Transcription:
Flu Fears and Facts: An Update on This Year’s Intense Flu Season

Melanie Cole (Host): Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different and according to the Centers for Disease Control and Prevention, this year’s flu season is off to a fast start and early indications suggest that it may be more severe than previous seasons. My guest today, is Dr. Fahd Ahmad. He’s a Washington University Pediatric Emergency Medicine physician at St. Louis Children’s Hospital. Welcome to the show, Dr. Ahmad. Explain a little bit about this year’s flu season. How would characterize what’s going on around the country?

Dr. Fahd Ahmad, MD (Guest): Thank you for having me and unfortunately, we are seeing a particularly severe flu season and here in St. Louis apparently, we are seeing it harder than most. We have run into a season where the flu strain that is circulating predominantly is more severe than what we often see, so it’s causing more severe illnesses. We are seeing children and adults get more sick than in prior years. and unfortunately, the vaccine which is being used widespread is sort of at a similar level to prior years, is not as effective against the most common strain, the one that is causing the most severe illness. So that is driving a lot of high levels of illness, and it is passing from person to person very quickly and because the vaccine for this particular strain that we are seeing the most isn’t very effective this year; it’s causing more severe illness and spreading faster as people can’t really contain it themselves within their own immune system.

Melanie: So as the vaccine is not working as well as it has done in past years; what makes this year’s flu so different than past seasons?

Dr. Ahmad: So, the problem is when they create the vaccine, they are trying to sort of guess months in advance which virus strain is going to be circulating so they can match up the vaccine. They can’t make us a vaccine that protects against all the strains, so they try and give us a vaccine that protects against the three most common strains that are going to be going and two of the strains have matched up pretty well and actually two of those strains are getting decent protection from the vaccine. The problem is, the particular strain of the H3 version that’s out there right now was not really well matched up with the vaccine and this particular version of the flu virus that the vaccine doesn’t do a lot for this year, by itself is already a little bit more severe. It spreads from person to person easier. It makes the person who gets it more sick and so people that are getting that version of the flu are having more problems compared to those who are getting the versions that the vaccine covered. And so, it is making them more dehydrated, longer fevers, more potential need for hospitalization and unfortunately, we have already seen more severe illnesses and even death in both younger children and adults.

Melanie: So, should parents and children still get their vaccinations? Is it too late in the season?

Dr. Ahmad: They absolutely should be getting their vaccine. It is not too late. There are plenty of places to still go, both your regular physician as well as walk-in clinics around the cities and the country that you are in, counties you are in may have plenty available. And there is more than one reason to do it. Even if you end up getting the flu and even if it is the strain that is causing more severe illness, while it may not prevent you from getting sick, it is still - looks like it is being shown to make the illness you get, not as severe, so having any immunity to any type of flu still helps protect a little bit and so in a little kid, or someone with a chronic illness, that can make a huge difference. And even if you don’t have a child or a chronic illness, even if you are a healthy adult; going from being sick for four or five days to maybe two or three days is a huge difference. And that’s just for those who get sick with the more severe strain, it still does protect reasonably well against a couple of the other stains that are circulating. It could help you not get sick at all and ideally the best-case scenario is it really prevents the severe illnesses, the severe hospital stays and hopefully prevent some deaths whether you are a child or an adult.

Melanie: Dr. Ahmad, as you are an emergency medicine physician, can you elaborate on the influx of patients needing emergency care this season and what are you seeing that is the most common complication?

Dr. Ahmad: We are seeing a very high volume of children come to our emergency department and I think the same is happening around our city, around the county, around the country whether you are vaccinated or not, we are still seeing many children get the flu, but most of the ones that we are seeing who get severely ill didn’t get the vaccine. So, we are seeing a high volume of kids with the flu. Many of them are coming in with high fevers 102, 103, 104 occasionally even 105. Certainly the common stuff you would expect with bad cough and colds or a runny nose, occasionally kids with GI upset kind of problems and those who have chronic problems like asthma, tend to suffer the most because when you get the flu and you have a chronic respiratory problem like asthma, or any kind of chronic lung issue of any kind; the flu virus can set that off and get you pretty sick from your underlying problem as well. And so, we are seeing not only a lot of children just come in because they are so febrile at home that the parents can’t control it and kids are miserable. Then we are seeing some kids whose underlying illnesses and medical issues are becoming worse and needing hospitalization to get more support.

Melanie: Have we reached the peak yet?

Dr. Ahmad: So, we are probably at the peak right now. It is possible the peak is starting to go down, what we don’t know is how long it will take to go down and when the bottom will come. So, while it’s perhaps just starting to go down a little bit, it is not quickly, and I would expect we are going to be seeing people with the flu for a while longer.

Melanie: So, what would you like pediatricians to know so that they can advise their patients about if their child is sick, about bringing their child in to the pediatrician’s office versus the emergency room, what red flags to watch for. You know parents are always nervous about the fever and how high should it go before you start to really worry? What do you want other pediatricians to know on how to counsel their patients on this?

Dr. Ahmad: I would guess that most pediatricians probably actually already have a pretty good handle on this approach because it’s going to be somewhat similar to what they handle every year with the flu whether or not the vaccine is effective or not or any child who is having severe illness with asthma or anything else, pneumonia, whatever it may be. And it still comes down to the basics. While we are sort of in a unique year with how severe the flu is, what’s not unique is the precautions you take and what you look for. So, the precautions are still the pediatricians know to try and get their patients vaccinated when possible. It they have abilities to do outreach to patients who haven’t come in and certainly we would love for them to try and reach out to them if they have that resource or if they are seeing them for another reason if they come in for some other injury with an ankle strain, try and get the vaccine while they are there. Take every opportunity you can. Even in the ER, we are trying to occasionally give flu vaccines when possible to kids coming in for other reasons. But when it comes to when the child needs to come to the emergency department versus go to their pediatrician versus stay home; I think some of that from pediatricians’ standpoint and the family standpoint is sort of what you would expect. I think if a child having a very high fever, if you can’t control it for the first one or two days, with the over the counter medicine and the child is getting dehydrated because you think they are not drinking enough and a child in diapers if they are only peeing two or three times a day, that child needs some medical evaluation. And it’s always I think okay to call the pediatrician first if you are unsure, if you think the child may be able to go to your doctor first and they are open, call them. And a lot of them will fit you in and a lot of our pediatricians are very accommodating and will see their own patients same day, if possible. But if you are worried that your child is severely dehydrated or having a significant amount of trouble breathing, if they have asthma and their asthma is flaring up or something else is going on, and you can’t control the symptoms at home; or they are getting worse quickly, that’s what the emergency department is for. We are always there. We are always open and if a pediatrician has a question or call we take phone calls from them. I talk to our community doctors all the time to give advice or help them decide when a child needs to come or if a child is already here, when to follow back up with their doctor.

Melanie: How long are they contagious? If someone does come down with the flu, how long should they really stay out of the public health area?

Dr. Ahmad: They can be contagious for several days. The fever alone can last four or five days for many children and the coughing can often last a while longer even when they are feeling a lot better. We don’t necessarily say they should stay home until the cough is gone because a lot of the cough after the virus is gone is just from irritation. But generally, you want to stay home until you are fever free for at least a day and ideally if you are actively coughing significantly having flare ups of your underlying medical problems and still needing fever or pain medicine, then you probably should stay home particularly if you have a child and if you have a child and you are sending them off to daycare because it is very contagious and it will spread very easily from person to person and if you are adults, try not to go to work. We have already had two of own physicians from our group get sick with the flu and they are definitely vaccinated and taking all the precautions and they were still exposed and unfortunately, got ill.

Melanie: What’s the best way to protect young children that are too young to receive the vaccine?

Dr. Ahmad: Well we don’t say to put them in a bubble, but I say do a lot of hand gel. Keep them away from other sick children. If you already know that there is an outbreak of something in your daycare and other children coming in with low grade fevers and coughs and colds, we don’t say keep them home when they are healthy, but just recognize that that is going to be a potential site of exposure and if you have other children in the home and a lot of our families do, they have more than one child; the older child will bring something home and there’s a baby at home and maybe they are playing together, maybe one – the little kid is eating food off the big kid’s plate or the big kid is touching the little kid’s toys. As much as you can keep them separated when one child is sick the better until the more severe symptoms are past. Because it is going to spread really easily in the same household when you are in a small room close together.

Melanie: What about some of the myths that people hear about vaccinations and the flu? How do you recommend that pediatricians debunk some of these myths and get the word out to as many people as possible?

Dr. Ahmad: I think that it is an ongoing challenge that every pediatrician in the community and in the hospital setting faces. The first thing I usually do when I am talking about vaccines with patients in the emergency department is to talk about not just the data but my own experiences. I have three children, I have three boys and the youngest is one year old and all three of my children as well as my wife and I get the flu vaccine as well as the other vaccines we can because most of the myths that are out there in terms of what being injected, concerns about mercury levels, concerns about live viruses or other more severe things they are not true. A lot of people are concerned about mercury levels in flu vaccines and there is such a small amount that it is actually really not even harmful and in some vaccines, you actually can get a flu vaccine with no mercury, if you are really that worried. The injectable vaccine has no live virus, it is all dead. You cannot get the flu from the flu vaccine. You may get achy for a day or two, but that achiness that you get is going to be far, far, far less than actually getting the flu. And you are not die from getting the flu vaccine. Whereas getting the flu itself, could make you severely ill and require a hospital stay. And that doesn’t really happen or if it does happen with the flu vaccine, it would be from an allergic reaction which is also incredibly uncommon. So, I think we have a lot of parents who are very well meaning and well concerned and just don’t want to expose their child to something that they are worried could be harmful, I don’t think there is any poorly intentioned parents out there. I think they just need to understand that some of what they are hearing out there as you say is a myth and that there is not only good science, but there are also lots of personal stories as well of many people that got ill and severely ill without the vaccine who may have been able to be saved or not get severely ill had they gotten it.

Melanie: So, in summary, Dr. Ahmad, what else do you think is important for pediatricians and other healthcare professionals to know about this year’s flu and when to refer?

Dr. Ahmad: I think keep in mind that this year we are seeing children get sicker faster and seeming to stay a little bit sicker a little bit longer and so despite how many patients you are seeing and how many patients we are seeing, we as an ER are an available resource and if you are worried that you are seeing a patient in clinic or you are talking to them on the phone and based on what you are hearing or seeing you are pretty concerned about how severely ill they are, that they might be dehydrated or need something that can’t be managed at home; go ahead an give us a call and we will certainly support whatever you or your patient needs. And whenever you do talk to the families, if you are talking with them and they haven’t received the vaccine in their home and their child is well enough to get the vaccine, try to get them the vaccine whenever you have the opportunity as long as the child isn’t so severely ill that they can’t take any vaccines. We would say go ahead and get it whenever you can and I think continue to push the things that our doctors in the community know are important, you know staying away from other sick people, and push fluids and good hygiene practices are going to continue to be the kind of most basic components we can do to help prevent the spread of it the rest of the season.

Melanie: Thank you so much for being with us today. It’s such important information. A physician can refer a patient by calling Children’s direct physician access line at 1-800-678-HELP. That’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital you can go to www.stlouischildrens.org that’s www.stlouischildrens.org . This is Melanie Cole. Thanks so much for listening.