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Talking Tamiflu

Prevention measures like handwashing, staying home when sick, cleaning and disinfecting surfaces, and vaccination are behaviors and actions school nurses have been busy promoting since long before COVID.  With both COVID and influenza, two contagious respiratory viruses, circulating this winter (not to mention other common illnesses including strep, RSV, rhinovirus, etc), these proven precautions are as crucial as ever in controlling the spread of disease and helping to keep our communities as safe and healthy as possible.  In fact, continuing to educate teachers, parents, and students on these vital steps in reducing disease transmission may be even more necessary this year, as people experience risk mitigation fatigue and vaccine hesitancy at rates significantly higher than in years past.  But, despite our most diligent efforts, there will still be cases of COVID and influenza in our communities.  Many school nurses are well equipped with their COVID guidance but when a student has the flu, parents tend to have just as many questions and one of the most common is about treatment with Tamiflu.

What is Tamiflu?

Tamiflu is the trade name for the antiviral medication, oseltamivir.  One of just four antiviral drugs approved by the FDA and recommended by the CDC for use in children this flu season, Tamiflu is used to both treat and prevent certain strains of influenza and is approved for use in children aged 14 days and older.  Ideally, it should be started within two days after symptoms develop, however, there can still be a benefit if treatment is initiated later, particularly for the treatment of confirmed or suspected flu in children with severe, complicated, or progressive illness.

How does it work?

By interfering with the proteins used by the influenza virus to reproduce, Tamiflu buys the immune system valuable time to fight off and ultimately destroy the virus.  This interference mechanism that delays viral replication is the reason it should be taken within 48 hours of symptom onset and also the rationale behind prescribing it for preventive situations, in some instances.

What are the benefits?

Generally, healthy children can recover from the flu with supportive care at home including rest, fluids, and over-the-counter fever-reducing medications.  However, all families need to contact their child’s healthcare provider to determine if antiviral treatment might be indicated as it can help shorten the illness, lessen the risk for complications, and may also reduce the risk of infecting others.  For children who are at increased risk of serious complications, including children younger than 5 and any child with chronic health conditions including asthma, diabetes, or heart or lung disease, the CDC and AAP recommend prompt initiation of antiviral treatment when flu is confirmed or suspected.

What are the potential side effects?

According to the FDA, the two most common side effects of Tamiflu are nausea and vomiting which typically occur within the first two days of the prescribed course and can often be alleviated by taking the medication with food.  In 2005-2006, there were reports of more serious side effects coming from Tamiflu use in Japan.  These included an increased risk for neuropsychiatric symptoms such as delirium and hallucinations which could possibly lead to self-harm and suicidal thoughts. Since then, there have been no reports of similar events and subsequent studies have not found any increased risk of neuropsychiatric effects associated with Tamiflu, however, it remains a listed side effect.

Antivirals can be a safe and effective treatment for children sick with the flu but they are not indicated for all children.  Early intervention is critical and that is where school nurses can provide care, support, and education to families by promoting preventative measures (better than any antidote or remedy!) and timely communication with healthcare providers to discuss possible testing and treatments.

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