The Australian flu continues to spread rapidly across all age groups, but children under 5 remain the most affected. Family paediatricians’ surgeries such as the emergency rooms of children’s hospitals are under pressure from the many cases of Covid, flu and bronchitis. Experts speak of a “tri-epidemic”, or the rapid spread of three viruses at the same time. “Something like this – says Vincenzo Tipo, head of the Santobono Emergency Department – is absolutely not usual. Generally, when the circulation of a virus is strong, the others withdraw into a corner. The particular virulence of this form of flu is certainly a consequence of the isolation, during the pandemic, which forced the immune system to rest, but it could also depend on the tri-epidemic”.
How can we limit the spread of viruses and protect the little ones? “In addition to the vaccine, the first weapon of prevention – specifies Tipo -, everything we have learned to do with Covid can come in handy, therefore using masks, washing your hands, limiting the attendance of crowded places. A particular appeal, near the Christmas holidays, goes to those families who have very young children. Be careful to prevent them from being infected: bronchiolitis is more fearful for them than the flu, which is also spreading like wildfire”. But let’s see what are the symptoms that characterize the Australian flu and when it is appropriate to take the child to the hospital.
Dr Tipo, how does the Australian flu manifest itself?
“It’s a much more aggressive flu syndrome than in previous years. It is characterized by high fever, respiratory symptoms, headache, muscle pain. One characteristic is the duration: longer than the usual 3-4 days and, in some cases, with respiratory complications such as bronchitis and pneumonia. In younger children, the difficulty is often in controlling body temperature”.
How to distinguish symptoms from those of Covid?
“It is practically impossible, at least in children, to recognize the two pathologies only from the clinic. The symptoms, all in all, are those of a viral infection. Obviously the presence of other subjects in the household affected by Covid favors this diagnosis. I must also say that Covid, at least the latter variant, has a fever that is not so high and of a shorter duration (48-72 hours maximum), never respiratory problems but, frequently, gastrointestinal disorders. Today, due to the great simplicity of having rapid and sensitive anti-Covid tests, it is always recommended to carry out a swab, even at home, when the symptoms described appear”.
Bronchiolitis in children, Santobono’s head physician: “We fear an explosion of cases in the coming weeks”
Cases are on the rise in all age groups, but children are the most affected. What is the situation at the Santobono at the moment?
“The Santobono is recording numbers of accesses to the emergency room that have hardly been touched in past years. Last weekend, also thanks to the Immaculate Conception, there were about 400 accesses per day. Naturally, all of this is reflected in admissions, so that, at present, the hospital is full in all its beds. Children are particularly affected because they pay more than adults for the “forced rest” of the immune system in the last two years. In fact, isolation and lack of schooling have not made possible the natural immunity (that is, the continuous falling ill) which strengthens all healthy children and helps them fight seasonal infections”.
In which cases should the child be taken to the hospital?
“A flu is still aggressive, however aggressive. In most cases, it is enough to administer antipyretic drugs and clear the airways when they are clogged with secretions. Obviously, children should be followed up by the family pediatrician who, once examined, will be able to recommend best therapy. Access to the hospital should be reserved for the most difficult cases or when requested by the treating pediatrician after the visit. I regret to say that most of the accesses we record are for trivial pathologies, the so-called white codes. For me it must be remembered that, however large and comfortable, the waiting rooms of the Santobono are still closed places where, with hundreds of people present, it is impossible to guarantee a minimum distance.This may be a favorable condition for the rapid spread of viral forms”.
How is the flu treated? When is antibiotic therapy used?
“The flu is, by definition, a viral disease against which there is no specific therapy as for bacterial diseases. The therapy is substantially symptomatic: antipyretics, products for cleansing the upper airways, some mild cough suppressants if this disturbs normal activities. A diet rich in vegetables and fruit, with antioxidant qualities, and good oral hydration help to overcome the disease. Naturally, in those cases, which are not very frequent, in which there is a suspicion of a bacterial superinfection (for example bronchitis, pneumonia) antibiotic therapy will also be useful. But this must be prescribed only and only by the doctor.
How important is it to vaccinate the little ones? When is the injection vaccine indicated and when the spray vaccine?
“The vaccine is a fundamental weapon of prevention. A mass vaccination is able to slow down the spread of the infection. Children must also be protected because they can be a vehicle of transmission for adults and the frail elderly. For children there are two formulations of the vaccine: a classic one, by injection, and a nasal spray. The first can be done from 6 months of life, the second from two years. Safety and efficacy are superimposable. These are inactivated viruses, in the injective one, and live but attenuated viruses in the spray one. According to some scientific works, the spray formulation, due to the route of administration, would be able to stimulate the production of specific antibodies in the nasal mucosa which is the main entry point for the virus”.