Swine flu in India: Children should avoid over crowded places, expert suggests

As India battles swine flu or swine influenza, parents of young children should take extra precautionary steps to keep their little ones safe and healthy.

Children too fall within the bracket of one of the "high risk" groups which include pregnant women, adults above 60 years of age, people with chronic medical conditions such as diabetes, heart or lung diseases and those with poor immune system.

The swine flu outbreak in India this year is believed to be worse than that of 2009, considering the high death toll and the scale the disease is spreading.

In an exclusive interview, Dr Sanjay Mehta, MBBS, MD (Paed.), Kalawati Saran Children’s Hospital, Delhi, spoke to Salome Phelamei of Zee Media Corp, about why children are at high risk of H1N1 virus, swine flu treatment and how parents can protect their child from the deadly disease.

What are the symptoms of swine flu in children?

Majority of infected individuals will have a mild type of illness which could be as follows:

• Sub clinical infection: Almost 30% cases get infected but never develop any kind of disease. Such cases are labelled as sub clinical infection.
• Common cold (Rhino-pharyngitis): Majority of the patients develop a rhino-pharyngitis, a disease no different than an ordinary cold caused by another virus. Such cases recover with simple fever and cough medications.
• Tracheo-laryngo-bronchitis: These patients have fever, hoarseness of voice and significant cough. Some of these patients may have loud croupy sound with normal breathing, such cases may need hospitalisation.
• H1N1 Pneumonia: This is the most serious stage of H1N1 infection which can lead to death. It’s extremely vital to deal with it clinically at the earliest, as timely treatment can save life. Fortunately this is rare and only 3-5 cases out of 100 H1N1 cases develop to this level.

Why are children at higher risk of swine flu? What should parents do to prevent their kids from contracting the flu?

Children are at higher risk of swine flu infection because their lung (airway) anatomy makes them prone to infection. Moreover, general immunity is less in lower age groups.

Parents should avoid over crowded places and keep their children away from infected persons. Children must wash their hands regularly and avoid cold and spicy drinks.

Is there any particular condition that makes them more prone to the disease?

Children with lung, heart, liver or kidney diseases, blood disorder, diabetes, neurological disorder, cancer, HIV (AIDS) and patients on long term cortisone therapy are at higher risk of contracting swine flu infection.

What should parents do if their child shows symptoms similar to swine flu? How can they take care of them at home?

Most of the children with flu infection only show mild symptoms like fever, cough and cold.

These symptoms can be managed at home by giving paracetamol, antihistaminic, steam inhalation and adequate diet. But, other children in the family should avoid contact with the infected child.

What are the treatment options for kids with swine flu?

Oseltamivir is the drug of choice for the treatment. Treatment should be given for 5 days.

By Weight:

For weight < 15Kg 30 mg BD for 5 Days

15-23Kg 45 mg BD for 5 Days

24-<40Kg 60 mg BD for 5 Days

>40Kg 75 mg BD for 5 Days

Oseltamivir is also available for syrup (12mg per ml).

Other supportive treatment is paracetamol, antihistaminic, adequate hydration and proper diet.

How long will it take for the child to recover from the flu?

Incubation period of the disease in young children is up to 7 days. The communicability of the illness lasts from 1 day before to 7 days after the onset of symptoms. Children may spread the virus for longer period.

Antibodies develop in 7 days after an attack: reach maximum level in 2 weeks: drops to pre infection level in 8-12 months.

There is no cross-immunity between different sub-types/strains.

In view of the escalating swine flu cases in India, is it safe/necessary to vaccinate a child?

Although flu vaccine is safe and it can be given to any healthy individual, but IAP recommends vaccination for the following individuals.

• Children with certain high risk condition and disease (like chronic, pulmonary (excluding asthma), hematologic, renal, liver disease, diabetes mellitus, congenital or acquired immunodeficiency (including HIV infection), and children on long term salicylates therapy, etc.)
• On demand by anxious parents after one-to-one discussion.

Besides, health care professional including pediatricians, laboratory personnel and health care workers should take the vaccination.