The country is in the grips of the worst outbreak of influenza since the 2009 swine flu pandemic.
Mary Anne Jackson is at the center of the Kansas City area’s medical response as chief of the pediatric infectious diseases section at Children’s Mercy Hospitals & Clinics.
“This is, what I have told pediatricians, a bad winter season that we’re having right now,” Jackson said. “We’ve had some record census days here in our hospital at Children’s Mercy and we’ve set some records in our urgent care in terms of number of children that have been seen.”
The Star sat down with Jackson for a question and answer session about what parents should know to protect their kids. It has been edited for length and clarity.
Question? Is this year’s flu considered an epidemic or a pandemic and what does that mean?
Answer: It is an epidemic, and epidemics of influenza occur every single year. It’s something we can count on. A pandemic means it’s a major change in the antigen, in the germ itself. So, for instance, 2009 was a pandemic with a brand new strain nobody had seen before. This is not a pandemic year, but it is an epidemic year.
Q: If I haven’t gotten my child vaccinated yet, should I?
A: It’s really important to continue to vaccinate, especially during this season. The reason for it is this: There is not just one strain of influenza that’s circulating, and in fact there’s not just one strain of influenza that is causing serious disease, including death, particularly in the pediatric population I deal with. So even in children who have influenza right now, who are sick with the flu, if they have not been immunized we are recommending that they be immunized because the worst thing that could happen is for them to get a second bout of influenza due to a second strain. And then certainly for people who are un-immunized, we are recommending influenza vaccine. Consider this: the projected vaccine effectiveness right now is about 35 percent. But 35 percent is pretty darn good. If I told you there was a 35 percent chance you’d win the lottery if you buy a ticket, you’d buy a ticket. I say buy a ticket and get your flu shot.
Q: Is the Influenza A strain the one that should be more worrying than others?
A: Certainly it’s true that in Influenza A H3N2 years, we tend to see more serious disease. This year reminds me a lot of our 2012 to 13 season in terms of the H3N2 predominance, the high peak of disease and the severity of disease. But having said that, Influenza B is a bad virus, not only in the adult population (it’s one that has been associated with heart attacks in adults), but also in the pediatric population. A third of pediatric deaths so far are related to Influenza B. Here’s the important thing about that: in terms of the vaccine’s effectiveness, it’s better for Influenza B than it is for this H3N2 strain.
Q: You mentioned pediatric deaths. How worried should parents be?
A: Since 2004, the CDC (Centers for Disease Control) has tracked pediatric influenza mortality, or childhood deaths due to influenza. On average there are 100 per year. At this point, and we’re still pretty early in the season, there have been 30 deaths and that hasn’t been updated by the CDC since Jan. 13. The vaccine will modify (lessen) disease, prevent hospitalization and prevent death in children. For those who are not immunized, antivirals treat influenza. So, I don’t want parents to think, “Oh, my child is going to die if they get the flu.” Most children do not.
Q: We want to take kids to the right care at the right time. So what are the symptoms people should worry about? When should they go to urgent care? When should they go to the ER?
A: I think the first thing you have to do is look at your child and whether or not there are underlying conditions or other issues where the child is at higher risk for complications from the flu. So, children under 2 are at higher risk for complications, and those with underlying conditions (like) heart disease, lung disease, metabolic diseases, cancer, transplant, all the immuno-compromising conditions. And one condition some parents may not think about, but pediatricians do, is children who have underlying neurologic diseases, particularly neuro-muscular diseases or diseases where they have difficulty swallowing. For those children, when they get influenza, they have a particularly difficult time.
Secondly, what should you look for? In most infections fever is a good indicator. So we say, in general, fever over 101 (degrees) is worth noting. And then looking at other symptoms. It’s usually respiratory symptoms we’re talking about and the ability to eat, drink, sleep and play. If your child has no fever but they’re unable to drink, they’re not having wet diapers or they have labored breathing, they need to be seen. For children with high fever, who are continuing to be able to eat, drink and play at intervals, if it’s an older child, you can check in with your pediatrician’s office and ask them if this child should be seen. Certainly you want to access an urgent care where you know they have pediatric expertise. I think that’s really important. For a child who’s listless or has labored breathing, or certainly if they have any changes in their coloring, if they have gray or bluish tints, those children shouldn’t go to urgent care. They should be seen in an emergency room.”
Q: There’s stuff going around online about taking colloidal silver or other natural supplements to boost your immune system and beat the flu. Does any of that work?
A: Absolutely not. There’s no data at all that suggests that any herbals, any supplements, will treat influenza or modify the course of the disease. It worries me when I see this because it does dissuade some parents from following traditional medicine, from getting their child immunized, from seeking care if they think their child has influenza.
Q: What about apps like Kinsa and expensive thermometers. Are they worth it?
A: Every parent has to make a decision about what type of thermometer to use. They have to get one that they’re comfortable with, that they’re going to use, that their child will be comfortable with. (The) Kinsa (thermometer) has this advantage of downloading into your phone so it’s pretty fancy and for those who have (smart)phones and $50, it may be a good choice for them. Those strips that go across the forehead are not reliable. The ear thermometers, under the arm, rectal thermometers, oral thermometers, those are all going to be effective and most that you buy at the retail drug store are going to be reliable ways to measure the temperature of a child.
Q: If somebody at school has the flu, should I be worried as a parent?
A: Yes, we’re in flu season, you should be concerned if your child’s not protected. It turns out that school age children are the major vector for transmission of influenza in the community. In order to transmit influenza, though, it is believed to be transmitted by small droplets, so you really have to be up close and personal with that small child who may be infected, and then realize it’s not 100 percent of children who do get infected. But if your child is exposed to influenza, the incubation period is one to four days, average two days, so that’s the time frame you’re going to be needing to look for any symptoms.
Q: Are school districts or health departments taking any extra steps this year, or should they be?
A: We take steps every year actually. They do it based on absentee rates. Once schools get to an absentee rate of 25 percent, they know that they have a large outbreak situation there and in fact some schools have closed in past years. The same rules are going to apply for every season. I think we are not at the peak of influenza yet, so it may be some weeks before we see those very high absentee rates in school systems related to influenza.
Q: How long are people contagious when they’re infected?
A: You’re contagious a day before you even know you have the flu, which is a problem, right? Because those are people who are at work and they’re at school and they seem fine and they’re actively playing and yet they can transmit influenza. How long you are contagious after developing symptoms really depends a bit on your age and underlying condition. Adults shed virus for a shorter period of time than children, and children who have underlying diseases, particularly immuno-compromising diseases, may shed virus for 10 days or longer. On average, it’s around four days. A day ahead of symptoms and three or four days after.