The flu virus is constantly changing, with new “models” of flu appearing each year. The Center for Disease Control and Prevention (CDC) looks at the strains of influenza that have affected Australia during their flu season, and does it’s best to evaluate which strains are likely to be the most prevalent in the US during coming year. While it has seemed that they haven’t been exactly 100% accurate over the past few years, the vaccines that they recommended did result in both fewer cases of influenza and milder, shorter illness for those who got the flu. We hope this year is even better.

For the 2018-2019 flu season, everyone, six months of age and older, needs to be vaccinated against influenza (flu). It takes about 2 weeks for the immunity of the vaccine to take effect, so it’s best to be vaccinated, if possible by the end of October. If you don’t make this deadline, go ahead and get vaccinated, no matter how late it is. It is better to have some immunity than none.

Protecting people living with Duchenne is especially important. A 2005 study done by the CDC found that children with neuromuscular disease are at a six-times greater risk of flu-related respiratory failure. So please vaccinate yourself, your child, and all members of your family.

What’s new for the flu in 2018/2019:

CDC Recommendations:

• Available, and recommended for people living with Duchenne, is the influenza vaccine, or “flu shot.”
• This season, the nasal spray (live virus) is again available for people ages 2 – 49 years old and should be as effective as the vaccine. This, again, is a live virus vaccine and is NOT recommended for people living with Duchenne.

The 2017/18 trivalent influenza vaccine will include protection against:

• Influenza A/Michigan/45/2015 (H1N1) pmd09-like virus
• Influenza A/Singapore/INFIMH-16-0019 A(H3N2)-like virus (Updated)
• Influenza B/Colorado/06/2017-like (Victoria lineage) virus (Updated)

Some will receive the quadrivalent vaccine that also protected against the B/Phuket/3073/2013-like (Yamagata lineage) virus.

Additional information:

• There are several types of influenza vaccines available. Your medical provider will tell you which is most appropriate for you and/or your child.
• Pregnant women should receive influenza vaccine.
• Some children, 6 months old – 8 years old, will need 2 doses of the influenza vaccine.
  • If your child is getting vaccinated for the first time, they will need 2 doses of influenza vaccine spaced at least 4 weeks apart
  • Children who have only received 1 dose of influenza vaccine will also need 2 doses spaced at least 4 weeks apart.
  • Your healthcare provider can find more information on CDC’s Children & Influenza (Flu) page.
• For additional information on the 2017/2018 influenza season and vaccine, please visit CDC’s Frequently Asked Flu Questions 2018-2019 Influenza Season page, as well as CDC’s Information for Schools & Childcare Providers page.

Symptoms of the flu

Symptoms of flu may include:

• Fever, chills (though not everyone with flu will have a fever/chills)
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Fatigue (tiredness)
• Sometimes diarrhea and vomiting

Symptoms usually appear 1 to 3 days after exposure. Although most people are ill for less than a week, some people have more serious complications that may require hospitalization.

What should I do if I think my child has the flu?

The influenza vaccine only protects against certain types of the flu, and is not always 100% effective, even against those certain types. People living with Duchenne are especially vulnerable to the effects of the flu, especially the pulmonary effects.

If your child has symptoms of the flu, call your primary health care provider immediately!

Rapid diagnostic testing, which checks secretions in the throat for the influenza virus, is 50-70% accurate for diagnosing influenza (most providers will send a negative specimen for culture, just to be sure that there is no virus present).  If the test is positive, starting an antiviral medication is recommended.

Antiviral medication should be started as soon as possible in the course of the illness and continued for 5 days. It is best if this medication is started within 48 hours of the beginning of symptoms, but the treatment can still has some benefit if started later, especially for patients who are experiencing a longer or more complicated course.

Antiviral medications

Antiviral medications can lessen symptoms of the flu and shorten the time of illness by 1-2 days. They can also prevent serious complications of the flu, like pneumonia.

There are two antiviral drugs recommended by the CDC:

• Tamiflu (Oseltamivir, pill or liquid)
• Relenza (Zanamivir, inhaled powder, not recommended for patients with pulmonary problems)

Antivirals may have side effects, including nausea, vomiting, dizziness, runny/stuffy nose, cough, diarrhea, headache, and some behavioral side effects; rare occurrences of neuropsychiatric events associated with Tamiflu.

Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients.

CDC Recommendations

The CDC recognizes that people living with neuromuscular disease are at higher risk for developing more serious complications from influenza. For that reason, prophylaxis (antiviral medication) may be suggested for people with Duchenne who are living with household members who have been diagnosed with influenza.

If it is felt to be appropriate to begin antiviral medication, antivirals should begin on the day of the household member’s diagnosis. Again, clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, and likelihood of developing influenza, is important when making antiviral treatment decisions for higher-risk outpatients.

Missing corticosteroid doses

If you/your child is taking corticosteroids regularly (daily, every other day), it is very important that you NOT miss doses.

If you/your child has missed 24 hours of corticosteroids, it is very important that you contact your primary care/neuromuscular provider for IV corticosteroid dosing.

Missing 24 hours, or more, of corticosteroids can result in acute adrenal insufficiency, which can be a life threatening condition. Please refer to the PJ Nicholoff Steroid Protocol (download) for any questions or concerns.

Besides antiviral medication, what other “over the counter” medications are safe to give a person with Duchenne?

You should always check with your primary health care provider and/or your neuromuscular provider regarding the safety and dosing of any medications.

For children over 4 years, the following over the counter medications are generally safe for people with Duchenne to take:

• Tylenol (acetaminophen)
• Cough medicine without Sudafed – cough medicine with cough suppressant should be used if the cough is interfering with sleep; using cough medicine with cough expectorants, using Mucinex, maximizing hydration, and using the cough assist during the day may help minimize coughing at night
• Cough drops
• Mucinex (check with your pulmonologist; some pulmonologists caution against using Mucinex in patients with breathing dysfunction; the thinned secretions may cause aspiration of the secretions, which can lead to an increased risk for pneumonia)
• Saline nose drops/spray

Is there anything I can do to help my coughing/breathing?

Caring for your child’s lungs when they have the flu is critical.  Information on caring for the lungs, the importance of cough, and assisting cough during an illness can be found on the PPMD website.

What else can I do to stay as healthy as possible?

• Wash hands often with soap and water for 15-20 seconds, especially after using the restroom and changing diapers.
• If soap and water is not available, use an alcohol based hand sanitizer.
• Wash your hands before preparing food or eating.
• Avoid sharing utensils with or drinking after someone who is sick.
• Avoid touching eyes, nose, and mouth with unwashed hands.

Pearls of Care:

• Be sure all family members have been immunized against influenza.
• If you think you/your child with Duchenne has the flu, contact your primary care and/or neuromuscular provider immediately.
• Use antivirals as recommended (for your child’s flu treatment or for prophylaxis).
• Take recommended over the counter medications.
• Maintain cough and breathing.
• Do not miss more than 24 hours of corticosteroids; if more than 24 hours of corticosteroids are missed, call your primary/neuromuscular provider for IV or IM steroid coverage in order to prevent acute adrenal insufficiency, which may be life threatening. Please refer to the PJ Nicholoff Steroid Protocol for any questions or concerns.
• Go to the emergency room if necessary; take all of your medications and equipment with you.
• Continue to do what you can to stay as healthy as possible.

A session on Flu and Airway Emergencies was presented by Dr. Lauren Camarda at the 2017 PPMD Annual Conference: