The current season, which began Sept. 28, 2025, and runs through May 23, 2026, continues to see a steady increase in cases across Cook Children’s Health Care System, primarily within primary care and urgent care offices. 

During the first week of February, the positivity rate for the flu hovered at approximately 30% in urgent care clinics, according to Kara Starnes, D.O. medical director of Urgent Care at Cook Children’s. 

Pediatricians encourage caregivers and families to take preventive steps, noting that a previous infection does not mean immunity for the season. 

“Even if you have already tested positive for the flu this season, it is worth getting your flu shot to protect against other strains,” said Phillip Scott, M.D., pediatric hospitalist, medical director for the Nelson Ku High Risk Asthma Clinic. 

While Cook Children’s Medical Centers in Prosper and Fort Worth have not seen a significant spike in hospitalizations, the system reports an increase in visits for the common cold. 

Don’t Let the Flu Stall Your Spring Break 

With Spring Break just a few weeks away, medical experts share tips to ensure families spend their vacation making memories instead of making visits to urgent care.  

“If you are traveling and will be in large crowds such as at the airport or at a large event, it is worth getting your flu shot for protection against the flu,” said Dr. Scott. 

Beyond prevention, the flu vaccine can significantly reduce the severity of symptoms if an individual does become sick, lowering the risk of hospitalization. 

Pediatricians also recommend the following: 

• Wash your hands
• Get a flu vaccine for you and your child
• Avoid touching your nose, mouth and eyes
• Cover your nose and mouth when sneezing and coughing
• Avoid close contact with people who are sick
• Keep your children at home and away from public areas if they are not feeling well 

Signs and Symptoms  

 Flu, RSV and COVID-19 are caused by different viruses, but all are upper respiratory illnesses that share similar symptoms such as:  

• Fever
• Cough
• Fatigue
• Sore throat
• Runny or stuffy nose
• Muscle pain and body aches
• Headache
• Vomiting and diarrhea
• Loss of appetite, taste, or smell
• Shortness of breath  

 Managing Symptoms  

If your child is sick, call your pediatrician first who can help you decide whether the level of sickness escalates to the doctor's office, urgent care, or the emergency room. For many children, viral illnesses like the flu, RSV, and COVID-19 can be managed at home with supportive care. Over-the-counter medications like acetaminophen or ibuprofen can help reduce fever and discomfort. Avoid ibuprofen in infants younger than 6 months.  

Maintaining hydration is crucial. Please encourage your child to drink fluids and consider giving them electrolyte drinks or popsicles. Saline nasal drops and cool-mist humidifiers can help alleviate congestion.  

A fever is defined as a temperature of 100.4 or above. A temperature above 100.4 in babies less than 2 months old is a medical emergency and needs to be evaluated in the emergency room. Any fever lasting longer than four to five days, or one that continues to climb and does not break with fever reducers, should be evaluated by a physician.  

 When to Seek Medical Attention  

While most cases can be managed at home, it's essential to recognize the signs of respiratory distress or dehydration, which require immediate medical attention.  

 Signs of respiratory distress:  

• Increased number of breaths per minute
• Increased heart rate
• Bluish color around the mouth, on the lips, or on the fingernails
• Pale or grayish skin
• Grunting sound during exhale
• Nose flaring
• The chest appears to sink in with each breath
• Head bobbing when breathing in
• Change in alertness  

Signs of dehydration:  

• Urine output is significantly below the child’s normal (at least once every 8 hours)
• Not producing tears when crying and the eyes appear sunken
• In infants, the soft spot on top of their heads looks sunken
• Dried mucus membranes (lining within the nostrils, mouth, throat)
• Sleepy and unresponsive  

If your child exhibits any of these signs, seek immediate care at an urgent care facility or the emergency department. Reserving visits to urgent care or the emergency department for truly urgent needs helps ensure timely care for those who need it most, reduces waiting times for everyone, conserves resources, and limits your child’s exposure to other viruses.  

Related Stories: 

• Is it Flu? What Parents Need to Know This Flu Season
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids
• Top 10 Questions Parents Ask About Vaccines 

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season. Our census is full, including beds, the Emergency Department and Urgent Care Centers. Wait times are extremely long. We ask parents and caregivers to contact their pediatrician unless their child has a moderate or severe illness or injury.

Be sure that you and your family are vaccinated against the flu and are updated on the latest COVID vaccines and booster shots. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“We are seeing increased cases of flu admissions, particularly influenza infections associated with pneumonias,” said Laura Romano, D.O., Hospitalist at Cook Children’s Medical Center. “In addition to causing respiratory symptoms, the flu can also cause myositis, which results in significant muscle pain and requires admission for IV hydration and pain management. The best way to prevent influenza-associated pneumonia and influenza-induced myositis is to get your flu vaccine.”

Respiratory illnesses, like flu and RSV, are typical for this time of year; RSV is a very common respiratory virus. Some children require hospitalization for RSV, but most do not. We are also seeing positive cases of COVID and rhinovirus in our patients.

There are limited treatments for RSV; most are available for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with a congenital heart disease.

“RSV cases continue to decline but we are still seeing children, particularly our most vulnerable patients, becoming significantly ill with symptoms,” Dr. Romano said. “Our most at-risk patients include those less than 12 weeks, any pre-term infant born at less than 34 weeks, or any baby with congenital lung disease or congenital heart disease.”

Patient Census

In the last 24 hours, 533 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) to transfer patients to the Pediatric Intensive Care Unit.

Across our seven Urgent Care Centers, there were 814 patients seen on Monday and 722 patients seen in the last 24 hours.

There are steps families can take to avoid getting sick. Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces.

Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic, Dr. Romano said. Children who haven’t been previously exposed to respiratory viruses are among the many children who are getting sick.

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Nov. 20 - Nov. 26: 222 cases (12% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Nov. 20 - Nov. 26: 812 cases (42.3% positivity rate)

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns). The pediatrician’s office can help you decide what steps to take.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

RELATED: Doctor's Note is Not Required for Excused Absence at Fort Worth ISD

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it is not a moderate or severe illness or injury. If you cannot get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

Bring your child to the emergency room if they have trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition.

Seek immediate medical care if your child is experiencing:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• Concerns for dehydration.
• In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.
• Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Preparation/Prevention

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you’re sick, wear a mask in public and stay home.

RELATED

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

To get an excused absence due to illness, please:

1. Contact your school’s attendance office to communicate your child’s absence. 
2. Submit a parent note in writing within five school days of your child’s return to campus. The excuse note should include the following:

• Student Name
• Student ID Number
• A written statement giving the dates and reason for absence
• Parent/guardian signature
• Parent phone number

3. If your child is absent for multiple days, contact your school for the attendance petition process.

From Cook Children’s Medical Center: Symptoms to be aware of and action to take

Like many hospitals and children’s hospitals around the country, Cook Children's is experiencing a surge in patients diagnosed with RSV, flu and other respiratory illnesses. The increase impacts our ability to care for patients in a timely manner.

RSV is a common respiratory virus. Some children require hospitalization, but most do not.

It is NOT necessary for your child to take a strep throat, flu or RSV test before returning to school.

RSV and Other Illness Guidelines for Parents

Parents should NOT go to the Urgent Care or Emergency Department for only a flu or COVID test. See your pediatrician, who can test for flu, RSV, strep throat and COVID. Adults can also use at-home tests or tests at a pharmacy.

Call your pediatrician if:

• If your child is experiencing mild respiratory symptoms but is not having difficulty breathing and is well-hydrated.
• If you need to have your child tested for RSV, the flu or COVID-19.

Seek immediate medical care if:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• You have concerns that your child is dehydrated.
• In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot on the head can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child requires frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.

Prevention:

• Get the flu vaccine and stay up to date on the vaccine schedule from the Centers for Disease Control and Prevention.
• Get the COVID vaccine and approved boosters.
• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If sick, wear a mask in public and stay home.

If your child attends a different district, please call your campus to find out what your absentee policy is.

RELATED

• RSV Decreases While Flu Continues to Increase at Cook Children's (checkupnewsroom.com)
• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Well…there’s no doubt about it. 2020 is going down in the record books as a real dumpster fire of a year.

We have a new enemy. The novel coronavirus has slithered its unpredictable and sometimes deadly tentacles into every aspect of our lives.

But I’m not here to talk about the new enemy. 

I’m here to talk about a well-known OLD enemy. Influenza. The grandfather of respiratory illness. The master of the mutation game, he comes back every year to infect us. And sometimes unpredictably, he can kill.

I’m here to tell you why this is the most important year yet to get your flu vaccine.

Let’s take a second to learn why I choose to vaccinate my family each year:

• Our goals for the flu shot are not to NOT catch the flu (although it is estimated to prevent 5+ million cases of flu in the United States each year). It is to avoid potentially devastating flu-related illness and death.
• The flu shot has been shown to reduce influenza-related deaths by 51% in kids with underlying health conditions and 65% in healthy kids.
• The flu shot has been shown to reduce flu hospitalization of pregnant women by 40%.
• The vaccine reduces hospitalization and death for those with cardiac disease, diabetes, and chronic lung disease.
• The flu shot reduces overall deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients. (Sources for these statistics are at bottom of article)

Okay, the science is there, obviously. The flu shot is an effective way to try to not get really, really sick with the flu.

Why is it so important this year? Well, if you haven’t noticed, a new villain is in town.

In 2020, the novel coronavirus (as of the date this was written) has infected over 5 million Americans, and has killed over 167,000 Americans.

During the 2019-2020 flu season, 39-56 million Americans were infected, 400-700K were hospitalized, and there were 24-62,000 deaths related to the flu.

Look at these numbers. They’re huge. What happens when we add them up? Things start looking very grim.

Remember those hospital beds and ventilator numbers we’re keeping an eye on? They get used, in large quantities, by flu patients every winter. Especially vulnerable are older and younger people, and people with underlying health conditions. We need those hospital beds. We need the ventilators and staff.

The flu seems to be more deadly to children (as far as we know…let’s remember we’ve not done this whole COVID-19 thing with full classrooms around the country yet). Every year we see kids sickened, hospitalized, and killed by the flu. During the 2019-2020 season, 187 children were killed by the flu. In 2020, COVID-19 has been responsible for the deaths of 49 kids under age 14 (as of 8/8/20).

What happens when you combine influenza and COVID-19 in a community? What happens when people start getting infected with both? The answer is…we don’t know.

The southern hemisphere’s winter happens during our summer, and during their recent flu season, many medical clinics closed, schools closed, and travel and social restrictions were imposed. So knowing how bad the flu season was, and whether or not flu and COVID co-infection creates a monstrous burden of disease, was unable to be studied very accurately under “normal” conditions down there.

In the U.S., we’re opening schools. Winter approaches, and we don’t know what it will bring. COVID-19 is here to stay for awhile, and the flu is coming. There is so much unknown, and so much we can’t control. What we CAN control? Lowering our risk for severe illness, hospitalization, and death by getting a flu shot. It’ll be more important this year than ever before.

My hope is that our newfound love for masks, distancing, and handwashing will lead to a quieter flu season. But unfortunately, season after season, the flu seems to always find a way.

Sources:

• https://www.cdc.gov/media/releases/2017/p0403-flu-vaccine.html
• https://www.cdc.gov/flu/prevent/vaccine-benefits.htm
• https://www.cdc.gov/flu/prevent/benefit-publications.htm
• https://www.sciencemag.org/news/2020/08/how-will-covid-19-affect-coming-flu-season-scientists-struggle-clues
• https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html
• https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm?s
• https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%208.6.20%20FINAL.pdf
• https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku

Is it strep or the flu? Maybe, both?

Strep and flu are two very different things, although they may have similar symptoms at times.

First, let’s distinguish between the two.

The flu is a viral infection that impacts the nose, throat and lungs. A flu, or cold, can make the throat sore and scratchy

Strep is a bacterial infection. Strep causes the throat to be very sore and it becomes very painful to swallow and they typically don’t eat, or only eat very soft things. With a cold or flu, children usually eat fine or if not the reason is appetite not pain with swallowing.

They both can cause a fever, sore throat, chills, muscle aches and even nausea.

So how do you tell the difference?

Even for a pediatrician, it’s difficult to distinguish strep from the flu by a quick look inside a child’s throat. Studies have been done that shows that without the proper tests, physicians can’t tell the difference half the time.

Strep can cause white spots, but rarely does. Usually the throat is somewhat red and can have the red spots which are petechia. The body aches in strep are also less severe in strep and one of the defining symptoms of flu.

The only accurate way to diagnose strep is through a strep screen or a throat culture.

Strep throat symptoms include:

• Red, sore throat with white patches
• Headache
• Swollen, sore glands in the neck
• Fever
• Red spots on the roof of the mouth
• Painful, difficult swallowing
• Chills
• Fatigue
• Nausea and possibly vomiting
• Decreased appetite
• Rash
• Muscle aches, especially in the neck, and abdominal pains, especially in younger children
• Swelling in back of mouth

We will take more tests to confirm the diagnosis that may include a throat culture, rapid DNA test or rapid antigen strep throat.

Most strep will get better in about a week to 10 days.

Your doctor will prescribe antibiotics to treat the infection. Although the symptoms may fade, the infection may remain. Please make sure to take all the antibiotics prescribed.

You may be surprised to find out that about 30 percent of people have strep in their throat at all times and it does not cause symptoms. To help reduce your child’s chances of strep, follow these tips:

• Wash your hands
• Don’t share food or drink
• Avoid exposure to other people with strep
• Replace your child’s toothbrush after starting antibiotics

Flu symptoms include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue
• Sometimes diarrhea and vomiting

We advise everyone to get the flu shot. However, if you or your child are sick with the flu, stay home, rest and avoid contact with other people. The Centers for Disease Control and Prevention recommends staying home for at least 24 hours after the fever is gone (except for medical care or other necessities). The fever should be gone without the use of fever-reducing medicine.

In some cases of the flu, you may be prescribed antiviral drugs that are prescription medicines. These aren’t sold over-the-counter and you can only get them with a prescription. The drugs aren’t antibiotics which fight against bacterial infections (strep for instance), but they fight against the virus.

You may hear someone say that their child got strep and flu at the same time. This can happen, but it’s very uncommon. Both are increase in the winter months, and symptoms such as sore throat, fever, etc. can overlap, which is likely why children are being treated for both.

Strep and flu two are entirely different things. Colds and flu always cause a sore throat, but strep is never the cause of cold symptoms.

So if your child has cold symptoms and a sore throat and gets tested for strep, it could be a false positive or it could just be a coincidence. For instance if your child has a cold or flu, then they go to the doctor or to school and are exposed to someone with strep throat. Now he or she has both. But they aren’t related.

And remember because they are different, they would each have to be treated differently and separately.

I hope this helps. We’ve been asked a lot about it lately. Stay healthy.

Dr. Bradley Mercer is pediatrician at Cook Children's Pediatrics (Fort Worth). To learn more about him and his practice, click here.

Last week (Dec. 22-Dec.28, 2019) at Cook Children's Medical Center, 1,457 children tested for the flu. Five hundred forty-six patients tested positive for Influenza B, and 169 more were positive for Influenza A. Another 258 kids tested positive for RSV. The report is only for those tested at the medical center and does not include the dozens of primary care offices at Cook Children's.

Already this flu season, two pediatric flu deaths in Tarrant County have been confirmed. The first death in early December was the first reported pediatric flu death in Tarrant County since 2015.

Flu B typically follows Flu A and is usually found at much lower levels. What makes this season unusual is that Flu B appeared first and in much higher numbers than Flu A. During the week of Dec. 23, 2018, 1,141 children were tested for the flu at the medical center with 484 kids testing positive for Influenza A and none for Influenza B.

Doctors at Cook Children's say Flu B causes the same general symptoms as Flu A – fever, upper respiratory symptoms and body aches. Generally, Flu B seems to be a little less severe but should still be taken seriously.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, says it’s hard to predict what’s next when it comes to the flu season. But normally, pediatricians in the area expect to see an uptick in flu a couple of weeks after kids go back to school following their winter break.

“The kids are bringing their germs with them and coming in contact with many other kids once they are at back at school,” Dr. Whitworth said. “It’s so important to stress good hygiene such as handwashing and covering your cough. And, I can’t stress enough to keep your child home if they are sick to prevent other children from getting the flu too.”

Dr. Whitworth said kids should stay home until at least 24 hours after their fever has gone away without the help of fever-reducing medicine. But if your child is still feeling the side effects of the flu even after the fever has gone away, she suggests they stay home for another day or so.

With so many children sick right now, Cook Children’s is currently under a “Facility Alert” due to an extremely high census. Between the Emergency Department and Urgent Care Centers, staff is seeing an average of more than 1,200 kids per day.

Cook Children’s has a variety of options for care including primary care offices, neighborhood clinics and urgent care locations.

“If your child is over 3 months old and has a fever, even a high one, it’s OK to see your pediatrician as long as they are breathing comfortably and drinking well,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Forest Park. “If your child has mild wheezing, we can give breathing treatments in the primary care offices. If you’re not sure whether your child’s issue is an emergency, our nurses can talk to you over the phone about symptoms and help you decide between the ER, urgent care and a primary care visit.”

Other quick facts about Flu B include:

• Flu B is spread via droplets like Flu A, so washing hands and covering coughs are essential to prevention.
• The vaccines contain Flu A and Flu B strains.
• Even if you get flu in the season where you get the flu vaccine, it's not for nothing. It may prevent more serious illness and complications as well.
• Treatment with Tamiflu is an option. Families and doctors must weigh the benefits vs. side effects. Talk with your doctor if you have any questions.
• Secondary infections (such as pneumonia) can occur after any strain of the flu. So be on the lookout for increasing fever or recurrence of symptoms after your child has begun to recover.

More On This Topic:

• Influenza/Flu Information
• Let's Learn About The Flu
• Is It Strep Throat or The Flu?
• What Parents Need To Know About RSV
• Let's Learn About Fevers

“Because of the sensitive nature of the information, we can’t share any other details, other than to say that the child had underlying health conditions,” said Tarrant County Public Health Director Vinny Taneja. “The patient tested positive for Influenza B which is circulating early and predominately this season.”

Tarrant County Public Health stated there has been a “sharp rise in flu activity this season, trending nearly a month ahead of the previous two years.”

Taneja added, “We want to remind everyone to get their flu shot. It’s definitely not too late, and the vaccine offers you the best protection against the flu.”

Last week at Cook Children’s (Nov. 24 through Nov. 30), 964 children were tested for the flu at the medical center. Of those children, 231 tested positive for Influenza B and 24 more for Influenza A.

“The flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “The vaccine is especially important for children aged 6 months to 5 years. They are at the highest risk for serious flu-related complications, including death. Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

You may remember the spray shot wasn’t previously available for children because it didn’t work as well. The newer versions appear to work as well as the shot. So the vaccine can be given this year either by a shot or nasal spray, depending on the child’s age and general health. Both protect against four types of influenza viruses: Influenza A (H1N1), Influenza A (H3N2) and two influenza B viruses.

The nasal spray is approved for use in people 2 years through 49 years of age. People who are pregnant or have certain medical conditions (such as asthma) should not receive the nasal spray influenza vaccine.

Based on guidelines from the CDC and the American Academy of Pediatrics, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. It is now recommended that people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

"All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines," the AAP wrote in the September 2018 edition of Pediatrics as part of its "Recommendations for Prevention and Control of Influenza in Children, 2018-2019."

Backing up the AAP and CDC, is recent research in the Annals of Allergy, Asthma and Immunology, which found the flu shot to be safe and recommended its use for people who are allergic to eggs.

Jason Terk, M.D., a Cook Children’s pediatrician in Keller, said previous recommendations on egg-allergic individuals not receiving a flu vaccine were based on the fact that most of the flu vaccine currently available is created from viral cultures in chicken embryos. Experts theorized there was a risk because of the concern that small amounts of the egg that the viral cultures come from could end up in the vaccine.

“After years of study and observation, it was found that no significant increased risk for reactions occured in egg-allergic people,” Dr. Terk said. “The recommendation to avoid flu vaccine for egg-allergic people has been removed. No medical intervention is without risk. But the risk of influenza and the complications arising from it far exceed the infinitesimal risk of influenza vaccination.”

If you have concerns, Dr. Terk said your pediatrician should be happy to answer questions about your child and why the flu vaccination should be given.

Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract. It affects all age groups, though kids tend to get it more often than adults.

Texas flu activity continues to rise and is at an above-average level, per the week’s DSHS flu report.

At Cook Children’s Medical Center, the lab tested 529 children for the flu during the week of Nov. 10-16, 2019. A total of 74 kids tested positive for the flu (63 with Influenza B and 11 with Influenza A) and 152 more were confirmed to have RSV.

“For more than 50 years, hundreds of millions of Americans have safely received season flu shots,” the agency wrote in its tweet.

“The flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “The vaccine is especially important for children aged 6 months to 5 years. They are at the highest risk for serious flu-related complications, including death. Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

Two types of flu vaccine are available for the 2019-2020 flu season. Both protect against four types of influenza viruses: Influenza A (H1N1), Influenza A (H3N2) and two influenza B viruses.

You may remember the spray shot wasn’t previously available for children because it didn’t work as well. The newer versions appear to work as well as the shot. So either vaccine can be given this year, depending on the child’s age and general health.

The nasal spray is approved for use in people 2 years through 49 years of age. People who are pregnant or have certain medical conditions (such as asthma) should not receive the nasal spray influenza vaccine.

Last week, eight children tested positive the flu at the medical center, according to Laboratory results from Cook Children’s. What’s interesting is that seven children tested positive for influenza B and only one for the A strain.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says this occurrence is a bit odd because the A strain usually precedes B. Pence adds that the majority of flu cases reported nationwide have been influenza B.

Since Sept. 29, 2019, the Centers for Disease Control and Prevention (CDC), found that 68.1% (289) of positive tests gathered from clinical laboratories nationwide were for influenza B.

The good news is Flu B is usually less severe than Flu A. The bad news is the flu season is just beginning. And while it remains to be seen what the flu season holds in store for the area, one thing is for sure: it’s time to get your flu shot.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

Speaking about the early flu season, the CDC reports:

• Nationally, flu activity is low and similar to what has been observed during recent previous seasons at the same time, but Louisiana and Puerto Rico are experiencing high levels of influenza-like-illness.
• Severe flu outcomes have been reported, including the first two pediatric deaths of the 2019-2020 season.
• Flu vaccination is always the best way to prevent flu and its potentially serious complications. Most flu vaccines protect against 4 different flu viruses. Get vaccinated now.

Other flu prevention tips include:

• Try to avoid close contact with sick people.
• While sick, limit contact with others as much as possible to keep from infecting them.
• If you are sick with flu-like illness, the CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care for other necessities. Your fever should be gone for 24 hours without the use of fever-reducing medicine.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands with soap and water. If soap and water aren’t available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

And only time will tell for sure, but some indicators lean toward a potentially severe influenza season.

Clinical experts in the U.S. watch the Southern Hemisphere of the world for signs of what might be in store for us in the north.

In Australia, where winter recently ended, the Department of Health reported the flu season arrived earlier than normal. Of special concern to the experts is the type of flu season seen in Australia – Influenza A (H3N2). H3N2 is a more dominant strain of the flu and causes more illnesses.

How effective the flu vaccine is depends on how well experts predict what strains of the flu will be circulating the globe that year.

“The vaccine strains are chosen about nine months before flu season, based on circulating strains from around the world by epidemiologists who are geniuses and do this for a living,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases.

Locally, the first case of flu (Flu B) was reported at Cook Children’s Medical Center two weeks ago. Last week, no one tested positive for either strain.

NBC News reports that one pediatric flu death has already been recorded in the U.S. – a 4 year old in California who had underlying health problems.

Jason Terk, M.D., a Cook Children’s pediatrician and a national expert on immunizations, adds his voice to other pediatricians and global health experts who say the flu vaccine remains the best way to prevent influenza.

“The great news about the vaccine is that even when it’s not always a perfect match for prevention, the flu vaccine can reduce the severity of the illness, even if you do catch the flu that season,” Dr. Terk said.

To make an appointment for your child’s flu shot, contact your Cook Children’s pediatrician. The vaccine is currently available in many offices and a second shipment will be delivered next week.

“It takes two weeks for the shot to become most effective. Because flu can hit as early as late October or early November, we recommend getting the flu shot as soon as possible and definitely before the end of October,” said Justin Smith, M.D., a Cook Children’s pediatrician.

More On This Topic:

• Flu Shot Appointments
• Influenza/Flu Information
• Let's Learn About ... The Flu
• How To Tell If It's Strep, Flu, Rotavirus Or Norovirus
• Comfort Menu to Ease Pain, Anxiety for Children Getting a Shot
• Is It a Cold or The Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

RSV has arrived at Cook Children's.

Last week, 178 kids tested positive for RSV, compared to only two who tested positive for Influenza A.

RSV is a virus. It’s short for respiratory syncytial virus. It causes a disease in young children (especially those less than 2 years) called bronchiolitis. The RSV season usually begins around mid-August and runs through March.

Bronchiolitis is a disease of the lower respiratory tract which causes children to wheeze. They are wheezy because their small airways have swelling and junk (mucous and cells from the lining of the airway) in them.

The smaller airways are similar to the area where a child with asthma has issues (which is why they wheeze). The difference is that children with asthma have a squeezing down of the walls of the airway (which is what a breathing treatment reverses). This is why breathing treatments in children with bronchiolitis usually don’t work.

Bronchiolitis is not just caused by RSV. There is a long list of viruses that can cause the same symptoms:

• RSV
• Rhinovirus (usually a cause of the common cold)
• Parainfluenza
• Human metapneumovirus
• Influenza (Flu)
• Coronavirus
• Human bocavirus
• Human polyomavirus

Here are some answers to the most common questions I hear from parents:

What are the symptoms of bronchiolitis?

Typically the child starts with runny nose and cough. This will progressively worsen over a few days and possibly develop into difficulty breathing and difficulty with eating. The symptoms typically last a total of about 5-7 days with the worst day being the day in the middle. It is not uncommon for the cough and runny nose from bronchiolitis to last 2-3 weeks.

How do we treat bronchiolitis?

In most children, treatment is done at home and consists of sucking snot (click here for more advice on this) and counting wet diapers. This isn’t very fancy but, unfortunately, until someone invents TamiRSV we don’t have anything more specific. As far as wet diapers go…I am looking for a wet diaper about every 6 hours.

Who goes to the hospital?

Getting admitted for bronchiolitis is usually based on: dehydration, severe difficulty breathing or low oxygen levels.

Children who can’t eat because they are breathing fast and are puking because of all the mucous draining into their belly are at risk for dehydration. Unfortunately, the only way to fix this is to put them in the hospital for intravenous (IV) fluids until they are able to drink better.

A child who is having severe difficulty breathing also needs to be observed in the hospital. Unfortunately, babies with severe bronchiolitis can get tired from all the heavy breathing they are doing and this can progress to needing ICU care. It is best to have those babies who are breathing that hard in the hospital so that they can be monitored closely by people who know what they are looking for…

Babies with bronchiolitis often need extra help keeping their oxygen level up by getting extra oxygen. We monitor these babies closely and I put them on oxygen for severe difficulty breathing or if their oxygen level is less than 90 percent.

Summary

1. Bronchiolitis stinks, it makes kids sick and I don’t have much to offer.
2. Whether it’s RSV or not often doesn’t matter.
3. Watch for difficulty breathing and decreased wet diapers.

For more information on bronchiolitis and RSV, read this post from one of our hospitalists.

Cook Children's medical staff saw its own cluster of patients in 2016 and has seen sporadic cases since then, as have other hospitals across the nation.

Acute flaccid myelitis (AFM) presents similar to polio in that it causes an abrupt onset of limb weakness an decreased muscle tone, which can have associated problems with urination and, in the worst cases, cause respiratory failure if the muscles involved in the breathing become weak.

“This is a very rare illness and we’re still not sure what causes AFM,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “It is mostly like caused by a virus or a genetic disorder. At this point, we must treat each child on a case-by-case basis, but the earlier a diagnosis is made, the quicker a plan of action can take place.”

The Centers for Disease Control and Prevention (CDC) says most patients will have a sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients will also experience:

• Facial droop/weakness
• Difficulty moving the eyes
• Drooping eyelids
• Difficulty with swallowing or slurred speech

If you notice any of these symptoms, please notify your doctor immediately. Through thorough testing of the nervous system, doctors will be able to diagnose AFM.

The CDC recommends the following as means of prevention:

• Up to date on all recommended vaccinations, including the poliovirus.
• Protect yourself from mosquito-borne viruses such as West Nile by using mosquito repellent and staying indoors at dusk and dawn.
• Remove standing or stagnant water from properties to minimize the number of mosquitoes in your area.
• Wash hands with soap and water.
• Avoid close contact with sick people.
• Clean surfaces with a disinfectant, especially those that a sick person has touched.

Two children tested positive for the Influenza A virus from the week of Sept. 16 through Sept. 22, 2018, according to Laboratory results from Cook Children's.

For the week, 85 children were tested for the flu, with 83 tests coming back negative. Interestingly, the first case of the flu was confirmed during the same (Sept. 21) in 2017.

The goods news is that flu vaccines are available at our Cook Children’s pediatrician's offices now.

Getting the flu vaccine is one of the most important things you can do for your child this time of year. Yes, hand washing and avoiding ill contacts are good ideas but that’s not going to be what ultimately protects your child from flu.

No one likes getting a flu shot, kids and parents included, but it’s essential to your child’s health. Here are 5 important facts about the flu shot you should know:

1. Get your child the shot. The American Academy of Pediatrics is recommending flu shots for every child over 6 months of age. Children and elderly adults are the most at risk for serious illness, hospitalization and death from the flu. Children under 2 and those with chronic medical conditions are at higher risk, but healthy children are hospitalized and die from the flu every year!
2. Get your own flu shot. Getting yourself protected helps to prevent the spread of flu in your house. It will decrease the risk of you contracting it, even if someone in your house gets it … and taking care of sick kids while you are sick is one of the hardest things I’ve ever done as a parent. If you have a child under 6 months with whom you have frequent contact (who cannot receive the vaccination) it is extremely important.
3. Ignore any early data about the effectiveness of the flu vaccine. Last year, early data about flu vaccine effectiveness caused many to skip their shot. But, at the end of the year, protection rates ended up being average (and any protection is better than none). Just get it done.
4. Choose the injectable vaccine. Nasal flu vaccines will be available again at some offices this year. However, based on past years, I am strongly recommending that patients get the injectable vaccine. After giving nasal flu vaccine for years before studies showed it wasn’t working, I’m not taking that risk with my children or my patients until we know more about how it’s working over the next few years.
5. Go ahead and get your child scheduled. Pediatric studies have not shown a decrease in effectiveness during a flu season because of getting the shot done early. Getting the vaccine at least 2 weeks before the season starts is critical to making sure they are protected and we never know what vaccine supplies will be when the season hits.

All About the Flu

• Influenza (flu)
• Is it a cold or the flu?
• Is the flu vaccine a good idea for your family?
• Frequently asked questions about immunizations
• How can I comfort my baby during shots?
• Immunization schedule
• Is the Flu vaccine a good idea for your family?
• Your child's immunizations: influenza vaccine

Doctors agree that nothing fights off the flu better than the vaccine, including all children 6 months and older.

And thanks to  recommendations, based on research, that includes children who are allergic to eggs.

A study by the Centers for Disease Control and Prevention (CDC) found the rate of anaphylaxis after all vaccines is 1.31 per one million doses given.

Based on guidelines from the CDC and the American Academy of Pediatrics, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. It is now recommended that people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

"All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines," the AAP wrote in the September 2018 edition of Pediatrics as part of its "Recommendations for Prevention and Control of Influenza in Children, 2018-2019."

Backing up the AAP and CDC, is new research in the Annals of Allergy, Asthma and Immunology, which found the flu shot to be safe and recommended its use for people who are allergic to eggs.

Jason Terk, M.D., a Cook Children’s pediatrician, said previous recommendations on egg-allergic individuals not receiving a flu vaccine were based on the fact that most of the flu vaccine currently available is created from viral cultures in chicken embryos. Experts theorized there was a risk because of the concern that small amounts of the egg that the viral cultures come from could end up in the vaccine.

“After years of study and observation, it was found that no significant increased risk for reactions occur in egg-allergic people,” Dr. Terk said. “The recommendation to avoid flu vaccine for egg-allergic people has been removed. No medical intervention is without risk. But the risk of influenza and the complications arising from it far exceed the infinitesimal risk of influenza vaccination.”

If you have concerns, Dr. Terk said your pediatrician should be happy to answer questions about your child and why the flu vaccination should be given.

You probably did, but hopefully that didn't prevent you from getting your child's flu vaccine.

New data from the CDC suggest that the vaccine was 50 percent effective for pediatric illness, which is actually a fair year. We’ve had better. We’ve had worse. But it's definitely way better than the 10-30 percent estimates that were being thrown around earlier this year.

In previous years, data have shown that nearly two-thirds of pediatric deaths have occurred in children who were not vaccinated. This data is even more significant as three-fourths of pediatric deaths have occurred in children who were not completely immunized (either no vaccines or only one vaccine in a baby who needs 2 for full protection).

Only 54 percent of children who died of flu had a condition that characterized them as high risk. This means that they were older, healthy kids who got the flu and died.

Is the flu shot perfect? No. Do I wish it were better? Yes.

But do any of these reasons for not getting one hold up?

"It doesn't sound like it's going to work very well this year anyway.""My kid's healthy, so I don't think they really need one.""We stay really careful to avoid others who are sick so we'll be good."

Nope. Nope. And, unless you live in a bunker from October to March: Nope!

It's actually still not too late. You can get protection from this year that will help and there is mounting evidence in adults that getting flu vaccines year over year may provide more protection than just for that season. We're still waiting on that evidence in kids, but logic says it could still apply.

The Fort Worth Urgent Care Center staff is seeing volumes in the 300s on a regular basis. Mansfield and Alliance UCC locations are seeing in the hundreds with the Southlake location seeing 60 to 90 patients regularly. Each site is seeing an increased volume, which is typical for the flu season. 

With that many children visiting the Urgent Care Centers, not all children are tested for the flu during their time at the Urgent Care Center.

So why are some children tested and some not being tested? There are a variety of medically sound reasons:

Currently, there is a national shortage on flu tests and stock is on backorder. The flu testing stock at each clinic is all the staff has left at this time.

The staff follows the Centers for Disease Control and Prevention and American Academy of Pediatrics recommendations on testing and treatment of the flu which is the following:

Children less than 2 years of age, should be treated for influenza. Additionally, any child at high risk from complications from the flu should be treated. Children with any of the following medical conditions are at high risk of complications such as pneumonia, central nervous system complications, exacerbation of chronic pulmonary diseases, and carditis.

a. Asthma

b. Neurological and neurodevelopmental conditions

c. Chronic lung disease

d. Heart disease

e. Blood disorders

f. Endocrine disorders

g. Kidney disorders

h. Liver disorders

i. Metabolic disorders

j. Weakened immune system due to disease or medication

k. Children who are receiving long-term aspirin therapy

“We have a finite number of flu tests and a finite amount of Oseltamivir which is the drug of choice for flu treatment,” said Parul Martin, M.D., medical director of Urgent Care Services. “As a result, the provider will determine if your patient has the flu by clinical criteria alone such as history and exam more often than a flu test. Additionally, the flu test is not always accurate. For example, I have had patients have flu exposure and flu symptoms, and have a negative flu test.”

If your child is healthy without the above listed medical conditions, the flu is self-limiting and does not require treatment. Bring your child in if he or she is having breathing difficulty, is not eating and drinking and is not urinating normally, looks sick when they do not have a fever or their fever has lasted longer than three to five days.

The best treatment for a healthy child that has the flu is not prescription medicines, but rather good old fashion TLC: rest, fluids, over the counter cough and cold medicines and Ibuprofen or Acetaminophen for the body aches, sore throat and headaches. Over the counter cough and cold medicines are only recommended for children 6 years of age and over.

“There’s a myth out in the community that fever will cause brain damage. This is not true,” Dr. Martin said. “Fever is our best friend and is the body’s natural defense mechanism. Allow the body to heal itself when your child has the fever. Do not treat the fever but rather treat the symptoms such as headache, decreased appetite or discomfort. Allow the fever to help fight the infection.”

For more information:

• Influenza/Flu Information

• Your child tested positive for the flu. But does she really have it?

• Guide for considering influenza testing when influenza viruses are circulating in the community

• Let’s Learn About Tamiflu

• 7 Facts To Help Parents Feel Less Scared About the Flu

Are you panicked about the flu? How do you know if your kid is getting worse? What about all these kids getting really sick, even dying?

Here's what I've been saying all day, every day in my office this week.

1. Healthy kids who get sick from the flu get really bad because they get dehydrated. Push fluids. If they don't want to eat, that's OK. But they have to drink. Monitor urine output. Kids should pee about every 6 hours. If they aren't, they need to be checked out.

2. Healthy kids also get sick from the flu because of respiratory complications. Monitor for signs of difficulty breathing, especially fast breathing or signs that they are working hard to breathe. Look under their ribs, is it sucking in and out heavily? If so, they need to be checked out.

3. Look out for kids whose fever gets better and then comes back. Many times parents write off those symptoms as just a little left over from the flu but they could be a sign of a secondary infection. Ear infections, sinus infections and pneumonia often frequently follow the flu. Once the flu is over and the kid is getting back to normal, they shouldn't come back.

4. Kids with chronic medical conditions should be watched closely for worsening of their condition. Asthmatics should be watched closely for breathing. Diabetics should have their sugars watched, etc.

The Urgent Care Centers at Cook Children’s are seeing more kiddos day in and day out than our Emergency Department (nearly double). The Fort Worth Urgent Care alone is seeing almost as many kids per hour than the ED on any given day.

Flu testing will be driven by the incredible experience of our Urgent Care providers. They are giving flu tests as needed, and they know best what flu looks like in North Texas and have the best skillset to determine appropriate treatment and testing. Click here to learn more about why your child may not be tested for the flu at one of our Urgent Care Centers.

While I think it's important you know how bad the flu can be, I'd like to give you a few quick facts and tips to make you hopefully feel better educated about it, and feel less scared.

1. The flu happens every year. It hits hard from December through March (and other months, but those primarily). There are deaths every year. Kids, healthy people, old people, babies, and folks with chronic illness die every year. We aren't sure if the rate of death is higher this year compared to years past. It may not be. But the media is certainly paying a lot of attention to it right now. Maybe that's both a good and a bad thing.

Remember that the flu is usually a "mild" illness (I mean, you feel like you've been hit by a truck, but we call that "mild" in medicine, ha).

It hits fast and fevers can go high, which is worrisome, but with a lot of rest, fluids, pain and fever reducers, things usually get better after 3-5 days. The cough and congestion can last for 2 weeks.

2. Scared to vaccinate? Hear stories? Hate shots? Have an uncle who loves to talk up a good conspiracy theory? Know this: you can still get the flu even if you get the vaccine.

BUT: it's usually milder, if you do get it. Studies have shown that the people (and children) who get very sick (think hospital, think death) are those who are largely unvaccinated.

"This study, which looked at data from four flu seasons between 2010 and 2014, found that flu vaccination reduced the risk of flu-associated death by half (51 percent) among children with underlying high-risk medical conditions and by nearly two-thirds (65 percent) among healthy children."

Get your kids vaccinated. It's not too late.

3. You are contagious with the flu 1-2 days BEFORE you start showing symptoms. How sneaky is that?

4. You are contagious 5-7 days after you start to show symptoms. Your KIDS can be contagious up to 10 DAYS after they start to show symptoms.

5. You should keep your kids out of school for at LEAST 24 hours after their last fever. This means fever without the use of meds to keep it down. If it's financially feasible for you, I'd even try to keep your kids out at least 7 days after the first symptoms start.

6. Call us (or your pediatrician) anytime if you're worried about the flu. We can walk you through what is normal and what isn't.

7. These are the reasons to worry:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

Flu-like symptoms that improve but then return with fever and worse cough

Tamiflu can help make it less severe sometimes, for some people. I wrote another post about who needs it, when, and why. Click here to read it.

I know this is long, but I think the more education you get about it, the more prepared you feel, right?

And remember - WASH YOUR HANDS! The flu can live on some surfaces up to 24 hours in cold weather! Think about all those door handles you touch! The cash you get handed back from the cashier! The snot that flies from every person's sneeze can cover a 6 foot radius around them!

Wash. Those. Hands!

Hugs! Dr. Diane

Once school was back from the Christmas break, kids returned to share their germs with one another. To make things worse, the brutally cold weather when they got back ensured that everyone stayed in an enclosed environment. All a perfect storm to see our flu numbers climb higher.

“We typically see an uptick in flu a couple of weeks after kids go back to school following the winter break,” said Jason Terk, M.D., a pediatrician at Cook Children’s in Keller. “Right now, we are seeing an increase in Flu B, but still see plenty of Flu A cases. Our patient volumes are still very high.”

Last week, 403 flu cases were confirmed at Cook Children’s, up from 345 the week prior. What makes this week different is the amount of Flu B cases seen. Last week saw 104 confirmed Flu B cases, up from 60 a week earlier.

“It’s expected that Flu B will follow or peak after Flu A, but it’s still earlier than expected this season,” said Morgan A. Pence, Ph.D., clinical microbiologist at Cook Children’s. “This is the earliest we’ve seen Flu B in the last four flu seasons and it looks like Flu A and B are overlapping more this year than in the past.”

The good news is that Flu B is usually less severe than Flu A. The bad news is it means a continuation of a flu season that is already looking to be the worst since the 2014-2015 season. The Centers for Disease Control and Prevention reports the death of 30 children nationally as a result of the flu.The CDC stated that all U.S. States except Hawaii have reported widespread flu activity.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Disease. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

These visits are most commonly a secondary infection with the flu and RSV.

“Actually, pneumonia has been what kills many people with the flu,” Audrey Rogers, M.D., a pediatrician at Forest Park, said. “The flu weakens your immune system and allows the bacteria to take hold and cause an infection in the air sacks of the lungs. That is what a classic bacterial pneumonia causes.”

Viruses cause inflammation of the air tubes more than the air sacks. But the bacteria cause a lot of damage and if it destroys enough of the air sacks it can be fatal. If your immune system is already weak it can be much worse. Infants, the elderly and immunosuppressed people are especially at risk if they have pneumonia. Classic pneumonia is usually diagnosed with a chest X-ray.

To learn more about this topic read:

Daughter's Pneumonia Gives Physician New Perspective as a Patient's Dad

“Our surveillance has indicated increased flu activity in recent weeks, and we anticipate high activity for the next several weeks,” says Juan Rodriguez, DCPH Assistant Director and Chief Epidemiologist. “It is important for residents to be proactive in practicing prevention through receiving the flu vaccine and taking action to prevent the spread of disease.”

DCPH recommends a three-pronged approach to fighting the flu:

1. Get vaccinated. The best way to protect yourself and your family from the flu is to get an annual flu shot, and the flu vaccination is recommended for everyone 6 months and older.

2. Remember that antiviral medications are a second-line defense against the flu. If you are experiencing fever, runny or stuffy nose, sore throat, cough, muscle aches and headaches, visit your doctor immediately, and take antivirals if prescribed. These remedies can help you recover quicker, and can potentially prevent you from being hospitalized with flu complications.

3. Take everyday preventive actions to help stop the spread of germs. Cover your cough and sneeze, avoid people experiencing flu symptoms, stay home when you feel sick and wash your hands often. These steps will help prevent respiratory viruses, including influenza, respiratory syncytial virus (RSV) and rhinovirus.

Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s, reminds parents if your child is sick or has a fever, to wait 24 hours before sending the child back to school. “It’s important to minimize contact with others, especially in close quarters,” Dr. Warmink said.

At Cook Children’s, the number of children who have tested positive for the flu has gone down over the past two weeks. Last week, 283 children tested positive for the flu. Two weeks ago, 429 tested positive.

All unvaccinated residents over six months of age are strongly encouraged to be immunized for the flu.

“We want to remind residents that it is not too late to get the flu vaccine,” stated Dr. Matt Richardson, Director of Public Health. “Getting vaccinated today will help protect families throughout the remainder of the season.”

DCPH reminds residents that getting vaccinated is a community effort that not only protects yourself, but also those at highest risk for flu complications, including:

• Pregnant women and women up to two weeks postpartum
• Children younger than 5
• Adults 65 years of age and older
• People living in long-term care facilities
• American Indians and Alaskan Natives
• People with chronic health conditions

For more information:

• Why Your Family Should (Still) Get a Flu Shot
• When Is The Flu an Emergency?
• 6 Tips To Help Your Child Get Through The Flu

“Should I even bother getting the vaccine,” I get asked.

“Yes. You should definitely still get your child’s flu vaccine.”

Here’s why.

Is it going to be a bad flu season?

Widespread influenza activity is present in 46 states, including Texas. Hospitalizations for influenza associated illness are on the rise, with nearly 4,000 reported. Children under 5 (as well as adults over 65) appear to be at the highest risk for hospitalization.

As of December 29, there were 13 pediatric deaths associated with influenza in the U.S. And it wasn’t just little babies either, six of those deaths occurred in children over 5 years of age. Only two of those children were known to have high risk conditions, which means that many of the deaths occurred in healthy children. 

One of the major concerns, regarding the severity of the season, is that much of the circulating Influenza A virus is of the type H3N2. In previous years where H3N2 has been common, we have seen increased numbers of cases and more severe disease. Last week, more than 237 children tested positive for Flu A at Cook Children’s. Two weeks ago, 380 kids tested positive for Flu by our lab.

Is the flu vaccine coverage going to be terrible?

Scientists often use the previous flu season from Australia to predict what type of flu season and vaccine effectiveness we are going to have. You might have heard early reports that suggested that this year’s vaccine might only have 10 percent effectiveness. But, the important point to remember is that meager 10 percent only reflected activity against H3N2 and truly predicting which strain will be most common is tricky.

Another important factor to consider is that flu activity is regional. Influenza A activity nationwide is showing H3N2 activity at 7,012 out of 7,754 overall cases, or 90 percent. But, in region 6 (of which Texas is a part), H3N2 was present in 466 of 589 or 80 percent of Influenza A cases. Still not great, but there’s plenty of vaccine preventable flu out there.

So, will the vaccine coverage be terrible? Maybe, but we won’t know for sure until the end of the year and I believe there is evidence to suggest that it will be better than the 10 percent estimates we were reporting earlier in the year.

Should I still get my child’s flu vaccine?

Flu vaccine is an important part of protecting our children from this terrible disease.

Your child will almost certainly be exposed to the flu this year, and probably multiple times. Flu causes serious illness, even death. Even if the coverage was only 10 percent (and I think it will be better), I would still recommend it. Flu vaccine has been proven, even in bad years, to prevent flu-associated death in pediatric patients.

Flu vaccine cannot cause flu. It is an injectable, killed virus which cannot cause infection. Side effects might include soreness at the injection site, low grade fever and mild body aches.

You still have time. We expect flu activity to be increasing over the next few weeks, possibly even into mid to late February. Once you get the vaccine, it takes about two weeks before your protection is up and going.

So, call and get the vaccine today…for you and your children.

With that many kids sick in our area, expect longer wait times if you take your child to the Emergency Department.

Cook Children’s has brought in extra staff to help accommodate the high number of flu cases seen in the Emergency Department. We are early in the flu season and that means waits times will only increase over the course of time.

“The winter is always the busiest time of the year for the Emergency Department. With the high volume of patients, our team needs to prioritize patients according to the apparent severity of medical illness or injury,” said Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s. “Our team works very hard to care for children as safely and quickly as possible, but we have to make decisions to see the sickest kids first and that sometimes causes frustration for parents.”

Normal signs of the flu include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue
• Sometimes diarrhea and vomiting

"The best way to prevent the flu is vaccination. It's very important for the entire family to be vaccinated against the flu, including parents and their children," said Parul Martin, M.D., medical director for Cook Children's Urgent Care Services. "Additionally, enforcing frequent hand washing and use of hand sanitizers can help prevent the spread of the flu virus and many other respiratory viruses."

She adds that the treatment for kids who have the flu, who are normally healthy and don't have chronic medical conditions is pretty straightforward: TLC, fluids, rest and symptomatic treatment.

The CDC recommends that the treatment for the flu is only for those patients at high risk, such as patients that are 2 years or younger and those patients that have chronic medical conditions for example: Autoimmune diseases, Cardiac concerns, and Pulmonary diseases such as Asthma. The treatment recommended for both Flu A and Flu B is oseltamivir which is most effective when taken within the first 48 hours of flu symptoms.

“Every patient who comes into our Emergency Department is important to us. However, some patients may be able to receive the care they need from their primary care physician, a neighborhood clinic or an urgent care center,” said Dr. Warmink. “The best thing a parent can do is know what constitutes an emergency so they know where to go when that time comes.”

If it is not an emergency, Cook Children’s offers other options for your child.

Call your child’s primary care physician first to schedule an appointment. To find a Cook Children’s pediatrician in your area, click here.

Cook Children’s is also home to seven Neighborhood Clinics in Arlington, five in Fort Worth and Richland Hills. Click here to find a Neighborhood Clinic. All neighborhood clinics accept Medicaid, Chips and most commercial insurance plans. Click here to find a Neighborhood Clinc near you.

After hours, consider one of Cook Children’s Urgent Care Centers. The Urgent Care Centers are filling up quickly as well, but your wait time will be a bit shorter and you will be able to treat your child with non-emergent needs such as the flu, strep/sore throat and cold symptoms. Click here to find an Urgent Care Center in your area.

The Urgent Care Centers have continued to see increased volumes because of the many respiratory viruses that are currently in circulation, flu being one of them, according to Dr. Martin.

UCC hours are the following:

• Alliance, Southlake and Mansfield are open from 11 a.m. to 10 p.m.
• Fort Worth UCC is open from 7 a.m. to midnight.

"The Urgent Care Centers gratefully welcome you and your family," Dr. Martin said. "We are prepared to see you and your family as promptly as our volumes will allow. My Urgent Care Center staff and providers are working very hard and doing everything we can do reduce our wait times at the clinics with your child's safety and care a priority."

Last week, 1,118 patients were tested for the flu at Cook Children’s and 429 tested positive (380 for Flu A and another 49 for Flu B).

Get your flu shot (go ahead, it’s not too late), wash your hands, say a prayer…all the things you should do to prevent you and your family from getting the flu. The flu season is in full force and you’ll want to protect your family as much as possible.

Unfortunately, despite all your efforts… you still might get the flu.

So, now what?

Here are 6 tips for helping your child get through the flu:

1. Push fluids, fluids, fluids. Healthy kids with flu often get sick and worsen because they get dehydrated. Kids with the flu should have something to drink beside them constantly. Water, Gatorade and Pedialyte are all good options. Watch to see how much they are peeing. They should pee at least every six hours.

2. Treat your child with a fever reducer. Using acetaminophen or ibuprofen can help with not only fever, but also the headache and body aches that come with the flu. Remember the goal is not dropping the number of the temperature, but making your child feel better.

3. Allow your child to rest as much as possible. This is not a time for strict adherence to screen time guidelines. Resting and taking it easy is a big part of getting through the flu.

4. Use a humidifier or steamy bathroom. Steam can help to loosen up the congestion and help your child breathe, it can also help with their cough.

5. If your kids are over 1, given them honey to help coat their throat and prevent coughing.

6. Follow your child’s chronic condition. Children with asthma should be watched closely for signs of wheezing and difficulty breathing. Children with diabetes should have their sugars monitored closely. Children with chronic conditions are more likely to need Tamiflu so call your doctor at the first sign of symptoms if you suspect flu.

I hope you all have a healthy and happy 2018 but when you do have problems, call your Cook Children’s pediatrician. We’re always here to help!

OK. Tamiflu. Let's talk about some facts.

At Cook Children's, 921 kids were tested for the flu the week before Christmas and 353 kids were positive (314 Flu A, 39 Flu B). So the flu has arrived in our area.

Every year our office gets inundated with phone calls about Tamiflu. Who can take it? Will it help my kiddo? Will it help me? Will it prevent contraction of the flu?

Let me try to spell a few things out so it makes some simple sense:

1. If you got your kiddo the flu vaccine this year, I want you to give yourself a big old fat kiss in the mirror because congrats on making a great decision for your child! While we aren't sure how good of a match it is until the season is over, way to give your child a fighting chance! The kids in the office that I've seen with the flu who have been vaccinated have typically been less sick than those who haven't.

2. Tamiflu (oseltamivir) is a medication anyone can take within 48 hours of starting the symptoms of the flu to REDUCE THE NUMBER OF DAYS ILL BY 1-1.5 DAYS. Notice how I didn’t say "make the symptoms go away" or "make it less severe." It mostly just reduces the number of days sick....by about a day.

3. Notice how I didn't say it cures the flu. Nothing cures the flu. It is a virus, and thus has no cure.

4. These are the reasons the AAP and CDC think a person should take Tamiflu if diagnosed with influenza (and are at "high risk of complications"):

• If under 2
• If over age 65
• Anyone with a chronic illness (diabetes, asthma, chronic heart disease, epilepsy, amongst others)
• Anyone who is immunosuppressed (cancer treatment, immune system deficiency)
• Women who are pregnant or postpartum
• Anyone hospitalized with influenza
• Healthy kids who have documented influenza and have a baby sibling under age 6 months

5. TAMIFLU DOES NOT WORK FOR VIRUSES THAT ARE NOT THE FLU. Meaning - if you or your kiddo has a "flu-like illness," and there are only about 400 circulating our area right now, Tamiflu will do nothing for you.

6. Tamiflu DOES NOT work much at all if taken more than 48 hours after the first symptom of influenza. Studies have proven this time and again.

7. Tamiflu sometimes causes more problems than it helps. It is infamous for making kids puke, be nauseous, have diarrhea, and have stomach cramps. (I personally took one dose of it a few years ago and swore I'd never do it again)

8. Tamiflu can help prevent a child from catching influenza, but given its cost and side effects, and chance for failure, we usually mostly recommend this for children who are at "high risk of complications" or have a very young or chronically ill sibling (see that list above).

9. Any provider can prescribe Tamiflu for any child they deem to be experiencing severe symptoms. If your child is really sick, and they have a positive flu test, and it's been less than 48 hours, we will write the prescription. But remember that clinicians also always have resistance in the back of our minds. The flu virus will LEARN and REMEMBER Tamiflu. And someday, maybe soon, it will no longer work. So if we seem "stingy" with this medication - that's why.

If you want to get jiggy with the beautiful science of all of this, a good stop for you would be this VERY informative page by the AAP: https://redbook.solutions.aap.org/selfserve/ssPage.aspx….

(Have fun with the 8,000 links on that page. SCIENCE! YAY!). If you don't want to read all of this information, please talk to your pediatrician if you have questions.

People are always asking my opinion of it, and I think I'm very "meh" about Tamiflu. It is costly and it can cause a lot of side effects. I do think it benefits the very young, the very old, and those with chronic illness, and I think it's worth it in those cases. Your best protection against the flu every year is to get the vaccine and wash your hands.

The flu virus can live on some surfaces for up to 24 hours. Isn't that astounding? Think about that. A guy sneezes in his hand, touches a door handle, and someone 12 hours later could touch it, wipe an eye or nose....and boom. Flu.

Again - WASH YOUR HANDS!

Hugs, everyone! Hang in there!

Dr. Diane

Alani Murrieta, a 20-year-old mother, died only two days after she began feeling ill from the flu, according to the Washington Post. Her young children and other family members had become sick during a long Thanksgiving holiday. While the other family members got better, Murrieta became progressively worse.

She went to a nearby urgent care center where she was prescribed Tamiflu. By the next day, she was coughing uncontrollably and, at one point, she coughed up blood. She was admitted to Banner Estrella Medical Center, where she was diagnosed with pneumonia. Two days after she became ill, Murrieta died.

Her family told CBS News that Murrieta did not get a flu shot, but doctors couldn’t say for sure whether it would have made a difference.

Murrieta was the eighth flu death in the United States this season, according to a Fox News report. Five deaths were reported in North Carolina, two in Oklahoma and then the latest in Arizona. CBS News, citing data from the Centers for Disease Control and Prevention, reports that 7,000 cases of influenza have been confirmed in the U.S., more than double the number this time last year.

“What we do know is the flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

The flu has arrived in Fort Worth. Last week, 33 kids tested positive for the flu at Cook Children’s and 28 of those cases were Flu A, the more severe and dominant strain.

Some experts are predicting a potentially severe influenza season based on what has been seen in other parts of the world. This year, Australia saw record-high amounts of flu cases. The flu vaccine, which is the same one used in the U.S., was only 10 percent effective in preventing Flu A.

“The concern is when people hear that news, they wonder if they should even bother getting the flu vaccine for themselves and for their children,” Dr. Smith said. “We saw some of those comments posted on Cook Children’s Facebook page. The answer is without question, ‘Yes!’ Parents, should take every precaution to protect their children during this time of year and that begins with the flu vaccine.”

Another concern often voiced by parents is the risk of contracting the flu from the vaccine itself.

Mary Suzanne Whitworth, M.D., medical director of Infectious Disease, stresses a person cannot get the flu from the flu shot. They may feel achy for a day or two but that is very different from being in bed with a high fever for a week from a true influenza infection.

“We do know that thousands of deaths nationally are prevented every year by vaccination against the flu,” Mary Suzanne Whitworth, M.D., medical director of Infectious Disease said earlier this week. “It is important to note that although the vaccine has known side effects that are similar to all vaccines given, side effects are mild and uncommon. Serious side effects are very rare.”

Along with getting the flu shot, parents should take the following steps to protect their kids from the illness:

1. Teach your kids to cover their coughs. Remember to cough into the crook of your elbow and not into your hands. And throw away the tissues.
2. Wash your hands. Other than a vaccine, this is the most important thing you can do to protect yourself and your kids from the flu. Teach kids to use soap and wash their hands for at least 20 second or long enough to sing “Happy Birthday.
3.  Kids with the flu are usually sick 3-5 days and then start to improve. If you or your child’s symptoms are worse than you expect or last longer, please call your doctor to discuss.

Only time will tell for sure, but a new article published in The New England Journal of Medicine makes the case for a potentially severe influenza season.

The article explains that clinical experts have been watching the Southern Hemisphere, which recently went through its “flu season,” for signs of what might be in store for us in the north.

Australia saw record-high amounts of flu cases. The number of notifications reached 215,280 by mid-October, easily beating the mark of 59,022 cases during the 2009 H1N1 influenza pandemic.

Of special concern to the experts is the type of flu seen in Australia - Influenza A (H3N2). H3N2 is a more dominant strain of the flu and can cause more severe illness.

What makes this news worse is that the vaccine used in Australia, the same one used in the United States, was only 10 percent effective in preventing H3N2.

Last week, 33 kids tested positive for the flu at Cook Children’s and 28 of those cases were Flu A.

The article asks whether our current vaccines can be improved, but also stresses that immunization is still our best defense against the flu right now.

“However imperfect, though, current influenza vaccines remain a valuable public health tool, and it is always better to get vaccinated than not to get vaccinated,” the authors of the articles write.

The Centers for Disease Control and Prevention (CDC) estimates that influenza vaccination averted 40,000 deaths in the United States between the 2005–2006 and 2013–2014 seasons.

Still, the vaccine has a rate of between 50 to 70 percent effectiveness against other strains of the flu and people who are vaccinated generally get a milder and less dangerous form of the illness.

“The vaccine strains are chosen about nine months before flu season, based on circulating strains around the world by epidemiologists who are geniuses and do this for a living,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases . “They are not perfect, but they are very good.”

Even when the vaccine is a perfect match to the influenza virus that a person is exposed to, there are other factors in play. The child or adult who receives the vaccine has to be a “good host” and their immune system has to respond to the vaccine and develop protection.

“This does not always happen if the vaccine recipient has a weak immune system or is on medications that inhibit their ability to respond to the vaccine, or other things we don’t understand yet scientifically,” Dr. Whitworth said. “We do know that thousands of deaths nationally are prevented every year by vaccination against the flu. It is important to note that although the vaccine has known side effects that are similar to all vaccines given, side effects are mild and uncommon. Serious side effects are very rare.”

Even more importantly, Dr. Whitworth stresses a person cannot get the flu from the flu shot. They may feel achy for a day or two but that is very different from being in bed with high fever for a week with true influenza infection.

“The flu season has definitely arrived in the Fort Worth area and the time to get vaccinated is now,” Dr. Whitworth said. “I am vaccinated every year by choice and my adult children choose to be vaccinated yearly also.”

Just in time to travel for the Thanksgiving holidays, 23 kids tested positive for the flu (20 Influenza A, 3 Influenza B) last week (November 12-18). That’s the most patients we’ve seen since a really bad 2014. In comparison, we did not see a single case of the flu during the month of November in 2015 and 2016.

“We’re seeing flu consistently now, and I expect it to continue increasing,” said Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s.

So what can parents do to protect their kids from the flu? Here’s some advice:

1. Get the flu shot. The flu shot takes two weeks before it can protect you from the virus. So you won’t have time for it to work the time you get to the grandparents’ house, but promise me you will get your vaccine as soon as you can. Click here to read more about the flu shot.
2. Teach your kids to cover coughs. Remember to cough into the crook of your elbow and not into your hands. And throw away the tissues.
3. Wash your hands. Other than a vaccine, this is the most important thing you can do to protect yourself and your kids from the flu. Teach kids to use soap and wash their hands for at least 20 second or long enough to sing “Happy Birthday” or Adam Sandler’s “Thanksgiving Song” (just making sure you are paying attention).
4. Call ahead. You’ve waited (or in some cases dreaded) all year to see the relatives, but it might be worth a call to see how everyone’s feeling. If someone is sick, steer your child away from the person as much as possible. Maybe, make a joke (but be firm) about a quarantine room for the sick folks.
5. If your kids do get sick while you are out of town, keep them comfortable. Give them an antiviral medicine (Tamiflu) and make sure they have fever reducers – ibuprofen or acetaminophen.

Hope this helps. Everyone have a safe and healthy Thanksgiving.

Not many kids look forward to the flu shot, but almost all of them realize that it wasn’t as bad as they thought.

Yes, it’s that time of year. Here are 6 questions we hear most often about the flu vaccine:

1. Who needs a flu shot?

We recommend the flu shot for anyone over 6 months of age. Kids under 5 have much higher risks of hospitalization, severe complications and even death. Pregnant moms have one of the highest complication rates.

2. Is it going to hurt? What about the mist?

Yes. It’s a SHOT. I never promise that shots aren’t going to hurt. I usually say, it’s going to hurt for a minute but it gets better soon. You might have some muscle soreness and achiness for a few days but it’s a lot better than having fever and body aches for 5 days. Unfortunately, we aren’t going to have the mist this year again. Previous years have shown that it wasn’t as effective so, pending new information, no one will be giving it out.

3. "What do you think, do you want to get one?"

When I offer the flu shot to parents, they commonly turn to their kid and ask this question of their children. Seriously, don’t do that. Of course your 4 year old isn’t going to volunteer for the flu shot. It’s a SHOT.

4. Is it going to work?

We don’t always know the answer to this question until much later in the flu season. When it’s too late to get your vaccine…so don’t wait to decide. My question is always: “Even if it’s only xyz% effective, isn’t that better than nothing?” Some years are better than others. Every year, despite the coverage rate, kids lives are saved because of the flu vaccine.

5. How bad is this season going to be?

We’ve heard reports that Australia has had a terrible season. Some experts say that might predict a bad season for us, but others say, it doesn’t matter and we can’t really predict. Bottom line is that it’s either going to be a bad year or it’s not, but we won’t know until much later.

6. When should I get my child’s flu shot?

Right now! Getting protected two weeks before the start of the season is important and we never know when it’s going to start.

Your Cook Children’s pediatrician has flu shots available and we recommend that you get them ASAP, before the start of the flu season. Call your pediatrician to schedule a flu shot today. 

The study, also published by the American Academy of Pediatrics, is the first of its kind to show how flu vaccinations significantly reduce a child’s risk of dying from influenza.

For four flu season, from 2010 to 2014, the CDC found that flu vaccines reduce the risk of flu-associated death by nearly two-thirds (65 percent) among healthy kids and by 51 percent among kids with underlying high-risk medical conditions such as asthma, chronic lung disease, heart disease and weakened immune systems.

“One of the questions we hear a lot from parents is does the flu vaccine really work,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cok Children's. “I hope this study helps parents see the real, life-saving value of the vaccinations. This report from the CDC shows us that the flu vaccine can play a major role in preventing more children dying from the flu.”

The study looked at 358 laboratory-confirmed, flu associated deaths. Of the reported pediatric deaths with known vaccination status (291), only one in four children (26 percent) had been vaccinated.

During the 2016‐2017 influenza season, 0 Tarrant County influenza‐associated pediatric deaths has been reported. As of week 12 for the 2016-2017 season, two influenza‐associated pediatric deaths have been reported in Texas, with a total of 55 reported nationwide.

To learn more:

• CDC Report
• AAP Report
• It's Only The Flu That Killed Her

About the Source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

At Willow Park, we are getting tons of calls for it if a child has been exposed, a parent has been exposed, a neighbor has it, your dog sniffed someone's bum who had the flu two weeks ago, etc.... 

Ask most physicians about Tamiflu and we'll tell you...."Meh." Tamiflu is helpful, but is not vital to getting over the flu.

1. It is not a "cure" for the flu. It allows for recovery one day faster than if you did not take anything.
2. It is expensive.
3. It does not come without side effects (especially tummy side effects) - sometimes worse than the symptoms of the flu!
4. It works best only if started within 48 hours of symptoms appearing.

Tamiflu is important to use and prophylax in children who have underlying medical issues - think asthma, diabetes, immune system deficiency. It is also indicated for use in children under age 5 if the child has the flu, or has a close contact with the flu.

It is NOT needed for healthy older children who are not symptomatic.

The best way to not catch the flu/get a milder version of the flu is to get the flu vaccine yearly! 

Hugs, 

Dr. Diane

About the Author

Dr. Diane Arnaout joined the Cook Children's Willow Park practice in 2011. Dr. Arnaout was born and raised in the Dallas-Fort Worth area. She served as a leader on the medical education committees during her internship and residency in pediatrics at the University of Texas Health Science Center in the Texas Medical Center at Houston, Texas.

From Jan. 15  to Jan. 21, 427 patients were tested for the flu, with 100 testing positive for Influenza A and five for Influenza B.

The CDC says influenza activity is slowly and steadily increasing. The CDC continues to encourage flu vaccines for everyone 6 months and older to help prevent influenza illness, as well as prompt treatment with flu antiviral drugs for people at high risk of serious flu complications who develop flu symptoms.

The good news is if you and your children received the flu vaccine you stand a good chance of being protected.

“The flu viruses isolated so far are covered in this year’s vaccine well over 95 percent of the time,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases said. “So, this is a good year to have gotten the vaccine. And if you have not gotten the vaccine yet, the season is starting late enough that you should go ahead and make sure your entire family is vaccinated.”

The flu season began with the announcement that the nasal spray flu mist vaccine wouldn’t be administered this year because the Centers for Disease Control and Prevention said it wasn’t effective. Then in North Texas, and around the country, the flu has been late in arriving.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

With the upcoming season, now is the time to get your child’s flu vaccines.

Only flu shots will be given this year to protect kids from becoming sick. This is due to recommendations from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) after last year’s FluMist was found to have failed against certain strains of the flu.

But parent’s shouldn’t worry, Cook Children’s has increased its doses of the Quadrivalent Influenza Vaccine (flu shot) for its primary care offices.

“Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease,” said Justin Smith, M.D., a Cook Children’s pediatrician. “Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.”

The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and was approved for healthy patients ages 2 through 49 years. But that is no longer the case. Only the injection is recommended.

To find a Cook Children's pediatrican in your area, click here.

Here’s the part where I am supposed to tell you about the 7-14 days of awful symptoms. Tell you that your body will feel like it is sinking into a deep hole. That your muscles will ache with every racking cough that escapes your body. That you will burn with high fevers for five days. That your head will feel like it’s exploding. That the drainage from your upper airways will puddle into your stomach, and that will make you barf. Sounds great, right? Well, you’ll get over it.

And you’ll slowly pick yourself back up. And eventually you will go back to work or school.

And you’ll tell yourself, “Geez…I am getting the flu shot from now on.” ;-)

But that’s not what I’m going to talk about. I’m going to speak for the thousands of people who no longer are able to speak about influenza. Because the flu can kill. And it has. 

Heck – there have been giant worldwide pandemics of the flu. The influenza pandemic of 1918-1919 killed more people than those that died in World War I - somewhere between 20 and 40 million people (though some sources list 50+ million). It has been cited as the most devastating epidemic in recorded world history.

The last flu pandemic we had was in 2009 (H1N1) and it killed over 200,000 people.

The flu is a “really really bad guy”, as my 2 year old likes to say. It’s super contagious (an infected sneeze or a cough a few feet away from you, and you’ll start to show symptoms within 4 days). It’s meanest to young children, older individuals (age 65+), pregnant women, and folks with underlying medical problems (think chronic lung problems like asthma, people with immune system dysfunction, diabetes, kidney disease, liver problems).

But let’s put all that aside. Let’s say you’re a healthy young person.

The flu can kill you, too. Or at least – make you really really really sick. Sicker than the majority of lucky souls who get away with the scenario in the opening paragraph.

I am a general pediatrician. During my training in medical school and residency I personally have taken care of:

• Countless cases of severe sinusitis, pneumonia, and ear infections due to getting the flu (which then makes kids susceptible to bacterial infections like these).
• A teen girl who was so sick with the flu that within 24 hours of catching it, she started urinating a brown substance. This substance was broken down muscle proteins. She was experiencing a well-known complication of the flu: rhabdomyolysis. Her muscles were literally breaking down and her kidneys were trying so hard to clear all the junk out that they eventually shut down. She needed dialysis. She spent 3 weeks in the hospital.
• A young pregnant woman contracted the flu while 29 weeks pregnant. The flu killed her in 24 hours due to respiratory distress (pneumonia) and her organs shut down. The woman birthed the baby while on life support and the child never knew his mother.
• A child with relatively mild asthma caught the flu, which made his asthma flare so bad that he required ventilation by a machine for over a week in the ICU. During that time, the flu made his body susceptible to other organisms, and he had to be treated for pneumonia and a blood infection called sepsis as well.
• In the PICU, I cared for a young boy who was, prior to the hospitalization, happy, vibrant, and healthy. There were pictures all over his ICU bed of him riding bikes and eating birthday cake. He caught influenza in school and within a few days it attacked his heart, causing something called myocarditis. The heart stopped beating as well as it usually does, and he needed full life support. That child eventually needed a heart transplant.

I want to say, “I’m not telling you these stories to scare you.” But I am. I want you to be scared of the flu. Because I’ve seen what it can do. And I don’t want that to happen to you or your family. Yes, the majority of the cases of the flu are mild. But sometimes, they aren’t.

The flu vaccine can help your body fight the flu. If you get the vaccine, our hope is that you or your child will either not suffer from any clinical symptoms, or develop an illness that is much milder than if you did not vaccinate. The vaccine was developed not only to save lives, but to prevent millions of days of missed school and missed work.

The people who are against vaccination will argue a couple of points I’d like to discuss:

• “The flu vaccine makes you sick.” – This is a common misconception. The flu vaccine can’t make you sick because it is either completely inactivated or it is not even the virus itself, but a protein that looks like the virus (tricking your body into making an army against it). Sometimes people get mild symptoms after the vaccine like a headache, general achiness, and a low-grade fever. People mistake this as being “the flu” when really it is their immune system generating antibodies and starting a great immune response. Also remember that the flu vaccine is usually given in the fall and winter, when tons of other respiratory viruses are circulating. Folks may catch those and the vaccine is usually blamed.
• “The flu vaccine doesn’t work”. – Actually, some years, this has been true for some people. The World Health Organization (WHO) recommendations are based on global surveillance of circulating influenza strains and on the effectiveness of the vaccine from the previous year. Sometimes they get it right. Sometimes they don’t. The flu is sneaky – It can mutate quickly. We don’t know until the flu season is in full swing. By that point, the vaccine has already been made and shipped out. So it’s important to get it every year regardless. And we hope for the best. Most years, it is right on target.

PLEASE consider yearly vaccination against influenza for yourself and those you love. The flu vaccine changes every year, so you need a new shot every year to boost your immunity against the strains we think will be the “bad guys” that year.

Related links:

• It's only the flu that killed her
• Chicken pox: Why We Vaccinate
• 4 Facts Parents Need To Know About the Flu

The AAP (American Academy of Pediatrics) and the Centers for Disease Control’s ACIP (Advisory Committee on Immunization Practices) stated, “Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-2017 season due to poor effectiveness.”

The first thought that went through my head was this: my kids have to get the injectable flu vaccine next year AND I have to convince them that it’s a good thing. (I may be a pediatrician, but I’m still a dad.)

The committee looked at data from the last three flu seasons showing that the nasal vaccine had limited to no effectiveness for preventing flu.

Here are 4 facts you need to know:

1. Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease. Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.
2. Assuming there’s no new information or guidance, your pediatrician should not offer your child the nasal flu vaccine. Even if we hear something new, I would choose to do the injectable vaccine and I will do so for my kids.
3. The committee is hopeful that this early decision will help prevent any issue with the vaccine supply. However, there are flu vaccine supply issues nearly every year so I recommend getting in to get your shot early.
4. There’s a committee out there who is looking at this data and making the best recommendations possible based on the latest information. Is it frustrating that we were giving a vaccine that didn’t work? Of course. Am I glad that I won’t do it for another year? Definitely.

Stay tuned for more information about flu and flu vaccines as we get closer to September when flu vaccine supplies start arriving at your Cook Children’s pediatrician’s offices.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for everyone 6 months of age and older, with rare exceptions. The vaccine status of this particular infant's parents was not reported, but Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s said parents must do their part to protect their children during flu season.

“It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Vaccination is recommended as long as the influenza viruses are still circulating.

At Cook Children’s, this was the latest in the flu season that a child has started in at least 10 years.The latest numbers from March 19, 2016, state that 102 patients have been diagnosed with either flu A (42) or flu B (60).

During the 2014-15 flu season, the CDC says there were a total of 148 influenza-associated pediatric deaths reported in the US of which 19 were reported from Texas.There were two pediatric influenza deaths in Tarrant County during that time period.

“The death of a child is such a tragedy,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases said. “This flu season is much later than usual and so far this year there have been fewer reported cases. But parents must continue to do everything that we’ve always recommended for flu prevention, including vaccinations. Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

What will the new year bring?

Will I be able to keep that New Year's resolution?

And where in the world is the flu?

Ok, you may not be asking yourself that last question. Out of sight out of mind right? Well, not at Cook Children's. Our lab specialists have been diligently testing cases each week for influenza. And for the first time in at least 10 years, they haven't identified a single case so far. Since 2005, the closest we've seen to a season hitting this late was back in 2012 when the first positive case popped up on Dec. 26. But here we are, just two days from 2016 and nothing!

Depending on where you look, outlooks on the impending flu season vary. One model, developed by researchers at Los Alamos National Laboratory, shows the flu season will likely peak in February. WebMD is using data from its online Symptom Checker to predict a spike in cases in early January.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, said the flu is unpredictable and she’s not sure why it’s “late.”

“We don’t know when it will start or peak,” Dr. Whitworth said. “We just generally go into each flu season with a wait and see attitude.”

Dr. Whitworth said how severe the flu season will be depends partly on whether or not the flu shot given is a good match to this year’s strains. Previously, in years when the flu shot strains didn’t match, doctors relied more on treatment with antiviral drugs (prescription medication) that fight against the flu in your body.

“For now, we don’t know how serious the flu will be, but for now getting a flu vaccine is still the best way to prevent what can be a potentially serious disease,” Dr. Whitworth said. “By immunizing every year, that’s how we, as a society, build up a community that protect themselves for new strains.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Are we there yet? “No. 5 more minutes.”

Are we there yet? “No. I will tell you when we get there!”

Did anyone hear this or something like it last week?

We’ve been asking a similar question to our favorite Cook Children’s microbiologist, Morgan Pence, Ph.D.

Is it here yet? No.

Flu season should be just around the corner, but it’s not here yet. Currently, there are only two regions showing Influenza activity across the state of Texas. Tarrant County is not one of those regions.

Flu season usually starts sometime in late October or November but occasionally we have later seasons. It appears that we are going to (knock on wood) make it till December before we see our first case at Cook Children’s this year.

There are few theories about why flu follows a seasonal pattern:

1.As weather gets colder and people are trapped indoors, the virus can more easily spread from person to person.

2.Colder temperatures lead to drier air. Dry air causes our noses to be drier which may make their defense against flu weaker.

3.Cold temperatures may allow the flu virus to live longer on surfaces.

Based on these theories, it’s possible that our warmer fall has caused a delay in the onset of flu season. With the colder temperatures last week, we may be reporting our first case soon.

Dr. Pence reports that our lab tested 74 specimens last week but none were positive for flu. She states, “Currently we are mostly seeing children with rhinovirus and RSV.” Rhinovirus causes the common cold. RSV can cause cold-like symptoms as well, but can be more severe in babies, especially those who were born premature.

What does this mean for you and your child?

1.If you haven’t yet, there’s still time to get your flu shot. (Even if the year starts late, it could still be a bad one).

2.Continue to teach your children to cover coughs and to wash hands.

3.Be aware if your child tests positive with a rapid flu screen, it may not be correct until flu activity is higher.

For now, Dr. Pence will still have to play the role of lab-mom.

Is it here yet? “No.”

Is it here yet? “No, probably 2-3 more weeks.”

Is it here yet? “No, but you’ll be the first to know!”

There are a lot of reasons I didn’t want to do this:

1. I was in the office seeing patients and you chose to go to elsewhere. This family had taken their child to a quick in-and-out urgent care center. Not even a Cook Children’s Urgent Care. (Hey, I’m human and I have feelings too. But, I can get past you taking your child somewhere else first, if it was in the best interest of the family.)
2. I don’t routinely treat family members to prevent the flu. If they are high risk with asthma or other chronic medical conditions, maybe. But the whole family? What about next month when someone else gets the flu? Monthly Tamiflu for the family?
3. Finally, the one that made me the most upset, this phone call came in August!

Why does that matter?

Flu is a seasonal disease. We typically start seeing flu sometime in late October or in November, but this is not always predictable.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says that we should “expect to start seeing it in the next two to three weeks, but it's hard to say because flu season fluctuates every year. There have been years where it hasn't really hit until mid to late December.” So far, Cook Children’s medical center has not had a positive test for flu.

There are two main tests that we use to diagnose flu. One test is more accurate but it takes more time and is more expensive. It is run in hospitals.

The other test is cheaper and faster but the results are not as reliable. This is the test that is run in physicians’ offices and urgent care clinics. It can also be run in hospitals as well, when rapid testing is indicated, but Cook Children’s does not run this test after April until flu activity actually starts in the late fall.

Why not?

The reason goes back to the characteristics of the test. Almost no test in medicine is 100 percent reliable. With all tests, there is a risk of a child having the disease, but testing negative and vice versa. The reliability of the test changes a lot depending on how many cases of the disease are in the community at the time.

Flu tests that are positive when flu activity is low are more likely to be wrong. This is less common but still possible.

Flu tests that are negative when your child has the right symptoms and flu activity is high are probably also wrong. This is one of the reasons that the Center for Disease Control and Prevention gives us the option to treat flu based on symptoms alone when activity is at its highest.

What did I do with my flu positive family?

I asked the dad to bring the child over and took a good history and physical. This took quite a bit of convincing that this was the right thing to do since they had already paid for a doctor’s visit elsewhere that day, so I promised to do it for free.

Turns out, the child’s symptoms were actually pretty weak for flu. I spent time explaining why the test was likely inaccurate and why I would not recommend treating him or his siblings for flu.

When my nurse called back the next day, the child was back at school and his family was $100s richer than they would have been.

“Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season,” Dr. Whitworth said.

The flu shot is recommended for children ages 6 months and older. However, the Centers for Disease Control says only 47 percent of the nation’s eligible population received a flu shot. The only age group that met the CDC’s coverage goal of at least 70 percent was children 6 months to 23 months of age with 75 percent getting their shot.

It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Last year, a lot of talk focused on how ineffective the flu vaccine was, with the CDC saying it was less than 23 percent effective against the dominant strain. The CDC says the vaccine will be more effective this year based on data from early detected cases.

Dr. Whitworth says it’s too soon to predict what the flu season will bring as far as severity and it’s difficult to say how effective the vaccine will be because different strains circulate each year. But vaccines are still the most effective way to fight against the flu.

During the 2014-2015 flu season, 145 children died in the United States from influenza-related illness and the American Academy of Pediatrics says many of those children had no underlying medical condition. The AAP states that an estimated 90 percent of pediatric deaths have occurred in unvaccinated children.

Two types of influenza vaccines are available for children this year, according to the AAP:

• The inactivated influenza vaccine (IIV) is given by injection and is approved for children 6 months of age and older. It is available in two types, one which protects against three strains and one which protects against four strains of influenza.
• Also available is the live attenuated influenza vaccine (LAIV), which is given by intranasal spray. It is approved for healthy patients 2 through 49 years of age and protects against four strains of influenza.

 The AAP also recommends:

• Everyone who is 6 months of age and older should receive annual influenza vaccine.
• Children ages 6 months through 8 years need two doses this flu season, if they have had less than 2 doses of flu vaccine before July 2015.
• Special efforts should be made to vaccinate household contacts and out-of-home caregivers of children with high-risk conditions, and all children under the age of 5.
• Parents should not delay immunization in order to receive a specific vaccine formulation. It is more important to be vaccinated at the earliest opportunity.
• Pregnant women, who are at high risk of influenza complications, can safely receive influenza vaccine at any time during pregnancy. This also provides protection for their infants during their first 6 months of life.
• Mandatory influenza immunization programs for all health care personnel should be implemented nationwide.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Ailments run the gamut from respiratory and fever issues (RSV and influenza) to gastroenteritis with vomiting, diarrhea and severe dehydration. And while there’s not one illness that stands out, one thing is for sure – children in the ED are sicker than they’ve ever been.

“Our ED is running beyond full capacity and has been since December. But in the last few weeks we’re seeing a larger number of very ill children than even during flu season.” said Corwin Warmink, M.D., assistant medical director of the Emergency Department at Cook Children’s. “The sicker the child, the longer it takes to diagnose, treat and properly care for them.”

In December, 20 to 30 kids were admitted for treatment per day from the Emergency Department, but by February, those numbers jumped to about 40 to 50 children a day.

The Emergency Department is averaging nearly 400 patients per day, and during its busiest times a patient will check in every two minutes.

Overall, children appear to be sicker this year. Compared to this time last year, Cook Children’s has seen a 60 percent increase in the percentage of children who need critical care.

As the number of patients admitted and treated in the ED increases, so does the time physicians spend with each child, which contributes to the much longer waiting times.

Depending on the severity of the illness or injury, it could take 4 to 6 hours to care for a child. But it’s not just one physician treating that child. Nurses and health care providers may be brought in too.

“Many of the children we see are dealing with very serious emergencies and they receive immediate care,” Dr. Warmink said. “We use all necessary resources and manpower to care for those children. Unfortunately, that means longer wait times for the families in the waiting room.

“Families could spend anywhere from 5-10 hours or longer in our waiting room, depending on the day they visit. We are actively bringing in extra doctors, nurses and support staff to try and improve these times.”

Dr. Warmink advises parents that Sundays and Mondays are the busiest days of the week in the ED. Evenings after 5 p.m. seem to be popular too.

Families with sick kids who aren’t experiencing emergencies do have other options. The first line of defense is your child’s pediatrician. Making an appointment with a child’s doctor may help avoid a long wait at the ED. Cook Children’s also has several Urgent Care Clinics for non-emergent needs.

Previous articles on this topic:

• More flu, longer waits in the ED
• Emergency? 6 signs from an ER doc
• Cook Children's to build new South Tower on main campus
• Is it RSV?
• 8 flu myths I wish would go away

This week presented an excellent opportunity for me to return the favor.

Our family chose to cancel our usual family Christmas. Not because the kids were bad and we’re not rewarding them. Not because we were frustrated with how commercialized it has become and are taking a stand. 

Actually, the rest of our extended family all got together and opened presents on the Sunday before Christmas as usual. We just didn’t go this year.

So, why didn’t we participate?

Flu.

Since I have been a practicing pediatrician, I have somehow avoided bringing the flu home. Whether it was luck or blessing or whatever you want to call it, we have been spared, until this year. My two boys have the flu.

So why didn’t we go?

Believe me, skipping the excitement and fun of watching our kids with their cousins is heartbreaking. This is the first year that all of our kids seem to know something is different about this time of year and Christmas at my grandmothers is always one of the highlights.

But, taking a risk with the rest of our family is not worth it and it should not be for you either. If your child is sick, find some other way to celebrate that doesn’t put others at risk. 

Think about those people who are most at risk from complications of the flu: children under 5 years (especially under 2, all the new babies out there), adults over 65 years (grandma and grandpa), pregnant women (your cousin’s first baby) and people with chronic medical conditions. These are just the types of people who it’s hard to stay away from at Christmastime.

We will make the best of today and pray that we are all better come Christmas Day. You should do the same.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Flu Myth #1

The flu shot can give you the flu.

Nope. Not true.

http://www.usatoday.com/story/news/health/2013/01/14/can-flu-vaccine-cause-the-flu/1833793/

Flu Myth #2

The only time I got the flu was the year I got the flu shot.

This may be true, but it’s completely coincidental. There’s no mechanism where the shot would make you more susceptible to getting the flu.

Flu Myth #3

The flu is annoying, but harmless.

This is true for many children, but we should watch for dehydration and difficulty breathing. Kids with asthma and other chronic medical conditions should be monitored closely.

Flu Myth #4

I had the “stomach flu.”

If you had vomiting and diarrhea only, you probably had another virus. Flu symptoms are fever, cough, congestion and body aches but rarely stomach problems.

Flu Myth #5

Because the flu shot is only covering 2 strains, you should skip it.

Getting coverage for 2 strains is better than 0.

http://www.checkupnewsroom.com/does-my-child-still-need-a-flu-shot/

Flu Myth #6

Over the counter cough and cold medicines help kids with the flu.

Cough and cold medicines do not work very well for anyone and can be harmful in kids. Just skip them. Run a humidifier and if over one year, give them some honey at bedtime.

Flu Myth #7

If you suspect your child has the flu, they need to see the doctor right away.

If they are drinking OK and staying hydrated, home care can be appropriate. Certainly call your doctor before going to the emergency room unless they have symptoms other than fever, cough and congestion.

http://www.checkupnewsroom.com/more-flu-longer-waits-in-the-ed/

Flu Myth #8

Every child who has the flu needs Tamiflu.

If your child is healthy (no asthma), the benefits of Tamiflu are minimal if anything, it is expensive and there are possible side effects. Consider these factors when and have a conversation with your doctor.

About the author

 is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Fever, headaches, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite.

Over the next few months, many children will have these symptoms and many parents will, and should, call their Cook Children’s pediatrician because of how their child’s feeling.

Unfortunately, many parents will assume the worst … Ebola. But the chances of that being a reality are extremely low. While knowing it’s not likely to be Ebola may be a relief, it’s important to remember that Ebola is not the only dangerous virus on the horizon for our children. The symptoms listed above are much more likely to be the flu.

Investigation of 25 outbreaks of Ebola over 38 years has shown that only direct contact with a person with Ebola would cause someone to become infected. Right now, there’s no approved vaccine to limit the epidemic in West Africa.

On the other hand, influenza can be deadly. The 2013-2014 flu season led to 108 pediatric deaths in this country. The flu is spread readily through the air by small droplets which can be infectious to someone near a person who is coughing and sneezing and is much more easily acquired and easily prevented through vaccination.

Please make sure to get your children the flu vaccine and parents should get them too! ASAP. Both injection and nasal mist vaccines are effective.

The flu season is upon us once again ... what do you need to know as a parent?

1.What are symptoms of the flu?

The flu may start like the common cold with symptoms of cough, congestion and runny nose, but may also be associated with prolonged fever, muscle and body aches and fatigue. It is spread from person to person when an infected person, coughs, sneezes or talks and droplets are released into the air. It can also be spread less often from touching surfaces where drops are present. The flu virus is contagious from up to 1 day before the person presents with symptoms and up to 5-7 days after the symptoms resolve.

2. How can you protect yourself?

The best way to protect yourself is by getting the flu vaccine as soon as it becomes available. Most doctors’ offices and clinics currently do have the flu vaccine available. Last year, flu activity peaked at the end of December to the beginning of January, but you may start seeing it as early as September-October this year.

Other means to protect yourself are effective hand washing and wiping down surfaces with anti-bacterial/viral cleansers.

3. Why get the flu vaccine?

In the United States each year, more than 200,000 people are hospitalized from seasonal flu-related complications. Last year, there were more than 105 pediatric flu related deaths in the United States. On average the effectiveness of the flu vaccine last season was about 61 percent.

4. Who should get the flu vaccine?

• Everyone over the age of 6 months.
• Higher risk populations include those between the ages of 6 months to 5 years, children with asthma or other chronic disease, pregnant women, people with immune problems and adults  more than 65 years old.
• Children under the age of 8 MAY require 2 doses of the vaccine 4 weeks apart from each other depending on their previous immunization status.

5. Which flu vaccine is recommended?

There are several options for flu vaccines this year. For 2014–15, U.S.-licensed influenza vaccines will contain the same vaccine virus strains as those in the 2013–14 vaccine.

Trivalent flu vaccine protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. This is only available in the injectable form.

The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The quadrivalent form is available as an injection and a nasal spray.

Specific Age Recommendations

• 6 months to 2 years: injectable flu vaccine only.
• 2 years to 8 years: nasal form is preferable according the Centers for Disease Control and Prevention (CDC). There was 50 percent more effectiveness with the nasal form vs. the injectable form in this age group. If the child is between the ages of 2 and 4 and has asthma or wheezed in the last year, then the injectable form is recommended.
• 8 years and above: either form is acceptable.

6. What happens if you get the flu?

See your health care professional as soon as possible because if it is treated with anti-viral medications in the first 48 hours, the duration as well as the severity of the illness can be decreased. The CDC does not recommend treatment of healthy individuals with anti-viral drugs, but certain high risk populations will benefit from treatment.