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Flu Season and Anthrax Scares: How Do We Separate the Two?

While a year ago a cough, fever and aches meant flu season - this year these same symptoms bring new anxieties. As the anthrax scare continues, parents are asking questions, trying to make sense of what is a seasonal virus and what could be more. Being well-informed before taking action is our best defense. We have to be careful not to do harm while trying to do good by taking unnecessary antibiotics or getting a flu vaccination before those who are at higher-risk, and therefore in greater need. The cases of anthrax are unquestionably frightening and unpredictable, but it is important to remember that the chance of contracting anthrax is small. Statistically, putting your child in the car without a car seat poses a greater health risk. Our children look to us for confidence and reassurance. While we may not have control over the events happening in our country, we can talk with our children openly and help to calm their fears. We can be more cautious. Don't let your child open or handle mail. If you believe a piece of mail to be suspicious, follow the CDC guidelines. If your child has been in a place that has been a target of anthrax exposure, tell your child's doctor and public health officials. Help your child stay healthy; make sure your child eats three nutritious meals a day and encourage physical activity. Help reduce the spread of the flu; encourage hand washing, make sure tissues go into the wastebasket, teach your child to cover his or her mouth while coughing, and discourage the sharing of drinking glasses. Flu season lasts from November to April, peaking in January and February.

Flu Shots
It has been argued by some that flu shots will help diagnose true cases of anthrax - in reality, these are two separate issues and illnesses. First, flu vaccination is not foolproof. Different strains of flu exist, and each year a new vaccine is made to protect against what researchers believe will be the dominant strain(s) for the coming season. The vaccination is 70 percent to 90 percent effective. In addition, there are numerous viruses that cause flu-like symptoms. If someone who has had a flu shot still develops flu-like symptoms, this does not mean he or she has contracted inhalation anthrax. Finally, since most children recover from the flu with no complications, flu vaccine is usually only recommended for children 6 months or older who are at high-risk of a more serious disease. It is recommended that household members of high-risk children, as well as those living with high-risk adults, also receive a flu shot. Children in the high-risk category include those who have:

  • Chronic heart disease or kidney disease
  • Lung disease, including asthma
  • Diabetes
  • Blood diseases
  • Cancer
  • Chronic renal and metabolic diseases
  • Long-term aspirin treatment (which increases the risk of Reye's syndrome)

Flu vaccine is considered safe and effective, with minimal side effects. Two weeks after the vaccine, your child should have immunity for this season. Please be aware that if your child has an egg or egg product allergy, he or she may not be able to have the flu vaccine, since eggs are involved in its production. Anyone with such an allergy should have skin testing before being given the vaccination.

Antibiotics
Even though taking antibiotics for flu-like symptoms may seem like a reasonable safeguard against anthrax - in reality, you may be causing a greater health risk by creating antibiotic resistance. This is especially the case with CiproTM, which in the past has been given as a last-line of treatment against infections resistant to other antibiotics. Since Cipro is a 60-day treatment, it gives everyday germs a longer period of time to develop resistance. If unnecessary widespread use of Cipro occurs, this antibiotic may no longer be useful. There are additional reasons against self-medicating and stockpiling - especially when it comes to children:

  • Many medications that are approved for adults have not been approved or studied in children. According to the FDA, the safety and effectiveness of Cipro in individuals less than 18 years of age is not established, except for post-exposure in inhalational anthrax. Both fluoroquinolones (such as Cipro) and tetracyclines (such as doxycycline, which also is being used to treat anthrax) can have adverse effects on children. These medications should never be taken outside of a doctor's care.
  • Antibiotics are powerful drugs, which may cause side effects. They should not be used unless medically indicated. Using an antibiotic when there is not a clear indication exposes people to all of the risks of the drug without any potential benefit. Possible side effects of Cipro include: dizziness, hallucinations, depression, increased risk of seizures, allergic reaction and severe tissue inflammation of the colon.
  • Antibiotics cannot treat viral infections, such as a flu or cold.

Nasal Swabs
While a nasal swab can help to determine if someone has been exposed to anthrax, it cannot determine if someone has contracted anthrax. Additionally, it does not always show a positive result even if someone has been exposed. Since nasal swabs do not provide any definitive information, they are not recommended as a diagnostic tool or a routine test.

Finally ...
Keep in mind that our children - preschool to college - are often the first to get the flu, having exposure to sneezes and coughs at school, in daycare and in dormitories. If your child comes down with a fever, cough and aches - and has not been in any areas known to be infected with anthrax or in contact with any suspicious substances - he or she most likely has the flu or another virus. Put your child to bed, make sure he or she gets plenty of fluids, and use non-aspirin fever reducers, if necessary. In these confusing times, we are all looking for answers. Use your family doctor as a resource. Call your child's doctor if you have questions about your child's health.

Sincerely,


Nancy W. Dickey, M.D.

Editor-in-Chief Medem Nancy W. Dickey, M.D., is a recognized leader in medicine. She is a past president of the American Medical Association and served on the board of the Archives of Family Medicine, a medical journal published by the AMA. She is Interim Dean of the Texas A&M University Medical School in College Station, Texas, where she maintains an active practice as a board certified family physician.

October 2001