PARENT GUIDE TO SWINE FLU (H1N1 VIRUS) -
IN CHILDREN ON CHEMOTHERAPY OR JUST OFF TREATMENT
This page will help explain a little bit about the management of children with swine flu or those who have been in close contact with swine flu and is relevant to children within the Haematology/oncology and BMT unit who currently:
1. are on chemotherapy or within 6 months of completion of treatment on standard chemotherapy or
2. are within 12 months of completing haemopoietic stem cell transplant (bone marrow transplant or Autologous stem cell transplant/Autograft)
INFLUENZA
Routine vaccination against influenza is recommended for children and young adults who have been treated with chemotherapy because Influenza may cause severe illness in high risk groups such as these. In addition to the patient, the parents/carers and siblings should also be vaccinated. It is the one vaccine that children on chemo are allowed and should have. If influenza season falls within 6 months of finishing treatment then they should have it at this point as well.
SWINE FLU’
Swine flu (H1N1 virus) has continued to be troublesome this last flu season (2010-2011). Fortunately the swine flu strain was incorporated into the seasonal flu jab and this meant that all eligible children and families who were vaccinated were covered for both. Our general advice this year has been the same as for the previous year:
All immunosuppressed children i.e. those on treatment or within 6-12 months off treatment (dependent on what sort of chemotherapy they have had) should receive the seasonal flu vaccination and be tested for the H1N1 virus if symptomatic.
DIAGNOSIS AND TREATMENT
In addition to the prompt commencement of standard treatment for febrile neutropenia or febrile non-neutropenia, appropriate treatment for swine flu should be started in patients who have signs and symptoms that could fit with swine flu.
Depending on the diagnosis, the doctor treating your child will decide if treatment needs to be adjusted, stopped or can continue whilst your child is unwell with swine flu.
For any children on immunosuppression for Langerhans Cell Histiocytosis (LCH) or other inflammatory disorder with prednisolone, azathioprine or other – if symptomatic, the immunosuppression should be continued and the treatment given in addition.
Preventative treatment is generally well tolerated and should be considered for close contacts of laboratory confirmed or clinically presumed cases only. A close contact is defined as a household member only and as being at less than one metre from the index case for more than one hour.It should be noted that adults are felt to be infectious only when symptomatic, and children may be infectious for approximately 12 hours prior to the onset of symptoms. Adjacent class mates and other class mates are no longer routinely offered anti-virals.
Treatment
Ideally treatment should be administered within 12-48 hours of onset of symptoms which are as follows:
• Fever [pyrexia ≥38°C] or a history of fever,
AND
• influenza-like illness (TWO OR MORE of the following symptoms: cough; sore throat; runny nose; limb or joint pain; headache; vomiting or diarrhoea)
OR
• severe and/or life-threatening illness suggestive of an infectious process.
Dr Helen Rees March 2011
