Thursday, July 2, 2009

Do campers need Tamiflu for "Swine Flu"?

Several calls have come in this week from parents who are inquiring about swine flu (novel H1N1) virus. The story is usually something like this: a few kids have been "definitively diagnosed" with Swine Flu and the camp has sent home an email letting parents know their children, in spite of their best efforts, have been exposed. They are being asked to call their pediatricians and ask if they would like the exposed (but not yet ill in any way) children to have prophylactic Tamiflu, the most commonly precribed anti-viral drug for prevention and treatment of novel H1N1 influenza.

My philosophy and that of numerous other experts(American Academy of Pediatrics, Centers for Disease Control, and New York State Health Department) is that prophylactic medication is not indicated for the vast majority of patients. If a child has labile asthma, or heart disease or is on chemotherapy or is otherwise in a weakened immunologic state and particularly at risk for complications of the flu, prophylactic medication may be indicated.

If a child comes down with typical symptoms of the flu (fever, headache, body aches, cough, and cold symptoms) Tamiflu can be given within 48 hours of the onset of symptoms. Even then, it only mitigates the illness by about 24 hours. And although this is anecdotal, this year's H1N1 flu seems to be fairly mild, causing illness for only a few days.

My personal feeling is that for the majority of people this flu is a fairly mild illness and I would just as soon we allow our children to develop some natural immunity. Natural immunity is the reason that most people born before 1957 have not had this flu. The flu virus from those years had some genetic resemblance to this current H1N1 and most adults over age 52 are actually partially immune due to exposure in childhood.

Another reason that prophylactic medication (usually given for 10 days) does not make sense is that exposure will not cease after ten days. Are we to give Tamiflu all summer long to campers as more and more kids turn up with the illness?

Fortunately this "Pandemic Flu" has not had the scarey consequences that were originally feared. It is unfortunate that the concern and planning that so many school districts went through this Spring is now transferred to camps. And of course the extraordinarily rainy weather has not helped any of us. Campers are huddled together indoors in relatively unsanitary environments because lightning could strike at any moment outside! If only it meant we saw more of the "Dear Mom, Dear Dad" a result.

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