Ask the Doctor: How to Prepare for the 2023 Flu Season

The 2023 flu season is expected to arrive earlier than usual with an uptick in cases already occurring in September. We may also see a tricky RSV season and an upward trend in COVID as a new variant is circulating.

The Flu, COVID, or RSV: What is causing my symptoms?

It may be challenging to tell the difference between the symptoms of flu, COVID and RSV, and you may hear these referred to as “ILI” or influenza-like illness.

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The symptoms of influenza may include fever that is difficult to control and lasting up to seven days, cold symptoms and cough, sore throat, red painful eyes, headache and muscle aches. Stomach pain, nausea, vomiting and diarrhea may also occur with certain strains. There are many other viral infections that can cause similar symptoms but usually not all at once. Since the treatment varies for different viruses, always contact your healthcare provider to describe your child’s symptoms and to discuss treatment and any questions or concerns you may have.

The flu and COVID are highly contagious and can be particularly dangerous to the very young and very old, anyone with a chronic disease such as asthma/reactive airways disease, and anyone with a weakened immune system. People with the flu or COVID can be contagious for up to a week, meaning that children may miss a lot of school or daycare and parents may miss work while staying home with their sick children.

Vaccines for Flu, COVID and RSV

With the anticipation of an early flu season this year, it is important to start making plans to receive your flu shot now. October is the ideal time to be vaccinated for both the flu and COVID. Waiting until the end of October or later means your child may have reduced protection during the beginning of both seasons. While it is difficult to predict how well the flu shot will work this season, receiving your annual flu vaccine remains among the most effective ways to protect yourself and your family from complications of the flu, such as pneumonia and hospitalizations.

Last year’s flu vaccine was about 60% effective, which is actually quite good. The new COVID vaccine, based on the latest Omicron variants, is a new vaccine that is a better match for the COVID strains that are circulating now when compared with previous versions.

The American Academy of Pediatrics recommends that all children 6 months of age and older get the flu vaccine annually. Children getting flu shots for the first time need two shots about a month apart. All adults should also get the vaccine. The flu vaccine not only helps prevent flu in the person receiving the vaccine; it also helps prevent those around them from catching the flu. The new COVID vaccine is recommended for infants and children over 6 months of age, as well as adults.

A new RSV vaccine is also available for infants (< 1 year) entering their first fall respiratory season and for children up to two years of age who have immune system problems or chronic diseases. There is a different vaccine for adults 60 and older, for pregnant women and for adults under 60 with multiple risk factors for severe illness. There is currently no RSV vaccine for ages

2-59, as most people in that age group will have already been exposed to or have already had RSV and developed natural immunity. Be sure to talk with your primary care physician to request more information and/or to get answers to any questions you have about the RSV vaccines.

Does the Flu Vaccine Work?

Experts say it is too early to judge how effective this year’s vaccine will be. Even if the effectiveness in preventing infection is low, the vaccine can still help prevent complications such as pneumonia and reduce the seriousness of symptoms in vaccinated individuals who contract the flu. The same is true for all vaccines.

Special Considerations for the Flu Vaccine Egg allergies

New recommendations state that patients with egg allergies should get the flu vaccine, but it should be administered in a doctor’s office setting where the child can be watched for at least 30 minutes following vaccination and be treated immediately for any allergic reaction.

First-time flu vaccine

The first time a child receives the flu vaccine, two shots are given at least one month apart. The vaccine, which is slightly different every year, is recommended to be given once every year just before the flu season starts and may also be given during the season. Catching one type of flu does NOT prevent infection from another type of flu, so even those who catch one type of flu should be vaccinated once they are free of symptoms.

Nasal flu mist

The nasal flu mist vaccine is a valid option for flu season, but it cannot be given to people with certain medical problems such as asthma. It takes about two weeks for all types of the vaccine to become effective.

Diagnosing the flu

A flu test is NOT necessary for your child to be diagnosed with influenza. Physicians and other providers have been encouraged by the Centers for Disease Control to make the diagnosis and treatment plan based on the child’s history of illness and physical exam. The rapid influenza test (as opposed to the test that can take several hours for results) has a history of being negative in significant numbers of patients who had the flu as diagnosed by other more sophisticated tests. A negative rapid flu test does NOT mean your child doesn’t have the flu. On the other hand, if the test is positive, your child DOES have the flu. If your child has flu-like symptoms, discuss with your provider whether or not he or she should be treated with oseltamivir (Tamiflu™) for the diagnosis of “influenza-like illness.”

How Can I Treat My Child for the Flu?

Oseltamivir (Tamiflu™), a medication given by mouth, is sometimes helpful in reducing the amount of sick time, the length of the contagious period, and the intensity of some of the symptoms; however, it is most effective when given within the first 48 hours of symptoms. In some people with the flu, oseltamivir significantly reduces sick time. In others, it may seem to have no effect at all. Stomach pain and vomiting are frequent side effects.

Baloxavir (Xofluza™) is available as a one-dose tablet for children over 12 years of age and weighing 40 kg (88 lbs.) or more. It is not available in liquid, capsule or crushable forms. It is also most effective when given within 48 hours of the start of symptoms. It should not be given with milk or milk products. Xofluza is not available in a generic form, so it may be quite expensive. Check with your insurance company to see if they cover Xofluza.

There is no guarantee that any antiviral medication will work against the flu. These medications are expensive and can have significant side effects; therefore, your provider may not recommend the medication unless your child is at risk of complications from the flu or if there are others in your household who are at risk of complications if they catch the flu from your child.

At its worst, influenza and COVID can be fatal diseases, especially for the very young, the very old, pregnant women and people of any age with chronic health problems. At best, both infections can cause days of misery and school and work absences. Please consider vaccinating your entire family against the flu on a yearly basis and for COVID based on the most current CDC recommendations, not only for their health, but also for the health of those around them. If you have questions or concerns, please talk to your primary care provider (PCP).

Although After Hours Pediatrics Urgent Care does not offer vaccinations, we will be happy to see your child if you think they may have the flu, COVID or RSV and you cannot get in to see your PCP. When coming to AHP with a child who has flu-like symptoms, we ask that he/she and any other sick family members wear a mask to help protect other families in the building, as well as our staff. We will be happy to provide all the masks you need.

For more information on After Hours Pediatrics Urgent Care and our locations, click here: https://www.afterhourspediatrics.com/locations/

Stay safe and healthy this fall!

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