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Yes, the so-called swine flu is out there and highly contagious. Yes, it can be deadly to certain people.
But if your otherwise healthy child has flu symptoms — cough, fever, sore throat — here's what the doctors at Arkansas Children's Hospital recommend:
Don't see a doctor. Unless your child is an infant, keep him at home. Don't bring him or her to the office or ER, because if your sniffling child doesn't have flu before he goes to a clinic, he'll have it after he does.
Doctors at Children's have been seeing as many kids in the past several weeks as they do during seasonal influenza's spike in winter. High numbers are presenting with flu-like symptoms, and many parents are asking doctors if they'll test their children for the H1N1 virus they know as swine flu (or pandemic flu or novel flu). And many are surprised at the answer: No.
The test for swine flu that can be run at Children's isn't conclusive. To diagnose H1N1 flu in a child, “I could do as good a job by flipping a coin,” said Dr. Jose Romero, chief of pediatric infectious disease at Children's. That is, the odds the test will be correct are about 50-50. (The state Health Department is able to run what Romero called a highly-sensitive and accurate “Cadillac” of virus tests, but most hospital labs don't have that capability.)
There's been a lot of hype around the swine flu, thanks to reports of fatalities when it was first detected, its ability to spread quickly and its pandemic-happy combination of pig, avian and human virus DNA. According to the state Health Department, five Arkansans have died from swine flu. Children's has admitted 83 patients this month who presented with flu-like symptoms. Of those 83, Type A H1N1 was confirmed in four cases.
Nor would the results of that test affect the way the doctor would treat the child. “We make the diagnosis of influenza based on symptoms,” Romero said. If a child has certain risk factors — such as heart or lung problems, diabetes or is immuno-suppressed, for example — that child will get treatment with anti-viral meds Tamiflu (oseltamivir) and Relenza (zanimivir). Infants and children with other serious symptoms — such as difficulty breathing or not taking liquids well — should also be brought in for treatment.
But the otherwise healthy child will be sent home without anti-viral meds. The child will feel lousy for a week, Romero said, but with Tylenol, “tender loving care and mom's good cooking,” he or she will recover.
There's a downside to prescribing Tamiflu as well — flu bugs are mutating to resist the drug, just as bacteria have learned to outsmart our antibiotics. The number of resistant cases is still small — less than 1 percent, Romero said — but will rise as more people use the drug.
Children's is following Centers for Disease Control flu guidelines.
Dr. Joe Elser, a Children's clinician, said the doctors at Children's General Pediatric Clinic will prescribe Tamiflu only about 10 times during flu season.
An H1N1 vaccine is expected to be available by mid-October, though Romero described the date as a “moving target.” The vaccine for seasonal flu is available now. Kids should get both, Romero said. They can even get them on the same day, though he advises parents not to wait to vaccinate their kids against seasonal flu. Children's has a mist vaccine in stock now; it's a nasal spray of live, attenuated virus used in children age 2 and older. Younger children will get shots. Romero said the hospital will have enough vaccine to treat “several thousand” children. The hospital has requested an equivalent amount from the state Health Department of the H1N1 flu vaccine; kids will need two doses of that vaccine.
Arkansas Children's Hospital's website, www.archildrens.org, has an informative page on the flu that includes CDC guidelines, state statistics and videos, including “How to Sneeze” (answer: in the crook of your arm, not your hands).
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