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An Update on the Flu Season- Things Have Gotten Tricky

January 21, 2015 by Dr. Mindy Calandro

“Ask the Experts” is a new series on Baton Rouge Moms where local experts will share their thoughts, opinions and answer questions relating to health, wellness and parenting. If you have a question for one of our experts, please leave it in the comments below and they might just answer in an upcoming post.

Now that we are settled into the winter months, I have no doubt that you have heard a lot about, and maybe even had a run in with, influenza this year. There is news coverage on a weekly, if not daily basis, about the flu this year. Some of the headlines have read, “Mutated flu strain,” “Flu vaccine not effective,” and “CDC warns ‘severe’ flu season possible.” So how is this flu season shaping up and why is this season’s flu virus making so much news?

The CDC reports that there is widespread flu activity (their highest designated level of activity) across 46 states as of the week ending on January 3, 2015. Louisiana was one of two states that started with widespread flu activity beginning in mid-November, which is pretty early for such high numbers of flu cases. Something else to grab your attention…there have been 45 pediatric deaths so far this flu season with 19 of these deaths being reported in this past week!

So now let’s talk about some of the big questions with regards to this year’s flu season.

“How do viruses mutate?”

Viruses are tricky little creatures, and one thing they are really good at is mutating. As a virus replicates, it can make changes to its structure so that the virus then looks different than it did before. There can be small changes to the structure of the virus that is analogous to people changing accessories or wearing sunglasses, which is known a “drift.” It is this drifting that allows viruses such as the common cold to make small enough changes that your body doesn’t recognize the virus right away, and therefore, allows you to get a cold more than just once. Then there is “shift” which occurs when the entire protein structure of the virus changes. When big “shifts” occur in particular viruses, it is like the virus has a complete facelift and is unrecognizable to the body. This is what occurred with the H1N1 Swine flu pandemic in 2009.

“So is this year’s flu strain ‘mutated’?”

Each year there are several strains of influenza that circulate and cause illness. The predominant strain of the influenza A virus that is circulating this year is an H3N2 drift variant strain. Now, H3N2 viruses are not new to the flu scene, but the specific “accessories” that this strain is wearing, if you will, is what makes it different. Scientists began seeing this “drifted” influenza strain in March 2014. The problem with the flu virus waiting until March to make this change? The flu vaccine was created in February 2014.

“Is this drift variant strain of the flu more severe than other strains of flu?”

Historically, when you look at past flu seasons that have had H3N2 strains of the virus, those flu seasons have been pretty significant. The 2012-2013 flu season had an H3N2 predominant strain, and that was the season where we saw 171 pediatric deaths. This was the highest number of deaths within the past decade except for the 2009-2010 which was the year of the H1N1 Swine flu pandemic. So far this year, the CDC is reporting slightly higher numbers of hospitalizations from flu related illnesses and complications compared to the past several years.

“I have heard the vaccine doesn’t work this year. Is that true?”

Production of a vaccine is not something that can occur overnight, and in order to manufacture the millions of doses of flu vaccine that are needed in this country, the work has to start early. Scientists study the strains of flu viruses seen during the prior flu season as well as flu strains reported around the world to try and determine what strains of the flu should be included in the vaccine. The final decision on what strains to include in the vaccine must be made in February preceding the flu season. Since the flu virus is ever changing, drifting, and shifting, this is like predicting hurricanes months in advance or who will play for the college football championship 6 months before college football even starts! Sometimes the predictions are correct and sometimes they are not even in the right conference by the time the games are played!

The H3N2 drift variant strain was the hiccup in this year’s prediction model. Since this H3N2 strain of flu did not even show up in the US until March, it was impossible for scientists to know that it would need to be included in this year’s flu vaccine.

“Does that mean the flu vaccine is useless this year?”

No! I still recommend for everyone 6 months and older to receive their flu vaccine this year. While the H3N2 drift variant is not included in the flu vaccine, the flu vaccine will still protect you from 3 or 4 other strains of the flu virus (depending on if you get the trivalent and quadrivalent vaccine). The flu vaccine is a good match for strains of influenza B that we are seeing, although influenza B generally only accounts for about 10% of flu cases each year. Also, for children who have received the flu vaccine and then get the flu, they are typically sick for a shorter period of time and have less severe symptoms.

Hopefully, this has answered many of your questions about what is turning out to be a very active flu season. For the most up to date information on flu statistics, you can visit the CDC website at http://www.cdc.gov/flu/index.htm. Also, you can check out my website at themommydoctor.com or send me an email at mindy@themommydoctor.com if there are other specific flu related questions you may have.

Hello Again Influenza!

November 24, 2014 by Dr. Mindy Calandro

It is November and with Mother Nature giving us a few tastes of winter weather, it can only mean one thing…the flu season is upon us once again. In fact, the flu is here with a vengeance as I have seen numerous cases of flu in my office especially within the past week. Therefore, it is important to start talking about how to protect children as well as adults from getting the flu. The flu is, of course, a virus that causes fever, cough, nasal congestion, runny nose and body aches. During the 2013-2014 flu season, the peak of flu activity across the country was from December through February, and the Center for Disease Control (CDC) confirmed 108 pediatric deaths in the US due to the flu last year.

The current recommendations from the CDC as well as the American Academy of Pediatrics (AAP) is for everyone 6 months and older to receive the flu vaccine. The very young, those children with underlying lung problems such as asthma, people with low immune systems, as well as those who are pregnant are at highest risk for the more serious complications from the flu. Even if someone received a flu vaccine during the 2013-2014 flu season, it is important for them to have the vaccine again this year. Flu vaccines generally provide immunity from the flu for only short periods of time, somewhere between 6-9 months, which is why it is critical to receive a vaccine each fall.

There are two flu vaccines again available this season. The trivalent vaccine protects against 3 strains of the flu while the quadravalent vaccine protects against 4 strains of the flu. It should be noted that both vaccines protect against 2 strands of influenza A virus, which accounted for almost 90% of positive flu cases across the country last year. The flu vaccine comes in two forms…a shot and a nasal spray. For those 2-49 years of age who are otherwise healthy and are not pregnant, the flu mist is recommended. In fact, based on recent studies showing improved efficacy of the flu mist in children 2-8 years of age, the CDC is now recommending the nasal flu vaccine over the shot for that age group. If your child is under 2 year of age or any child with a history of wheezing or asthma, someone with a lowered immune system or if they are around someone with a very low immune system, then the flu shot is recommended over the nasal spray.

So what are the side effects of the flu shot and flu mist? The most common side effects seen with the shot include soreness or redness at the injection site, fainting, headache, and muscle aches. As for the nasal mist, children can have mild runny nose, sore throat, or cough that usually lasts 1-2 days. One very rare side effect called anaphylaxis is an acute and severe allergic reaction that would occur within 1-2 minutes of receiving the vaccine (so while you are still in the doctor’s office). It is estimated that anaphylaxis to a vaccine occurs in less than 1 in a MILLION doses. For those people with a history of significant egg allergy or those with a history of Guillain-Barre syndrome (GBS), which is an acute, paralyzing neurologic illness, they should talk with their doctor before receiving the flu vaccine.

There are certainly myths out there in regards to the flu vaccine. Getting the flu shot cannot give you the flu! The shot is inactivated flu, meaning there is no live virus present, so there is no way to become sick with the flu from the shot. The nasal spray is a live virus vaccine but the virus is attenuated, meaning it is a much weakened version of the flu and can therefore NOT cause the true flu. This weakened flu strain that is present in the flu mist is “cold-adapted” which means it cannot cause any type of infection in warm places like the lungs.

It should be noted that it takes your body about 2 weeks from the time you get your flu vaccine to make the appropriate antibodies against the flu, so you are just as susceptible to the virus during that time period. Also there will always be “breakthrough cases” of the flu in those people who have gotten the flu shot. This is because the vaccine is not a 100% guarantee. However, in my experience and from surveillance studies, those children who have gotten the flu vaccine and still get the flu virus, are less ill and have the illness for a shorter period of time.

So while you are heading out to stock up on warm winter clothing and preparing your home for the holidays, make sure to protect your children and yourself from the guest who didn’t receive an invite to Thanksgiving dinner…the influenza virus.

What concerns me more than Ebola…a pediatrician’s perspective

October 3, 2014 by Dr. Mindy Calandro

As many of you probably already know, the first case of Ebola diagnosed on US soil occurred on September 30, 2014 in Dallas, Texas. Ebola…the word alone is frightening and likely conjures up images ranging from people in hazmat suits to scenes from the movie Contagion. But guess what? There are viral illnesses out there that scare a doctor like me far more than Ebola does.

What you should know about Ebola.

I think the most important thing for people to understand about Ebola is how this virus is spread. Unlike the common cold or the flu, Ebola is not spread through the air. The only way to contract Ebola is by coming in contact with bodily fluids (i.e. sweat, tears, blood, urine, or feces) of someone who is having symptoms of the illness. If an infected person is having no symptoms such as fever, vomiting, diarrhea, or bleeding, then they cannot spread Ebola.

There are countless reasons why we are fortunate to live in the United States of America, and in this case, our highly advanced and well equipped health care system is one of those reasons. The countries of West Africa that have been ravaged by Ebola are some of the poorest countries in the world and have very limited medical resources. In fact, there are not even enough hospital beds for the number of sick and dying Ebola patients right now in those countries. We are lucky to have hospitals that have isolation rooms that can keep a patient diagnosed with an illness such as Ebola away from all other patients. We have the benefit of the Centers for Disease Control (CDC) with countless doctors and scientists who are casting a huge net to find anyone who may have had contact with any infected people in the US so that we can prevent the spread of this disease further. I am confident that our health care system will prevail over Ebola. To find the most up to date and reliable information on Ebola, visit http://www.cdc.gov/vhf/ebola/index.html.

So let’s talk about those viruses that give me so much more worry than Ebola. The flu and respiratory syncytial virus (RSV)…the “seasons” are fast approaching. Both of these viruses cause significant disease in thousands of children each year in this country. Last year alone 108 children died from the flu – now that gets my attention. Both the flu and RSV are spread through the air by respiratory droplets, meaning through coughing or sneezing. The flu can affect children and adults of any age, and while it can cause significant disease and even death in healthy children, the youngest children and those with underlying lung or immune problems are at highest risk of severe complications of the flu. RSV is typically an illness of the very young as most children will have had RSV by their second birthday. Those infants who were born prematurely and those with lung or heart problems are at the highest risk for serious illness when they have RSV.

How to help protect children from Flu & RSV

What can we, as parents, do to protect our children from these much more common and prevalent viruses? In regards to the flu, the answer is simple…get your kids the flu vaccine. It is recommended that all children 6 months an older receive a flu vaccine every year. Even if your child had a flu vaccine last year, they need another one this year. The flu vaccine provides immunity to the flu but only for a short period of time, about 6-9 months, which is why annual vaccination is important. If your child is 6 months to 8 years of age and it is their first year to receive a flu vaccine, they will need two vaccines separated by 4 weeks. For those children 2 years and older who are otherwise healthy and have no history of asthma or wheezing, then the intranasal flu mist is recommended. For those less than 2 years of age, anyone with a history of asthma or wheezing, or those with a lowered immune system, then the flu shot is the only option. The peak of flu season is generally from December to February, so it is important to get the flu shot early, typically late September or October, so that the immune system has time to build the appropriate response to the flu virus for the season.

When it comes to RSV, prevention of the illness really focuses more on good hand washing and trying to limit the spread of germs by encouraging children to cover their cough and sneezes and not sharing drinks (or toys) with those that might be sick. For a VERY select few infants and children, namely those born before 29 weeks gestation, those with significant cardiac disease and those with chronic lung disease, there is a vaccine called Palivizumab, or Synagis, that aims to prevent RSV. Since this vaccine is very expensive, the criteria to qualify for this vaccine are very stringent. If you think your child falls into any of the above categories, you should talk with your child’s pediatrician to see if they might qualify for this vaccine.

So while the media will continue to camp out on the lawn of Texas Health Presbyterian Hospital in Dallas, Texas to bring us “breaking news” updates in regards to Ebola, I hope this article helps you to put the risk of Ebola vs other viruses into perspective. Let us not forget about the fast approaching flu and RSV seasons which are guaranteed to bring significant illness and unfortunately, even death, in the coming months.

Enterovirus D68 – What Parents Need to Know

September 17, 2014 by Dr. Mindy Calandro

As many of you have probably heard on the news or read about on the internet, there is a respiratory virus that is rapidly spreading across the country. The virus is called Enterovirus D68 (EV-D68). According to the most recent data from the Center for Disease Control (CDC), the virus has been documented in 130 children across 12 states from mid-August until September 16, 2014, and Louisiana is one of those states. In fact, two cases were confirmed here in Baton Rouge in recent days.

What are the symptoms of Enterovirus D68?

As with other common cold viruses, EV-D68 typically begins with runny nose, cough and sometimes fever (the majority of cases have not had fever though). This virus differs from the common cold in that these initial symptoms rapidly progress in some children to cause difficulty breathing and wheezing. Children with a history of asthma are probably more likely to have these more severe symptoms, but many documented cases of wheezing have occurred in children who have never had prior wheezing episodes.

How is the Enterovirus D68* spread?*

EV-D68 is spread by respiratory droplets meaning coughing, sneezing or saliva. It is important to have good hand hygiene and wash hands thoroughly with soap and water throughout the day especially prior to eating or after coughing or sneezing. It is important to note that alcohol based hand sanitizers do not rid the hands of this virus. If your child is sick with cold symptoms, they should not be around other children especially in the daycare or school setting. Finally, disinfect frequently touched surfaces such as toys or doorknobs especially if someone has cold-like symptoms.

Who needs to see their doctor if they are having the above symptoms?

For those children who have a cough and runny nose but are otherwise happy, playful, eating well and sleeping well, close observation by parents is all that is required. In many cases, your child probably has a “typical” cold virus. However, if your child has a history of asthma or of needing breathing treatments or if they are having a first time occurrence of wheezing, then I recommend erring on the side of caution and bringing your child to their doctor sooner rather than later. Any child with difficulty breathing needs to have immediate medical attention.

Is there a test for Enterovirus D68?

Unlike flu test or strep test, there is no rapid test for this virus. This means that doctor’s offices and most emergency rooms cannot rapidly test for EV-D68. For those children that are hospitalized with symptoms, a nasal swab can be obtained and sent into the CDC for specific testing for this virus. Again, because this is a specialized test, it is not something that can easily be done in your doctor’s office.

Is there a vaccine for Enterovirus D68?

No, at this time there is no vaccine for this virus.

What is the treatment?

Given that EV-D68 is a virus, the mainstay of treatment is symptomatic care. Most children will require rest, increased fluids, and close observation. For those children who may have more severe respiratory symptoms such as wheezing or difficulty breathing, breathing treatments, supplemental oxygen, and hospitalization may be required. This, of course, can only be determined by your child’s doctor. Antibiotics will not help with EV-D68 because it is a virus.

In conclusion, any outbreaks of illness that predominately affect children can be scary for parents, and I think that sometimes media coverage of such illnesses can further increase the anxiety parents might be feeling. The most important thing that we as parents can do in situations such as this is arm ourselves with the most up to date and scientific based information so that we can provide the best care to our children. For more information on the EV-D68 outbreak, visit http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html or http://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Reports-of-a-Severe-Respiratory-Illness-on-the-Rise.aspx