandemic never developed; there were only a few cases. But the vacccine was very loosely associated with some bad outcomes. No flu vaccine since then has had problems like that. The data are quite clear with regard to flu vaccine. If you get a well matched vaccine (the H1N1 vaccine is well matched) then you are highly unlikely to become infected with flu. If you don’t get the infection, you can’t die from it. People have to weigh for themselves the risks vs the benefits of getting the vaccine. I believe the benefits far outweigh the risks.

    I’m not sure what you mean by “government drug companies”. The pharmaceutical companies are private companies; there is no such entity as a “government drug company”. All companies make products to sell, with the ultimate goal to make profits. That in itself doesn’t mean their motives are underhanded or evil. The profit incentive is what drives commerce, and provides such a massive array of choices for consumers. If you don’t want to buy their vaccine, don’t. If you are unsure about the quality of a product, look at independant assessments in such places as Consumer Reports for regular products and in medical research articles for products like vaccines. The vaccine literature is broad, and is a great source of information. Just be sure to check in the article for who funded the research. If it was funded by the same company that makes the product in question, I would be wary of the report. If the study was funded by a foundation, or NIH, or another independant group, the research should be able to stand on its own merits.

    No, you should not be “afraid” of this virus. If 20 million have been infected and only 4,000 have died, then only one infected person in 5000 has died from this virus. That is a very low level of lethality, lower than for garden variety seasonal flu that we see every winter. More people have died in the past 6 months in auto accidents. However, that is 4,000 people who would today be alive if not for H1N1. For them, and for their families, H1N1 has truly been a disaster.

    #9

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cdc situation overview

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in graphical form in a report called FluView. See the latest update by clicking here.

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