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.
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.