Each flu season seems to have some kind of surprise in store for parents and pediatricians.
Last year, the big surprise was that we had such an early and intense flu season, in which 165 children died. Experts described it as the worst start to flu season in a decade. Before that of course, there was the emergence of swine flu and the swine flu pandemic.
The other big surprise last year was the early, widespread availability of flu shots and the availability of over 166 million doses of seasonal flu vaccine.
As flu season ended last year, the new surprise was the emergence of a new strain of bird flu in China, H7N9, which got more than 135 people very sick in China and caused 44 deaths. Fortunately, "the increase in case counts has fallen off from the month of April, when multiple cases were being reported each day." And "there is still no evidence of sustained (ongoing) human-to-human transmission with this virus and no cases have been reported outside of China." Cases have started to pick up again recently though, with four new cases in October.
Of course, the big surprise this year was the government shutdown and the news that the CDC would "be unable to support the annual seasonal influenza program." Fortunately, the shutdown is over, the "CDC has resumed analysis of influenza surveillance data and testing of influenza laboratory specimens," and after a few weeks of getting caught up, routine flu activity reports have also restarted.
Especially with the bad flu season we faced last year, parents should take steps to help avoid the flu and to keep their family from getting sick. In addition to getting a flu vaccine, this can include frequent hand washing, avoiding close contact with people who are sick with the flu, disinfecting contaminated surfaces, including toys and kitchen counter-tops.
Flu vaccine recommendations for the 2013-14 flu season didn't change from last year. Experts still recommend the vaccination of all people who are at least six months old. The availability of 138 to 145 million doses should make that easy too.
Also remember that children who are less than nine years of age, still need two doses of the flu vaccine if this will be the first time that they are getting vaccinated. Your kids might also need two doses if they are less than nine years of age and haven't had at least two doses of seasonal flu vaccine since July 1, 2010.
If your own pediatrician doesn't have flu shots, you might check with your local health department, hospital, or pharmacies, and find a flu shot wherever you can.
Flu Season Activity ReportsThe latest weekly flu report from the CDC states that flu activity "continues to increase in parts of the United States," including that there is already:
- regional flu activity in nine states (Alabama, Florida, Kentucky, Louisiana, Massachusetts, Mississippi, South Carolina, Texas, and Utah)
- local flu activity in thirteen states (Alaska, Arkansas, Colorado, Georgia, Maryland, Michigan, Minnesota, New Hampshire, New Jersey, North Carolina, Oklahoma, Virginia, and Wyoming)
- sporadic flu activity in just 27 states (Arizona, California, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, Nevada, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Washington, West Virginia, and Wisconsin), The District of Columbia, Guam, Puerto Rico
- only one states (Vermont) is still not reporting any flu activity
Keep in mind that so far, this season's flu reports are not unlike the flu activity reports that we saw last year, which ended up being an early and intense flu season. That is likely why the CDC is advising that "people who have not already gotten a flu vaccine for the 2013-2014 season should do so now."
Google's Flu Trends, which relates flu searches in an area to how many people are actually sick with the flu, is still reporting a low level of flu activity in the United States. Google Flu Trends is supposed to 'estimate flu activity faster than traditional systems.' It is a good complement for the CDC surveillance system, but is by no means a replacement, as we saw during the 2013-14 flu season, in which Google's Flu Trends greatly overestimated peak flu levels.
Knowing where there is flu activity can be helpful though, because if you have classic flu symptoms in an area where there are a lot of flu infections, especially widespread or intense flu infections, then you likely have the flu and should see your doctor right away if your child is a candidate for one of the flu medications, such as Tamiflu (oseltamivir) or Relenza.
Keep in mind that the FDA expanded the approved use of Tamiflu in 2012, at a dose of 3 milligrams per kilogram twice daily for five days, to treat children as young as 2 weeks old. As with older children and adults, Tamiflu is for those infants who have flu symptoms for no longer than two days. But unlike older children and adults, Tamiflu can not be used to prevent flu in infants.
Because of the increased demand for the oral suspension form of Tamiflu, as in past years, it was frequently on back order last year and was hard to find in many areas. Your pharmacist should be able to compound the 75mg Tamiflu capsules into a suspension for your child though in the event of a Tamiflu shortage. The CDC also states that "for those patients who cannot swallow capsules, the capsules can be opened and the contents may be mixed with chocolate syrup or some other thick, sweet liquid, as directed by a healthcare professional" who can figure out an age-appropriate dose for your child, perhaps by using the 30mg or 45mg Tamiflu capsules.
Each year, the flu is reported to be responsible for almost 36,000 deaths, including about 85 deaths in children. In the 2009-10 flu season, 281 deaths in children were reported to the National Notifiable Diseases Surveillance System.
There were 169 pediatric flu deaths during the 2012-2013 flu season.
There have already been 3 pediatric flu deaths during the 2013-2014 flu season.
The CDC has also reported that during last year's flu season:
- 90% of pediatric flu deaths were in children who had not received a flu vaccine
- 40% of the flu deaths were in children who had no underlying chronic health problems
- 40% of children had received a flu vaccine by mid-November
- this year's flu vaccine reduced a child's risk of having to go to the doctor by at least 60%
CDC. FluView. 2013-2014 Influenza Season Week 48 ending November 30, 2013
CDC. Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2013. MMWR. January 11, 2013 / 62(Early Release);1-4.
CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2013-14, MMWR 2013, September 20, 2013 / 62(RR07);1-43