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What's going around ... in school? Michigan doctors predict what will make kids sick this fall

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Our "What's Going Around" segment usually focuses on what doctors are already seeing in their offices, but every September, we change things up and ask doctors to predict what they'll be seeing. Think of it as an "illness forecast" for the first weeks of school. Keep reading for expert advice on how to keeps kids healthy.  

What are the top illnesses you expect to increase in school-age children during the first weeks of September?

Kinglsey Thomas, MD, chair, Department of Pediatrics at St. Joseph Mercy Oakland: 

“Our office anticipates seeing an increase in the number of viral infections, including gastroenteritis and upper respiratory infection. Children may experience coughing, a runny nose, nasal congestion, loose stools, nausea, vomiting and abdominal pain.”

Lauren Snabb, MD, Pediatrician at the Children’s Hospital of Michigan:

“In the summer and early fall months, Enteroviruses are a common cause of illness in school-age children. These viruses can cause a wide range of symptoms, including cold-like symptoms and vomiting with diarrhea. These symptoms often occur with fever.” 

Helen Stewart, DNP, Pediatric Nurse Practitioner, McLaren Oakland Children’s Health Services Clinic:

“Common cold; flu; respiratory syncytial virus, which is a virus that causes infections of the lungs and respiratory tract; gastroenteritis; strep throat.” 

Marie Michelle Lozon, MD- Division Director, Pediatric Emergency Medicine, University of Michigan Health System:

“When children start school, especially little ones in kindergarten and the early grades, they are put back into a ‘close quarters’ situation. They pass respiratory viruses most commonly. Respiratory viruses are passed through ‘droplets’ which are either sneezed or coughed (and if you have ever seen a special video of sneezes, the droplets come out super fast and far) and also through touching surfaces and each other.  These illnesses often start with scratchy throat, congestion and can progress to cough.  Kids who are ‘susceptible’ to asthma or wheezing, may go from cold symptoms to wheeze and respiratory distress.  Fall, with weather changes and viruses, is tough for those kids.”

“Many of those viruses (of which there are thousands of types) come with fever which makes kids miserable, but is not dangerous, just makes for aches, malaise.”

“Sometimes, without us really knowing why, a ‘new’ virus makes it’s way into a population, like what happened in fall of 2014 with Enterovirus D 68.  This virus made lots of kids cough, wheeze and need intensive care.  It was a terrible fall season.  But last year, we did not have such a bad ‘new’ virus outbreak…just the ‘usual.’”

“Also, INFLUENZA starts to circulate in late fall, not usually September, but doctors will start encouraging getting seasonal flu shots. “

Dr. Anthony Ognjan, Infectious diseases specialist with McLaren Macomb:

“Upper respiratory infections increase two weeks after school starts and remain high for 4 to 7 weeks.”

Brent Fuller, MD, FAAP, FACP, Beaumont Children's, Warren:

“In the first few weeks of school I would expect to see an increase in Streptococcal Pharyngitis (Strep Throat), viral upper respiratory infection (URI) such as those caused by rhinovirus and adenovirus, Hand, Foot, and Mouth Disease, and pinkeye (both viral and bacterial).  Don't forget influenza season is just around the corner!”

Dr. Kelly Levasseur, DO, Beaumont Children's, Royal Oak

“The top two illnesses I expect to increase are gastroenteritis and strep throat.”

Jeremy Lapham, Family Nurse Practitioner,  CVS MinuteClinic Ann Arbor:

Common Cold- A common viral infection of the nose and throat. Symptoms include a runny nose, sneezing, and congestion. High fever or severe symptoms are reasons to see your primary care provider, especially in children. In contrast to the flu, a common cold can be caused by many different types of viruses. The condition is usually harmless and symptoms usually resolve within two weeks. Peak cold activity hits during the winter and rainy months of the year. Colds are spread by skin-to-skin contact (handshakes or hugs); by saliva (kissing or shared drinks); by touching a contaminated surface (blanket or doorknob) and by airborne respiratory droplets (coughs or sneezes).

Norovirus- Often referred to as stomach flu, is a viral infection causing inflammation of the stomach or intestines or both. This is called acute gastroenteritis. Symptoms start 12 to 48 hours after being exposed to norovirus. Most people with norovirus illness get better within 1 to 3 days. Children who are dehydrated may cry with few or no tears and be unusually sleepy or fussy. Prevent norovirus via handwashing especially after using the toilet, changing diapers. And always before preparing food. Alcohol based hand sanitizers may also be used in conjunction with hand washing but is not a substitute. When you are sick do not prepare food for others for at least two days after symptoms have resolved. After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces using  a chlorine bleach solution (5–25 tablespoons of household bleach [5.25%] per gallon of water) or other disinfectant

There is no specific treatment for norovirus it cannot be treated with antibiotics because it is viral not bacterial. If you have norovirus you should drink plenty of liquids to replace fluid lost from throwing up and diarrhea. Oral rehydration fluids that you can get over the counter are most helpful for mild dehydration.

Allergies – Allergy symptoms include itchy eyes and skin, sneezing, nasal congestion, wheezing, and rash. Seasonal allergies result from grass, weed, tree pollen, or molds. Cat and dog dander allergies are common. Food allergies include peanut or milk.

Pharyngitis-- Pharyngitis, or sore throat, is discomfort, pain, or scratchiness in the throat. It often makes it painful to swallow. Pharyngitis is caused by swelling in the back of the throat (pharynx) between the tonsils and the voice box (larynx).  Most sore throats are caused by colds, the flu, coxsackie virus or mono (mononucleosis).

What can parents, teachers, or kids do to decrease the risk of spreading these illnesses? 

Dr. Fuller:

Disease burden can be prevented/ reduced by students staying home when they develop symptoms and not returning until they are better (fever free x 24 hours, not coughing, etc...), promoting proper hand washing in school (or hand sanitizer), individuals avoiding touching their faces as much as possible (to avoid direct inoculation), and discourage sharing of drinks or food. 

Dr. Ognian: 

“Make sure you, your teachers and your children have received all the recommended vaccines as recommended for their age group. In Michigan, there are (unfortunately) still plenty of children who are under-vaccinated or not vaccinated at all, which increases the risk of “outbreaks” of vaccine-preventable diseases.”

“Cleanliness is very important. Good handwashing trumps everything else we can ever do. Soap and water with good friction and skin rubbing. Hand sanitizers are not bad.”

Dr. Thomas: 

“No. 1, wash your hands. Make sure you and your kids maintain proper hygiene.  Cover your mouth while coughing, avoid crowded environments, avoid smoking and drink lots of fluids.”

Dr. Snabb: 

“Parents and teachers can remind kids to wash their hands regularly, especially after using the bathroom. Many cases of Enteroviral infections are spread through the fecal-oral route, so good hand hygiene is essential.”

“Enteroviruses can also be spread through respiratory routes. Parents and teachers can help by reminding kids to cover their mouth when they cough or sneeze by using the crook of their elbow. This method helps to prevent the spread of germs (as opposed to coughing/sneezing into their hands or the open air).”

Stewart: 

“Make sure kids wash their hands. While this is obvious it cannot be stressed enough. Eighty percent of infections are spread by touch. Two of the most important things are getting kids vaccinated and teaching them to wash their hands.”

Dr. Lozon:

“All common sense strategies: Don’t send sick kids to school. Parents do this all the time because they have to go to work and they don’t want their child to miss school. They may load them up with Tylenol and send them to school or daycare hoping for the best.  During those feverish first days are when those children are the most “infectious.”  We make it too hard for parents to stay home with sick children. 

Handwashing, covering cough are the other common sense strategies.  It’s hard for little kids to remember, so parents and teachers may have to remind kids to cover cough or clean their hands but they should also congratulate them when they do."

Dr. Levasseur: 

“Make sure that they teach their kids the proper techniques of hand washing and to keep their hands away from their mouth and face.  Kids also need to understand that they should not share their drinks and eating utensils.”

Is there anything different about this year (weather conditions, circulating illnesses, etc.) that will affect what's going around? 

Dr. Levasseur: 

“So far this past month we have seen hand, foot and mouth disease more prevalent than in the past 3-4 years.  There is not another illness that I can think if that is likely going to be different this year.”

Dr. Lozon: 

“Not that we see so far..the ‘usual’ is expected … but you just never know … we were taken by surprise with Enterovirus and  Influenza H1N1 in 2009 and 2010 when there was a worldwide pandemic of that flu type.  That flu type was “novel” (new) and hit kids VERY hard. Now that we have a suitable vaccine for that type, we can prevent it. Flu viruses are very clever and change their ‘type’ each year. They can change a little, but are still prevented by the vaccines or they can fool us and change a LOT and we don’t have time to produce an effective virus before the flu season and lots of people get sick.”

Dr. Ognjan: 

“We have had a relatively warm, dry summer. This had kept the disease-carrying mosquitos population down so the number of mosquito-borne illnesses cases are down (West Nile virus), but the risk will remain until the first frost when the mosquito population dies off. Additionally, the warm weather prolongs water activities which increases the spread of water viral infections (enterovirus).”

Dr. Thomas: 

“Swimming pools and beaches have high levels of bacterial content and may cause increased exposure to illness.  If you, your child or someone coming into contact with your child has traveled to a foreign country, they should make sure they are properly immunized as they can pass along bugs and illnesses.”

Dr. Fuller: 

“There is not really any difference this year in terms of weather that should affect illnesses but high pollens (especially ragweed) can worsen allergy symptoms making it easier to develop respiratory infections this time of year.”

What is the biggest thing you wish parents would do to help keep their kids healthy this fall? 

Stewart: 

“Make sure vaccines are up to date, get your children immunized against the flu and make sure that children understand the importance of good hygiene and handwashing.”

Dr. Snabb:

“Also remember that flu season is just around the corner. Check in with your doctor and arrange for vaccination of yourself and your child as soon as possible.”

Dr. Ognjan: 

“Make sure that kids are fully and appropriately vaccinated. There is also a lot to be said about preventative practices, such as healthy diets, appropriate amount of sleep and rest and regular physical activities to build strong, healthy bodies. Parent should also educate their children early on appropriate hygiene (handwashing, keep hands away from eyes and mouth, see your family doc before infection spreads).”

Dr. Lozon: 

“A healthy, organized life…good sleep, good, healthy food, good hand hygiene and covering cough.  Also GET YOUR FLU VACCINES.  TALK TO YOUR DOCTOR IF YOU HAVE QUESTIONS.  We are so lucky to have mostly very good vaccines that we seldom have a flu epidemic that kills children, but every fews years we DO.  I have seen children DIE from influenza complications before my eyes in my long career, so I have great respect for this virus.”

Dr. Fuller: 

“The best thing parents can do to keep their kids healthy this fall is to ensure that they are getting enough sleep (8-10 hours nightly depending on age), provide a healthy diet (plenty of fruits and vegetables, avoid fatty and sugary food and drinks, and drink plenty of water), and encourage exercise (1 hour of aerobic exercise daily).  This will help the immune system function at peak efficiency.  Things such as mega vitamin C, Airborne, zinc, etc... have not been shown to be beneficial and should be avoided.”

“Routine childhood immunizations are an important step in the protection of children, including the seasonal influenza vaccine.  Please get a flu shot this fall and don't forget to wash your hands.”

Dr. Levasseur: 

“Make sure that their children’s vaccinations are up to date and everyone who can get it gets the flu vaccination.”

Dr. Thomas:

“Use proper hygiene, avoid smoking, make sure that people coming around the home (such as grandparents) are immunized and avoid public areas known to have higher levels of bacteria.”

Anything else you would like to share regarding what will likely be going around in school this fall? 

Dr. Thomas: 

“Eat a healthy/balanced meal, exercise regularly, avoid soft drinks and drink lots of water.”

Stewart: 

“Keep kids home if they are sick so they do not spread infections to their classmates.”

Dr. Lozon: 

Make a plan to get children vaccinated, make sure they are getting sleep.  Tweens and teens do not get enough sleep and this can make them more susceptible to illness.  Make a deal with another family or friend or your co-parent about who will stay home if a child wakes up sick.  Sending a child to school sick is wrong for both that child and his or her classmates.  The vast majority of feverish illnesses in children are VIRUSES and only require what we call “supportive” care…fever medicines for comfort and lots of fluids…just like Grandma used to do.  Some illnesses that start as a simple viral infection can linger and get worse and need other types of treatments, and your child’s doctor can advise about those.  Plan your flu shot starting NOW … either ask your doctor when FLU clinic will take place in their practice or where you and your child can get immunizations in the community.

Dr. Levasseur: 

“Many younger children who are in daycare and preschools will likely be sick about half of the year with cold symptoms, including runny nose, cough and congestion.  As they get older they will likely not be sick as often.  Most fevers will be caused by a viral infection, if you child has ear pain, signs of difficulty breathing or signs of dehydration they should get in to see their doctor as soon as possible.”

Dr. Ognjan: 

“Children’s immune systems are relatively “inexperienced”—it is OK to get sick from time to time to boost their immune system. But be sure they are appropriately vaccinated against the more severe, serious and potentially life-threatening vaccine-preventable diseases.”