| FAQ - Common Pediatric
Epidemics RSV, Influenza, Rotavirus and Enteroviruses |
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Emergencies
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Although many infectious problems in both
adults and kids come in epidemics, this is particularly true in pediatrics
where several times during the year there will be waves of ill kids.
This page looks at several of those. RSV are initials known by many parents. RSV stands for Respiratory Syncytial Virus. Although present year round, in temperate climates such as Missouri it tends to be a winter disease. The RSV "season" is generally said to be October through May but most of the disease comes in a wave of illness that will hit sometime late December through February. RSV is highly contagious and is spread by respiratory secretions that can be infective from close contact but can also remain infectious on counter, doorknobs, etc for several hours. Hence good hand washing and keeping kids apart will help prevent the spread. A typical course of RSV would be for an infant to become ill with clear runny nose then a day or two later start with a cough that initially seems like it is "drainage" only to become progressively gagging and choking. The infant then starts to wheeze and can develop difficulty breathing. Typically it peaks on its 3rd or 4th day unless there is a complication and then the infant coughs for a week or two or thereafter. Common complications included ear infections, pneumonias, dehydration from poor intake, and a need for oxygen. There is not effective treatment other than to support a child through the illness--IV fluids if the child is dehydrated, oxygen if necessary, and for some nebulized albuterol to temporarily relieve the work of breathing. Generally the younger the child the more severe the symptoms. Young infant with special health problems such as have been premature, having heart or lung disease being particularly at risk for becoming sick. For these at risk infants there are special shots to try to prevent them from becoming seriously ill. There is no immunization available for healthy children. Watch for:
See Also Croup and Bronchiolitis Rotavirus is a gastroenteritis or stomach flu that like RSV can be seen year around but in Missouri generally arrives in an epidemic about the same time as RSV. It also attacks younger children, typically under three years of age. Like RSV it is highly contagious and good hand washing can help limit the spread. Rotavirus often starts out of the blue with fever and non stop vomiting. Diarrhea generally starts the next day and is explosive large amounts of malodorous green mucousy stools. One wise guy wise doctor once remarked about Rotavirus, "they have vomiting for 12 to 18 hours then diarrhea for 12 -18 days" which is not much of an exaggeration. Complications included dehydration and electrolyte imbalances. There is no cure for rotavirus other than time and close attention to hydration. At this time there is no immunization. Please refer to the link below for general management guidelines. See Also Vomiting and Diarrhea Influenza has a season that runs concurrently with rotavirus and RSV. The term "flu" is often used to describe a number of illness that sweep through communities such as "stomach flu," "summer flu," etc, there is only one true flu or influenza. For many there is no mistaking influenza. It hits hard and fast and patients generally feel really bad. Influenza is characterized by the sudden onset of fever, frequently with chills, headache, malaise, muscle aches , and a cough that initially is slight but eventually becomes a nagging hacky cough that lingers for several weeks. Sore throat, nasal congestion, runny nose, and cough become more prominent a few days into the illness. The eyes may also be red and there may be abdominal pain. Nausea, vomiting and sometimes diarrhea can occur. In some children, influenza can appear as a simple upper respiratory tract infection or as a fever for several days with few respiratory tract signs. Influenza is spread from person to person by breathing in small particle droplets, or by contact with articles recently contaminated by someone sneezing or coughing. During an outbreak of influenza, the highest attack rates occur among school-age children. Secondary spread to adults and other children within the family is common. There are two types of influenza––––––––influenza A and influenza B. You cannot look at a person's illness and tell these apart.Within a community, influenza usually peaks within 2 weeks of onset and last 4 to 8 weeks but sometimes longer. Because there can be two type of influenza in a community at the same time, the influenza season can be 3 months or more. Influenza is highly contagious, especially among enclosed populations. Patients are most infectious during the 24 hours before the onset of symptoms and during the most symptomatic period when fever is at its worst. Viral shedding in the nasal secretions usually ceases within 7 days of the onset of illness but can be more prolonged in young children and in patients with immune problems. There are a number of complications from influenza with ear infections, sinus infections and pneumonia complicating up to 25% of flu cases. Studies have shown that children younger than 5 years of age have the second highest rate of hospitalization with influenza, only exceeded by persons older than 65 years of age. Children under the age of two are even more likely to be hospitalized than older people. Nationwide about 100,000 individuals are hospitalized with influenza and tens of thousands die. How to Prevent Influenza: There are 2 ways to try to prevent influenza. One is through vaccinations. Flu shots arrive every fall and can be given to children as young as 6 months of age. For kids under 9 years, the first year of vaccination requires a set of two shots at least a month apart. After the initial set, only one per year is required. You cannot catch the flu from a flu shot. There are some minor side effects (pain for example) but pediatricians use a split virus vaccine so these are less likely. One contraindication to flu shots is a significant allergy to eggs. Flumist is an in the nose vaccine for those who do not want shots. It also requires two vaccines initially for children . Flumist can be given from ages 5 to 50. It is more costly and some children cannot receive it. Influenza is one of the few virus for which we have antiviral medications. There are several different medications that can be used to attempt to prevent influenza. Some are effective only against influenza A. Others are effective against both influenza A and B. These medicines can be taken to attempt to prevent a person from catching the flu. In addition, these medicine can shorten the illness and make one feel better a day or two sooner if started within the first 48 hours of symptoms, however, some of these medications have a relatively high incidence of side effects. Enteroviral illness such as herpangina, hand-foot & mouth disease can also be found year round in warmer climates but in Missouri tend to occur in the summer to early fall. Enteroviral illnesses are highly contagious and good hand washing can help limit the spread. All ages can be infected but younger kids tend to have higher fever and more sores in the mouth. There are several different families of enterovirus and the illness can present in a great number of ways. Common findings are fever, sore throat, headache, sores in mouth, chickenpox-like blisters on the palms, soles and buttocks, diarrhea, vomiting, Uri symptoms and cough.. Viral meningitis can be a complication of enteroviral infections. There is no treatment. No vaccine is yet available. See also fever in summer.
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