To parents and carers
We thought it was very important pass on to you some specific information about Swine Flu in people with breathing problems. The virus can spread quickly through the community and it is very important that you know what to do in the event that you suspect your child may have caught the infection.
Background
Swine Flu is a new strain of Influenza A (H1N1). It has now spread to more than 100 countries around the world.
The most common symptoms are fever, sore throat, diarrhoea, headache, feeling generally unwell and a dry cough - in other words, symptoms very similar to the usual winter flu. Children who have swine flu are less likely to have a temperature than adults.
In general the symptoms have proved mild but a small number of people have developed more serious illness. Children with respiratory conditions may need extra treatment so it is very important that you get advice and treatment urgently if you think your child has developed Swine Flu. As you will have heard there is a medication called Tamiflu which may help to control symptoms of the infection and should be taken within 48 hours of symptoms starting.
Infection Control Precautions which have been advised
We recommend these are followed as a routine in your home:
- Covering your nose and mouth when coughing or sneezing and using a tissue where possible and trying not to sneeze explosively
- Disposing of dirty tissues promptly and carefully
- Maintaining good basic hygiene e.g. washing hands frequently with soap and water to reduce viral transmission
- Cleaning hard surfaces (e.g. door handles) using normal cleaning agents as this removes the virus from these surfaces
- Making sure that your children follow this advice
What symptoms would make us think your child has Swine Flu rather than a usual chest infection?
If your child has fevers (above 380C) or muscle aches, vomiting, diarrhoea or headache, in addition to their usual symptoms, then it is possible that your child has Swine Flu and you should seek advice. If your child has these symptoms even without a temperature, you should still get advice.
What action do I take if I my child has these symptoms?
You must contact your GP urgently and report:
(a) that your child has symptoms of possible Swine Flu and
(b) that your child also has a respiratory condition (give as many details of the condition and its treatment as possible).
Your child will not be tested for the virus but instead you will simply be advised to give your child Tamiflu which is an effective anti-viral treatment.
Tamiflu is generally given as a tablet but children who are younger than one will be given it in liquid form. For children older than one who can't swallow capsules, the advice is to open up the capsules and mix them with a 'sweetened' food product.
To avoid further spread of Swine Flu you will be asked to arrange for a family member or friend ie "a flu friend" to collect the Tamiflu prescription from the GP surgery. Do not be surprised if this arrangement changes and the GP advises that your "flu friend" picks the Tamiflu up directly from a pharmacy, as this is one of the plans that may be introduced if there are large numbers of people needing Tamiflu.
It is very important for effective treatment that you get
Tamiflu within 48 hours of your child's symptoms starting. In other words do not delay contacting your GP.
You must also contact the Paediatric respiratory team at Royal Brompton Hospital to discuss any extra treatment for your child's chest. Your child may need an extra antibiotic treatment to prevent the Swine Flu being followed by a bacterial chest infection.
We will advise you on the best course of action. There are 3 options:
Option 1 - If the swine flu infection is mild you will be asked by us on the telephone to start your child on a suitable antibiotic by mouth. We can organise for your GP to prescribe extra antibiotics and again it would be sensible for your "flu friend" to pick these up for you from the surgery. It may help for you to make sure that you already have an up to date course of the antibiotic that your child has taken in the past with viral infections.
Option 2 - If over the telephone it sounds as if your child may need intravenous antibiotics (through a drip) we may ask you to bring your child to Royal Brompton Hospital or recommend treatment at your local hospital. If you bring your child to Royal Brompton, to reduce the risk of spreading the Swine Flu virus, we will ask you to come to a special area (this may not be the usual clinic area or ward) at a specific time. We will then examine your child and make a decision about intravenous antibiotic therapy. To make sure beds are available for anyone who may be seriously affected by the virus, we will be encouraging children who are well enough to be supported at home to have a home IV course.
Option 3 - If your child is seriously unwell when you bring him/her in you will be advised that your child should stay in hospital.
Again, we emphasise that most cases of Swine Flu have been mild and indeed there have already been cases in our patients which have been mild. This letter is to make sure that you are aware of our plans to deal with the problem.
What actions do I take if a family member (under the same roof) is prescribed Tamiflu?
If a family member has been given Tamiflu then any child with a respiratory condition should also take it as a preventative measure, even if he or she does not have any symptoms. We strongly recommend that you contact your GP and explain that your child has a chronic chest condition, and that the hospital is recommending Tamiflu for 10 days for the child with respiratory problems only (i.e. NOT for the whole family). The dose will vary according to the age of your child.
Contacting the Paediatric Respiratory Team
During working hours, ie: Monday to Friday 9am - 5pm you should ring Royal Brompton switchboard 0207 352 8121 and ask for the operator who can then Bleep the on-call Paediatric Respiratory Registrar doctor (Bleep 1237).
Tamiflu
The Government has made available large stocks of Tamiflu and this is best obtained from your GP, so it is very important that you get your treatment this way.
As the Swine Flu spreads through the population we may need to change our services but we will continue to keep you informed. It is most important that you ask for expert advice over the telephone, please avoid simply arriving in clinic if you feel your child has symptoms suggesting Swine Flu.
A vaccine will soon be available. As soon as this happens we will obviously inform you.
Paediatric Respiratory team
