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Dr. Neumann’s KidsTravelDoc Ten Tips: Update on children/travel/flu

Date January 20, 2013

Flu Influenza KidsYou need not go traveling to catch the flu – but it does help. Weekends visiting out-of-town relatives, skiing holidays, cruises, and air travel, for example, place your kids in close contact with people from different localities near and far. In flu season (December through March), there is a fair chance that someone in the crowd is already infected. And these viruses like nothing better than to infect more people and continue hopscotching hither and yon. Unless your family is vaccinated, your child may be the culprit that introduces flu into your home community. 

Here are some facts on flu/travel.

1. The more you travel, the greater the risk of contracting the flu. People who travel together become ill together. The Centers for Disease Control (CDC) recommends flu vaccine for travelers during flu season, specifically for those going on cruises and on organized tours. Physicians on cruise ships can test for the flu and have results in fifteen minutes. All ships carry medication that generally reduce the severity and length of illness, but only if the medication is started in the first day or two of the illness. Ship physicians can – and do – confine passengers with the flu to their cabins.

2. The risk of acquiring flu during air travel appears to be small.  Cabin air is replaced every few minutes with air from outside (air at high altitudes is sterile) or recycled through sophisticated filters. But flu organisms can survive for many hours, perhaps day, on seats and armrests.  Washing your and your infant’s hands and wiping surfaces with appropriate disinfectants may reduce risk. If possible, change seats if a nearby passenger coughs and sneezes.

flu33. During flu outbreaks, percentage-wise more children than adults are stricken. Adults may possess some residual immunity from previous flu illnesses/immunizations, possibly preventing or ameliorating subsequent attacks. Once children are infected, they harbor the virus longer than adults and become major sources of transmission. 

4. Flu is a more serious disease for children than most parents realize. Most affected children require medical care. In the U.S., each year about 20,000 children under the age of five years are hospitalized due to flu; most of these are under the age of two. Children as young as six months can safely receive flu vaccines. Children younger than six months are susceptible to the flu and tend to have severe cases. It is therefore especially important that all adults and older children who have contact with infants be vaccinated.

5. Flu vaccination must be repeated each year. Flu viruses undergo continuous change and vary geographically; most years different vaccines are produced for the Northern and Southern Hemispheres.  Vaccines are reformulated yearly based on ongoing surveillance of flu activity around the world.  Experts then select strains likely to circulate the following flu season.

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6. Most years, flu vaccines are quite effective, but don’t expect miracles. The vaccines significantly reduce the incidence of flu-related illness but some years strains come along that are not well covered by the vaccines. 

However, flu vaccines do not significantly reduce the total number of “flu-like” upper respiratory infections (URIs) that children experience.  Children in day care and preschool, have one to two URIs a month during the flu season due to the countless other cold viruses that circulate. And children who travel are exposed to additional cold viruses, ones that do not circulate in their home communities.

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7. When traveling, should you carry standby anti-flu medication? This is controversial. Severe cold-like illnesses are difficult to distinguish from flu without specific testing at the time of the illness. Allowing parents to treat the symptoms will result in much unnecessary treatment. Available flu medication, oseltamivir (TamiFlu), is ineffective against non-flu colds.    

However, standby treatment may be indicated for children with chronic diseases including diabetes, asthma, weakened immune systems, and neurological and neurodevelopmental disorders. Such children are more likely to experience serious complications from flu, pneumonia, for example.

8.  Optimum protection for travel requires advanced planning.  Children receiving flu vaccine for the first time need two doses, given at least one month apart. Significant immunity begins two weeks after the second dose. Children (and adults) previously vaccinated require only one dose, with immunity also taking two weeks to develop.

9. Acquiring flu from the vaccine is a myth.  Years ago flu vaccines were less refined and sometimes caused “flu-like” side reactions such as aches and pain and fever, but never the flu. Now vaccines are better and side reactions are rare and mild.   Another reason for the myth: flu season is also cold season. Severe colds   are so common in children that, by chance, such illnesses can occur soon after flu vaccination and are then erroneously blamed on the vaccine. 

10. Check the current flu activity at your destination.

In the U.S., the CDC reports weekly flu activity for each state at http://www.cdc.gov/flu/weekly/usmap.htm.

In Canada, see http://www.fightflu.ca/index-eng.php

In the United Kingdom, see http://crofsblogs.typepad.com/h5n1/2013/01/uk-flu-activity-update-for-january-10.html

In Australia, see http://www.influenzaspecialistgroup.org.au/surveillance 

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