The Measles Epidemic of 2014-2015- UPDATE

The Measles Epidemic of 2014-2015- UPDATE

January 29, 2015

The United States is right now experiencing an epidemic of measles, a threat to children not seen in the US commonly since the 1950's.

The Current Epidemic

It appears all the current cases of measles erupted from one source, a child with measles in the Disneyland in California.   To date there are 70 people who have the disease measles from that one source, but many thousands exposed.

What is Measles?

Many think of measles as yet another pesky but harmless, colorful, childhood illness, like chickenpox.  And there are some similarities- both cause fever, and a very distinctive rash, highly contagious, and once occurred in most all children.

But the difference is that measles can cause a permanent and quite severe impairment of the brain, leaving the affected person forever disabled.   

Across the world, measles is blamed for about 5% of all childhood deaths.  

So, it is not a harmless childhood infection, despite the fact that most children who get it recover well.

The key symptom of measles is a unique rash- large red dots- and also usually causes a very intense pink eye, cough, runny nose, and high fever.   But you have to have the measles rash to be diagnosed with it.

The Broader Context 

This is not the first outbreak of measles in the United States since we came close to eradicating it in the 1960's.    But the difference this time is our reaction to the news that otherwise healthy children are now in harms way.

There is only one reason that countries experience measles epidemics:  if enough children are not immunized to allow the virus to spread.   One a population reaches a certain percentage of being immunized against measles, the disease disappears.  This fact has been demonstrated time and again.

In recent measles epidemics, there has been not so much concern, because the nation has been in the grip of a passionate worry that the measles immunization causes autism.  And so, for many years, when the word measles was raised, the word autism came to mind, and the fear of the disease paled in comparison to the threat of autism.

Now, however, the fact that the measles immunization has nothing to do with autism has actually taken hold across the nation.  Today, parents of young children are less and less concerned about the idea the measles immunization can cause harm, and so the very real threat to their child that measles poses is rising up, and rapidly.

This explains why this Disneyland outbreak has captured the headlines like no other in many years.  The image of children being put at risk of serious neurologic hazard from a visit to Disneyland has struck fear and concern across the US.

BOTTOM LINE

The measles outbreak from Disneyland is not very large, but is happening.  Time will tell if it grows or dissipates.  But the real lesson of this outbreak is that the era of worry about the measles immunization is drawing to a close, and families across the country are once more becoming united in having their children not risk the tragedies that a measles infection can cause.

A special note:  We can give the MMR to even young infants who are exposed.  Normally we wait to one year of age, because prior to that time mother's antibodies will clear the vaccine.  But if an exposure occurs, MMR can be given during infancy, it just won't count as a long-term MMR in the series.

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

From Norwalk Ohio to the world- the new stomach flu is here- and an influenza update

From Norwalk Ohio to the world-

The new stomach flu is here-

 and an influenza update

One thing is far from new- stomach flu in the winter.

Background on the stomach flu viruses

Every year for probably many hundreds or thousands of years, certain viruses appear across the country to cause vomiting, diarrhea, and fever, that is, stomach flu, every January, February, and March.

For most of our lives that virus was rotavirus, but rotavirus immunization in the United States has effectively cut down on the presence of rotavirus.

Sadly, a new virus has fully taken the place of rotavirus, that is the norovirus.  The norovirus is so widespread at exactly the same time as rotavirus once was, that the number of people who get stomach flu and the severity of it is essentially unchanged.

So this winter, like all others, a very large number of our children are suddenly starting to vomit heavily then develop diarrhea, staying sick for a week, and raising concerns about dehydration.

So what does the norovirus have to do with Norwalk, Ohio?  Well, it was first discovered there in 1968.  The virus was completely unknown across the world until this discovery, leading to it being named the Norwalk virus until more was known about it and a category of virus was created and the species name norovirus adopted fairly recently.

The norovirus is now the most prevalent cause of stomach flu in the winter across the US, and most cruise ships!   

What to do if your child gets the stomach flu

It turns out that stomach flu, although an entirely miserable experience, is typically quite harmless.  

The whole illness has to do with gut viruses landing in your stomach, causing the stomach, then the intestines, then the colon to get inflamed as it burns along the whole tube of the gut.

Landing in the stomach leads to stomach inflammation, and therefore, vomiting.  That usually starts the illness and lasts 1-3 days.  Once the virus passes to the intestine and colon, diarrhea appears and lasts until the whole intestine is healed, which usually takes 5-14 days.  Fever may or may not be present.

The inflammation of stomach flu tends to be relatively minor.  It causes all this trouble, but does no lasting damage to the gut or stomach.

So the key risk your child with stomach flu is really not the germ, but the risk of dehydration.  This does not actually happen in the vast majority of cases, but it can.  The greatest risk is during the heavy vomiting period.  If there is not much vomiting, diarrhea tends not to cause dehydration since your child can simply drink to keep from getting dry.  Heavy vomiting however can keep drinking from working.

One way around  this is to use the strategy of limiting drinking to small sips that get absorbed before they can hit the stomach and be vomited.  This works if you limit drinking to one teaspoon every 5 minutes.  Eight hours of this provides 16 ounces of fluid with no vomiting of what is swallowed.

Of course, sometimes the vomiting and diarrhea is so intense that no strategy can keep up, and dehydration occurs.  How do you know if this has happened?  Here are the signs:

• No or little urination
• Dry cracked lips
• Sunken eyes
• And, wilted lack of energy.

The good news is that no matter what, it is easy to reverse dehydration- it just involves adding water by drinking or by IV.  If drinking fails we turn to the ER for IV hydration.

FOOTNOTE ON INFLUENZA

The latest data from the CDC show that the influenza virus epidemic of 2014-2015 is following the track of the epidemic of 2012-2013 to a remarkable degree, making it a very typical epidemic.   As such it is waning as spring approaches, and we anticipate influenza infections will become infrequent as February arrives and proceeds.

Also, thankfully, the number of childhood deaths is much smaller than in prior epidemics of influenza virus.

All in all, despite all the excitement in the news, this appears to be a very average, typical winter of influenza caused colds and flus and is on the wane.

To your health,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Influenza Winter 2015 UPDATE: Saturday, January 10, 1PM

Influenza Winter 2015 UPDATE:  
Saturday, January 10, 1PM

The CDC has recently released the latest data on this year's influenza virus epidemic, and the news is very good.

Every week the CDC reports a comprehensive set of data on how many people are infected with the flu virus that week, how many are getting hospitalized ,and how many deaths this virus is causing, especially in children.

As we share this week's information with you, it is once again very important to keep in mind that only a minority of a winter's colds and flus are caused by the influenza virus, in fact about 25-30%.  All the other colds and flus we have are caused by all sorts of viruses, like the rhinovirus, adenovirus, RSV, etc.  So all the news reports and all this data concern only the influenza virus.

The good news is that this winter's influenza epidemic is giving an early sign of weakening, of being past its peak.

Even more striking, the pattern of this year's influenza virus epidemic is matching the pattern of the epidemic of 2012-2013 almost exactly!  This epidemic appeared in December and peaked around New Year's.  The rise and fall of 2012-2013 is so far almost an exact match to this year's epidemic.

That means the worst of this year's influenza epidemic may be over and it is very reasonable to hope that the intensity is already fading.

Here is more good news:  there are far fewer of the most frightening outcomes this year than in years past.  The number of childhood deaths from influenza virus infection by this time of year in the 2012-2013 epidemic (which matches this year so closely) was about 50-60 deaths.  This year that number has dropped to 26, across the whole country.  To put that into further context, influenza virus infection typically kills about 20,000 people in the US every year, and this year that may only include <100 children.="" i="">

These data are especially important to know as the news and reporting on this year's influenza epidemic are giving a needlessly frightening message.  If you read the paper, watch TV, or listen to the radio, the impression is that the United States is under the assault of a historically dangerous influenza outbreak with unprecedented levels of illness, risk of dying, and failure of flu vaccination.

None of these impressions are true.   This year is very much like most others, lots of colds and flus circulating in the winter.  The actual numbers are about the same as in 2012-2013 which was a year the generated almost no comment of worry, and the number of deaths in children is actually much lower than that year.

As for the impact of immunization, it is true that the most widespread subtype of the influenza virus circulating right now is not the exact form of the one in the vaccine, but even so, those vaccinated have a 50% of being protected from that strain.

Finally, to repeat our perspective on Tamiflu.  There are three reasons to be cautious in its use:

1. It is not free of side effects.  Children especially are at risk for developing seizures, and it can cause serious behavioral disturbances.
2. It does not deliver dramatic improvements consistently.
3. If millions of relatively healthy people use it for most colds and flus, we hasten the day when even its limited efficacy is available.

Of course, if a person does develop a dangerous influenza infection, defined as one impairing the ability to get air in and out of your chest, or in some other way impaired in function, the use of Tamiflu is clearly worth the risk of its use despite its impact being limited.

Bottom Lines:

1.  This year's influenza epidemic is actually a rather typical winter flu season.  Its magnitude and timing, so far, nearly exactly match the 2012-2013 epidemic which caused almost no comment at the time.

2.  This year's influenza epidemic is giving early signs of being on the wane.  If this turns out to hold up, we won't have much to talk about influenza in a few weeks.

3.  The scary news reports on this year's influenza virus epidemic are highly misleading.   These infections are overwhelmingly harmless to healthy children, the frightening reports of deadly infections in children fail to discuss just how rare this is.  And, so far this year, fatal illness in children is quite a bit lower.

4.   The flu immunizations have worked, those who got them, even this year, turned out to be less likely to get sick, and when ill had milder illness.

5.  As with any illness, if you have serious troubles such as struggling to breath, severe pain, a stiff neck, dehydration, call for help.

We hope you and your family get through this winter in good health, and that any colds or flus you get- although unpleasant- remain harmless.

Happy and Healthy New Year,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Influenza Winter 2015 UPDATE

Influenza Winter 2015 UPDATE

The rates of infection with the influenza virus in the United States continue to climb, as expected at this time of year.

Before going further, we should repeat that there are many viruses that cause viral respiratory infections, and in fact, so far this year the number of such colds and flus due to the influenza virus has reached 30%, so over 2/3 of all colds and flus still are not from the influenza virus.

Now, on to the latest on the influenza virus.

We have talked before about how the influenza virus changes every spring as it leaves the human community, and every late fall when it returns to us. Sometimes the influenza virus that actually appears completely matches the subtypes in that winter's vaccine, sometimes not so much.

The current data suggest that the dominant strain appearing in the US is indeed the H3N2 strain, and it is different than the H3N2 in the flu spray and flu shot, that is, the flu vaccines for the winter of 2015.

We now know the following details on how well this year's flu vaccines protect against the H3N2 out there:

• About 50% of the H3N2 circulating do match what's in the flu vaccine, and those vaccinated are protected very well against it.
• About 50% of the H3N2 circulating do not fully match what's in the flu vaccine, but match well enough to blunt the severity of the infection.

And, a word on the terribly frightening reports on childhood deaths from the influenza virus of the winter of 2015.  The total across the entire United States is 15 deaths.  Each are horrifying losses, but the fact remains that across a nation of 100 million children, this number actually demonstrates that this terrible outcome is extremely unlikely.

Bottom Lines

1.  If you got or get this year's influenza vaccine, by spray or shot, you will almost certainly reduce the severity of the dominant influenza virus out there, the H3N2.

2.  If you got or get this year's influenza vaccine, by spray or shot, you have a 50% chance of full protection against the main influenza virus circulating right now.

3.   If you got or get this year's influenza vaccine, by spray or shot, you have a 50% chance of only partial, but still significant protection against the full severity of the main influenza virus circulating right now.

4.  If you haven't gotten a flu vaccine for the winter of 2015, it is not too late, we anticipate another month or two of lots of influenza virus causing lots of illness.  The flu vaccine only takes 2 weeks to provide its protection.

5.  Viral respiratory illnesses are a true misery.  And this year's influenza virus is causing very high fevers and much suffering.  But they are not dangerous infections for 99.999 (really)% of our children.   This means that very nearly all children who get these infections will do what very nearly all children do when they get colds and flus- recover without hazard or complication.  This year is still really not much different than others in that regard.

A Happy and Healthy New Year to all,

Dr. Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

The best source of data on the influenza virus- http://www.cdc.gov/flu/weekly/

The Best source of Data on the Influenza Virus-  

http://www.cdc.gov/flu/weekly/ 

We have gotten such a wonderful and enthusiastic response to recent posts about infectious diseases, that I thought it would be of interest to share a great source of information- the CDC.

In particular, I want to share how the information about the influenza virus is presented every week by the CDC.

Keep in mind that viruses, like animals, are classified into a variety of species, each of which are different in many important ways.  The influenza virus is one species of virus, that comes in many subtypes.   Colds and flus are caused by many different species of viruses, including RSV, rhinovirus, adenovirus, coronaviruses, etc.  Influenza virus causes only about 1/3 of winter-time respiratory colds and flus.

The CDC actually tracks the presence of the influenza virus in America, in great detail, for all sorts of reasons.  The primary one is actually to specify which varieties are in circulation so that the right types enter each year's vaccine, and to monitor this major cause of illness.

This webpage:   http://www.cdc.gov/flu/weekly/  gives anyone access to a veritable gold mine of data on the influenza virus.

Here is a brief tour of the six types of trends this web page follows on this virus:

First of all, all the data are reported weekly and usually lag 1-2 weeks behind.  Today for example the page reports on Week 50 of 2014, and we are in week 52.

Viral Surveillance

This is a very interesting report, as it tells us what percentage of respiratory swabs in people with colds and flus are positive for influenza.   It also tracks which subtypes are in the swabs- Type A, Type B, and subtypes like the now famous H3N3.  Note that as of December 13, 2014,  about 25% of people with colds and flus had influenza.  This means that even in the thick of the influenza onslaught, 75% of us with a cold or flu do not have an influenza infection.

The graph in this section is a bar graph with green, red, and yellow bars, color coded for the subtype of influenza virus on the swabs.  Bar graphs going up means more swabs are positive for the influenza virus.

Pneumonia and influenza mortality

This is a jagged red line going up and down between two wavy black lines.

The red line is the percentage, every week, of deaths in 122 American cities due to pneumonia and influenza.

Even without an influenza virus epidemic happening, about 6-7% of all American deaths are due to pneumonia, usually in the elderly.  That number goes up in the winter and down in the summer.  When the red line goes above the top wavy black line, that means pneumonia and influenza deaths have reached epidemic proportions, they have not yet done this in the US as of December 13.

Influenza Pediatric Deaths

These are the green bar graphs, and they track a very sad set of facts, how many children die of influenza in the US each week.  The numbers here, thankfully, are very small.  About 20,000 people die of influenza infection in the US every year, but only 100 or so each year are children, so far this year that number is 11.  A terrible loss, but quite rare.

Influenza associated hospitalizations

This line graph has many colored lines, one each for an age range, that tells us how many people, per 100,000, are hospitalized for influenza virus infections each week.  Note that by far the most hospitalizations occur in the elderly, and as expected these rates go up in the winter.

Outpatient Illness Surveillance-  This is the section I refer to most to report the progress of each winter's spread of all viral respiratory illnesses.  

This is a set of different colored lines set against a dashed black line.  Each line traces the percentage of visits to a doctor in the US for a fever of at least 100.0 with cough and/or sore throat. 

Note how the typical year really takes off in December, peaks around New Years, and slowly fades across January and February.   2014-2015 is the red noted by the red triangles, and seems to be following a course very similar to  2012-2013.  

Geographic spread of influenza virus, state-by-state

The final two graphics are state maps of the US that report levels of all viral colds and flus (green and red) and levels of influenza virus activity (Yellow and brown) for the week being reported.

BOTTOM LINES:

1.  Respiratory colds and flus do indeed peak in the winter.

2.  This year is not exceptional in the rate of illness, as of December 13.

3.  We are in the midst of the great peak of respiratory colds and flus for this winter.

4.  Even in this peak season, about 75% of the respiratory colds and flus are from viruses other than influenza virus.

5.  The detail does indicate a large proportion of the influenza virus actually circulating, unfortunately, is a subtype not included in this year's influenza vaccine.  Keep in mind this vaccine is manufactured every spring and as such, has to be a prediction of what subtypes will circulate the following winter.  This year the mismatch was significant.  FluMist offers more protection across varying subtypes than the injected flu shot.

6.  MOST importantly.  As with most years reported, infection with influenza in healthy children, although a miserable experience, tends to be quite harmless.   At it's worst, so far this year, about 99.99% of children who get this infection recover without need of hospitalization.

Again, we offer this guide to the CDC data, since we find it helpful and reassuring.  We will continue to report the trends for colds and flus, and the influenza virus, as the season progresses.

Here is to a Happy and Healthy New Year,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Croup- What is It, When to Worry?

Croup-  

What is It, When to Worry?

What is Croup?

Croup is a variety of a cold that presents the greatest worry and perhaps the greatest risk of all forms of a cold.

The word croup is actually derived from ancient root words that mean "to call out, to cry, to shout hoarsely"

Like all colds, croup is an infection of the respiratory system by a virus.  What makes this respiratory infection croup is not the germ as much as the geography.

When a virus causes a cold or respiratory flu, what happens physically is that the virus burns the lining it attacks.   If the virus attacks the nose, the lining of your nose gets burned and you develop a sore, runny nose.  If the virus attacks the throat, you get a sore throat, and if it burns the lining of the lungs you get the all too familiar cough of a cold.

Croup happens only when the virus attacks a very specific area of the respiratory tree- the vocal cords and voice box.  What is so special about this area?   Think about narrowing and where narrowing counts.   If your nose gets very swollen and clogged with mucus, you can always get around that by breathing through your mouth.   And if some part of the lungs gets swollen and filled with mucus, you can always get around that by having the air go in and out of other parts of the lung.

But, if the vocal cords get badly swollen, so swollen that the gap between them is closed, then no air can flow, and that is very bad.

So, croup is a cold that has landed on the vocal cords, and caused enough swelling there to create some problem with air flowing, usually a barking cough.

When to Worry

As with all infections, the amount of irritation, swelling, and mucus production varies from mild to severe.

The sequence of severity for croup is as follows:

1.  Croup always starts off as a barking cough with no trouble breathing when not coughing.

2.  The next stage, if it gets more severe, is some difficulty breathing noted by a whooping sort of sound on breathing in.  This is called stridor.  It is a sharp, moaning sound on breathing in.

3.  If croup gets even worse, then not only is there a barking cough, and stridor, but now you can see your child tugging and pulling air hard to get it into their chest.

4.  At the most severe, it becomes truly challenging for the child to get air in their chest.

Fortunately, the vast majority of cases of croup we see never go beyond the mildest stage, simply having a barking cough.  If your child has a barking cough, but breathes easily and without that sound we call stridor, there is no danger, this croup is too mild to cause any harm.

A small number of children we see go on to have stridor, but not many go beyond that.

So, when looking at your child with a cold, if you hear a barking cough but hear no stridor and see that he or she is breathing comfortably, no reason for worry.

And, of course, if you hear stridor or see any difficulty getting air in and out of the chest, that is when to be concerned and contact us.

In very, very instances, breathing is really very hard for the child and there is a great deal of struggle.  This is the situation that truly is emergent and indicates the need to call 9-1-1.  

What to Do?

If your child's croup is mild, only the barking cough, there is not much to do.  As with other colds and coughs, there is no medication that will actually change the cough. Comfort measures may help, such as sipping comfort foods and drinks.

If the cough goes on to stridor, give us a call.  While at home, you can sit in a steamed-up bathroom which will dissolve some mucus around the vocal cords and ease breathing.  And/or, you can step outside which will allow cold air to shrink some of the swelling around the vocal cords.

If the stridor is mild, we can start a prescription of oral steroid for a short time which will shrink the swelling around the vocal cords and restore easy breathing.

Again, if trouble breathing is pronounced, the right course of action is to call 9-1-1.

Bottom Lines

Croup is a cold with a specific location, the vocal cords.  We see croup every cold and flu season.

It tends to be mild, with only a barking cough, but can be more severe.

If it is mild with only a barking cough, not much to do.

If it starts to make breathing difficult, then you need to call.

Here is to a happy and healthy holiday season,

Dr. Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Influenza 2014-2015 UPDATE December 19, 2014

Influenza 2014-2015 UPDATE  

December 19, 2014

The influenza epidemic of the winter of 2014-2015 continues to evolve, here is what we know as of today.

No one needs a doctor to know that respiratory viruses are infecting many, many people right now.

In the Greater Cleveland area, it seems almost everyone is sick with a cold or flu, or knows someone who is.  The numbers are so great that absences have forced at least 3 area schools to close for one or more days in December.

Here are some key facts about this year's epidemic:

The infections

1.  Many of these cases are caused by one species of virus, the famous influenza virus, but not all.

For an entire winter, about 1/3 of all colds and respiratory flus (that is not stomach flus) are caused by the influenza virus.

2.   We are in a period of lots and lots of influenza virus activity.  The CDC tracks this carefully.  We are on track to have this virus cause most of its havoc in its typical time period, namely, appear in December, peak in middle to the end of December (now), and fade slowly through February, vanishing by spring.

3.  As many know, the flu vaccine is always a prediction.  Typically about 3-4 subtypes of influenza virus circulate every winter, but the subtypes vary year to year, and so in making a vaccine in the spring for use in the winter, a prediction has to be made.  We always hope the subtypes that are in the community turn out to match those in the flu vaccines.

4.  This year, one strain, called A-H3N2, is different in our community than in the vaccine.  That means the vaccine will not protect so well, or in some cases, at all, if the A-H3N2 that is circulating infects you.   The influenza vaccine given this year does protect against the other 2-3 strains.

5.  Putting all this together, we are seeing a big burst of influenza virus activity, much of which is not protected against by this year's influenza vaccine.  These two facts combine to explain why so many of us are sick.

The course of this infection

Influenza viral colds and respiratory flus are very much like all viral colds and flus- you feel awful, fever, lots of mucus, sneezing, prolonged coughing, sore throat, and a variety of other experiences like headache, stomach ache, neck ache, achiness.

This year the fever is especially high, more in the 103-105 range than the more usual 99-102 range.

Like all such viruses, the illness itself typically lasts about 8 days, but if the cough is intense, it can go only without complications for 2-3 weeks.

When to Worry

Fever itself is a harmless, if miserable and agonizing, experience.  That is, once fever ends, there is never any sign of ongoing harm caused by it.  The normal range of fever in humans is 100.4-105.8.  Now high fevers of 103-105.8 are miserable to experience, but even these high fevers are harmless.

So when to worry?  If one of these four symptoms occur:

• Stiff neck (not sore neck or achy neck).  A stiff neck means you can't bend your neck.  If you can touch your chin to your chest, your neck is not stiff.
• Trouble breathing when not coughing.   Simply look at your child and if he or she is breathing comfortably in and out of their mouth when not coughing then they are not having trouble breathing.
• Severe pain anywhere.
• Fever, 106 and beyond.  Temperatures below 106 are harmless.

Treatment

Medical science has very limited options to treat viruses, including influenza.  So most treatments that are safe and helpful are comfort measures, like using ibuprofen, comfort foods, back rubs, ice cream, soup, tea, etc.

A word on three medications:

Tylenol or acetaminophen

Acetaminophen has been associated with increasing the risk of a child developing asthma, so we do not recommend its use.  People should also know that if you give your child ibuprofen, adding tylenol does not tend to control the fever any better.

Tamiflu

This has been a very good year for those who sell Tamiflu.   A run on the drug has been ignited by the widespread use of rapid influenza testing and recommendations to use this drug.

There are two issues with the use of Tamiflu in children.

1.  Particularly in children, the risk of Tamiflu causing a child to have a seizure is increased. This risk is strong enough that TV ads for Tamiflu actually feature this risk as one to be especially concerned about.   Tamiflu is also known to cause delirium and behavioral disturbances, and propel those who take it to commit acts of self-injury that at times can be quite serious.  This pattern of side effect- seizure, delirium, and serious behavioral disturbance all point to Tamiflu having some effect on brain function.

2.  Tamiflu sometimes works well giving people relief, we all know those who have had this experience.  But many people, including most people in careful studies of the drug, don't really have much relief from Tamiflu, especially children.

Given that nearly all influenza infections in healthy children cause no lasting harm, exposing children to a drug that can cause significant impact to the brain seems to be causing more harm than good.

If Tamiflu is not used, there is no benefit to testing for the influenza virus, since if the test is positive, no change in treatment will be made.

Over the counter cough and cold remedies.

With the exception of ibuprofen, the hundreds of cold and cough remedies, including decongestants, expectorants, and cough syrups, don't work.  This is based on many, many studies, and reflects consensus statements from many professional societies.  The FDA is currently investigating 500 of these medications for fraud!

BOTTOM LINES

1. Every winter influenza virus comes to make us ill, usually in December.
2. True to form it is here in December
3. This year, a dominant subtype sadly does not match its subtype in this year's flu vaccine, so a lot more people than usual are ill.
4. Influenza, like all respiratory viruses, causes much misery, but in healthy children, not much harm.
5. Tylenol may increase the chance of developing asthma and is not recommended.
6. Tamiflu causes more harm to children, particularly to their brains, than adults, and often has little benefit, so it is not recommended in routine cases of flu in otherwise healthy children.
7. This year's flu is a high fever flu, but fever is harmless at 105.8 and below.
8. It is important to call if fever reaches 106 or above, if significant pain is present, if there is trouble breathing, or if there is a stiff neck.

Here is to a happy and healthy holiday season,

Dr. Arthur Lavin

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