Course Management of Prevalent Infections in Children Following a Disaster

Influenza in adults typically begins with the sudden onset of fever, often accompanied by chills or rigors, headache, malaise, diffuse myalgia, and nonproductive cough. Subsequently, respiratory tract signs including sore throat, nasal congestion, rhinitis, and cough become more prominent. Conjunctival injection, abdominal pain, nausea, vomiting, and diarrhea are less commonly associated with influenza illness. Influenza symptoms may be different among different age populations with older children and adolescents having more classic adult influenza like symptoms. Neonates may present with fever and a sepsis like picture and toddlers may have few respiratory signs but have vomiting and diarrhea as their predominant symptom. The usual incubation period between the time someone is exposed and infected with influenza virus to the time that they experience symptoms of illness ranges from 18 hours to 5 or more days with an average of 2-3 days. Once infected with influenza the principal site of replication is the columnar epithelium in the back of the throat. Viral shedding in respiratory secretions occurs for 1 day before illness and 5-10 days after illness onset. Viral titers are generally higher in young children with shedding lasting 10 days or longer. Peak shedding of virus generally occurs during the first 3 days of illness and correlates with the presence of fever.