Six out of every 10 children visiting doctors due to sickness are exhibiting flu-like symptoms, as per rough estimates. India is struggling with a slightly severe wave of seasonal flu caused by Influenza A or H3N2 virus even as paediatricians across the country have reported a rise in such cases the past two months.
On Friday, the ministry of health and family welfare cases of viral fever caused by the H3N2 virus had registered a spike but were likely to dip from this month. But experts cautioned that children along with senior citizens were among the most vulnerable to contracting seasonal influenza, including the H3N2 virus.
According to Dr Dinesh Raj, paediatrics at Holy Family Hospital in Delhi, there has been a 30 to 40 per cent increase in out-patient attendance of children complaining of flu-like symptoms over the past two months. “Out of every 10 OPD patients, five to six have flu-like symptoms,” he said.
Dr Nehal Shah, an associate consultant at Mumbai-based SRCC Children’s Hospital, said out of every 10 patients seen at OPD, almost six to seven were presenting with flu-like symptoms.
Dr Yogesh Kumar Gupta, a consultant at the paediatrics department in Fortis Hospital, Bengaluru, also spotted a similar trend. “We have been testing children for the flu and a significant number of influenza A (H3N2) positive cases have been picked up,” he said.
While the experts said the infection usually lasted for about five to seven days and the fever might go away at the end of three days, cough might persist longer even in mild cases.
How to spot it?
Doctors have been examining children with high-grade fever, severe body pain, cough, cold and respiratory distress in the last one to two months. Classic symptoms of this flu are acute onset high-grade fever with body ache, headache and running nose.
While cough increases with a resolution of fever, the illness lasts around eight to 10 days. Doctors have also noted occasional gastric disturbances like loose motions and vomiting.
Who all are at risk?
“Kids with asthma, comorbid illnesses (such as obesity, neurological problems, heart diseases) are at increased risk,” Dr Raj from Holy Family Hospital told News18. “However, all of them have done well. Some cases with respiratory distress required admission and recovered in four to five days with supportive management.”
“As with any viral infection, be it Covid-19, adenovirus or H3N2, the paediatric population is always at high risk,” said Dr Maninder Singh Dhaliwal, paediatrics pulmonology at Faridabad-based Amrita Hospital.
He added: “Children below five years of age, children with asthma, diabetes, heart disease, weakened immune systems such as on steroids and neurological conditions need to be protected.”
When should you be concerned?
Doctors said there was a significant increase in children needing hospitalisation with respiratory symptoms, needing oxygen. If the cough is increasing and fever continues to rise after three days, it is a “worrisome sign”, Dr Dhaliwal said.
“Another subset of children coming to the hospital with post-viral acute bronchitis because of H3N2 or other viral flu,” he added.
This occurs when the acute infection of the virus settles down but allergic reaction tends to continue with children having persistent coughs with no fever. “A small subset of children requires hospital admission for oxygen therapy if a flu infection is causing severe pneumonia,” Dr Dhaliwal said.
He added: “H3N2 infection like any other viral infection may cause life-threatening pneumonia, requiring advanced respiratory support like mechanical ventilator and a prolonged paediatric ICU course.”
Reason behind surge: opening of schools and fall in hygiene level
According to Dr Parvinder Singh Narang, head of the department of paediatrics at Max Super Speciality Hospital, there has been an increase in flu and any flu-like illnesses since Covid because “schools have opened up and people are not using the kind of hygiene they were with regular masks and handwashing”.
“Recently, there has been more increase in H3N2, a type of flu A, and another flu that is also very common H1N1, besides the two flu B viruses that continue to prevail throughout,” he said. “Generally, children tend to recover but they are a source to spread viruses to others.”
Experts cautioned that there should be no unnecessary use of antibiotics. “The respiratory symptoms start later, not in the beginning and there is no need to give antibiotics to the patient as flu is a viral illness and it gets better on its own,” Dr Narang added.
He further said, “Antiviral medication, if started in the first two days can help reduce symptoms, and it is only used in these cases where you diagnose them early; it’s not required for all patients unless they have some comorbidity that can cause another problem in recovery.”
The experts also gave advice to parents, saying self-medication should be avoided.
Flu shots the answer?
Doctors said the Indian Academy of Paediatrics advises influenza shots for children under five years of age as they are at risk of severe disease. Above five, those with comorbidities may take shots.
The plan of flu vaccination among children begins from six months to five years of age. “To start with two doses in the first year and, subsequently, repeat the flu vaccine every year before the rainy season starts,” Dr Narang said.
He added: “The flu vaccination will be able to help curtail flu-like illnesses in general. So every close contact with sick individuals must keep good hygiene and take the flu vaccine, the prevention is by vaccination and good hygiene.”
How to take care?
Flu is highly contagious and it spreads from one person to the other through respiratory droplets. So, keeping good hygiene is important as well as using a mask. Protection is essentially about following personal and respiratory hygiene.
Hand washing, sanitisers and use of masks, especially if you are in close contact with someone who has symptoms, may help, experts said. Also, they said vaccination with flu shots played a role in prevention as well as decreasing the severity of the disease.
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