January marks the start of another new year. As many families return from their travels abroad and adjust to the start of the school year, many clinics are seeing the usual peak of coughs and colds in children. In addition, facing the challenges of the new school year can sometimes take a toll on your child’s immune system, and the last thing parents want is for them to fall sick - it will be troublesome for the whole family. This article covers how parents can help their child steer away if there is a flu bug spreading around.
First off, what exactly is the difference between the common cold and the flu bug? Most of the time, people use the terms interchangeably to mean the same thing – having caught a cold. However, the flu bug specifically refers to the influenza infection, while the common cold refers to the general group of viruses that cause symptoms of a cold including fever, sore throat, sneezing, coughing and a runny nose.
Although influenza infections commonly have similar symptoms to a cold, it can be more severe with possible life threatening complications and the symptoms can last for a much longer time. Parents definitely need to take note not to overlook this. For example, one would often expect the fever from a common cold to last about four to five days before resolving on its own, but influenza infections can often cause fevers that last a week to even 10 days. In addition, adults and older children with influenza infections can often suffer from other related symptoms like headaches, muscle aches and severe tiredness.
In young children especially, in addition to the common cold symptoms, influenza infections often cause gastrointestinal symptoms like diarrhoea and vomiting. In its more severe form, the infection can progress to cause chest infections (pneumonia) and brain infections (meningitis/ encephalitis), with some cases of death from affecting the function of other organs including the liver and the heart. The influenza infection is also known to make children more vulnerable to developing bacterial ear infections during their illness.
To look for the presence of the influenza virus, a simplest test is carried out by taking a swab of mucous from the nose. Some clinics are able to carry out this test easily and the results are available within five minutes. However, the test itself is usually only up to 70 per cent accurate as it depends highly on the quality of the sample taken. This can vary if for example, your child has minimal symptoms of a runny nose and hence has very little mucous, or that the test was done very early during the infection and there was not enough virus particles present in the nose etc. As such, sometimes even though the results for the test may be negative at first, a repeat test done later on may show that it is in fact the influenza infection.
There are of course, more accurate tests that can be done in the laboratory which similarly require taking swabs or samples from the mucous or throat. However, as these tests can be costly and take a while for the results to return, it is not commonly done unless children are hospitalised for a severe infection or in circumstances where there is a pressing need to find a cause for the child’s fever.
If the symptoms for influenza infection can be similar to a common cold, is there even a need to test for it? The reason why doctors test for the influenza infection is to predict how long the illness will take to recover, and also so that antiviral medications (eg. Tamiflu) can be prescribed. If tested positive in the first two days of the illness, antiviral medications are effective in preventing potential complications of the infection and speeds up recovery. However, the antiviral medications may have limited effect on recovery if many days have passed. According to the United States’ Centers for Disease Control and Prevention, children below the age of five with asthma or long term respiratory conditions are at a particularly high risk of developing severe influenza, and hence are recommended antiviral medications.
Once a member in the family has the influenza infection, it can easily spread to other family members. Sometimes, doctors may recommend the antiviral medications for the rest of the family as prevention. It should be noted that antiviral medications can cause side effects of nausea and stomach upset in some. Parents, do voice out your concerns to your doctor about the anticipated effects if these medications are recommended for you or your child.
Thinking about preventing the flu? Most definitely! The flu vaccine is widely available in Singapore and is an optional vaccine and would not be routinely done unless you have made the decision to do so. The flu vaccine can be given to little ones from the age of six months. For children below the age of nine, two doses of flu vaccine would be given one month apart for the first time. Thereafter, the flu vaccine is a single dose and can be administered annually. As it is a dead (inactivated) vaccine, it does not cause the flu infection for those who have received the vaccine. However, muscle aches around the injected area and fever for one to two days are expected. In most countries, the flu vaccine is widely available before the start of the winter season but as Singapore is a tropical country, many have wondered if we even have a ‘flu season’. Data from the Ministry of Health indicates that Singapore in fact, sees two peak periods of influenza cases – May to July and December to February.
While most people would visit the clinic to request a ‘flu jab’ for their child, there are some differences in the flu jabs offered in different clinics and at different times of the year. The flu vaccines made each year is based on the WHO predictions on the possible circulating strains based on research data. In the past, most vaccines had three strains (two strains for Influenza A and one for Influenza B). However, vaccines with four strains are now preferred as they have better coverage (two strains for Influenza A and two for Influenza B). If available, most doctors would recommend the vaccine with four strains.
Furthermore, the flu vaccines are usually updated twice a year (around April and October) as these periods are close to the winter season of the Southern and Northern hemisphere respectively. The vaccines are hence known as the Southern hemisphere or the Northern hemisphere vaccines. Since Singapore is an equatorial country, it then begs the question as to which vaccine would be useful. In short, the WHO has recommended the Southern hemisphere vaccine for those staying in Singapore. However, for patients specifically seeking the vaccine for travelling during the winter season, it is good to check with your doctor if you will need a more updated vaccine shot prior to your travel.
Although the flu vaccine certainly is helpful in preventing influenza infections, children are still susceptible to the common cold caused by a whole host of respiratory viruses. As such, maintaining good hygiene by proper handwashing, coughing into a tissue or wearing a mask, as well as keeping your child at home when they are ill can certainly help prevent the spread of colds.
Specialist in Paediatric Medicine
Consultant
Dr Christelle Tan is a paediatrician and an avid volunteer who is passionate in paediatric global health. Her special interest is in childhood infections and vaccinations. She holds a postgraduate diploma from the University of Oxford in Paediatric Infectious Diseases. She had been previously involved in conducting the global health and leadership workshop and is an invited lecturer for the Master of Public Health course in the Saw Swee Hock School of Public Health, National University of Singapore. Dr Tan has also served the underprivileged population around the region in countries such as Timor Leste, Indonesia, Thailand, Cambodia and the Philippines. Her practice includes all area of general ambulatory paediatrics, including a wide range of common childhood conditions like childhood infections, rashes, asthma, childhood allergies, growth and developmental concerns.
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