Lung & Respiratory Infections

About Adenovirus Infections

Adenoviruses are a group of viruses that can infect the membranes (tissue linings) of the respiratory tract, eyes, intestines, urinary tract, and nervous system. They account for about 10% of fever-related illnesses and acute respiratory infections in kids and are a frequent cause of diarrhea.

Adenoviral infections affect babies and young children much more often than adults. Childcare centers and schools sometimes have multiple cases of respiratory infections and diarrhea caused by adenovirus.

Adenoviral infections can occur at any time of the year, but:

• respiratory tract problems caused by adenovirus are more common in late winter, spring, and early summer
• conjunctivitis (pinkeye) and pharyngoconjunctival fever caused by adenovirus tend to affect older kids, mostly in the summer

Adenoviral infections can affect children of any age, but most occur in the first years of life — and most kids have had at least one before age 10. There are many different types of adenoviruses, so some kids can have repeated adenoviral infections.

Signs and Symptoms

Depending on which part of the body is affected, the signs and symptoms of adenoviral infections vary:

Febrile respiratory disease, an infection with fever of the respiratory tract, is the most common result of adenoviral infection in kids. The illness often appears flu-like and can include symptoms of pharyngitis (inflammation of the pharynx, or sore throat), rhinitis (inflammation of nasal membranes, or a congested, runny nose), cough, and swollen lymph nodes (glands). Sometimes the respiratory infection leads to acute otitis media, an infection of the middle ear.

Adenovirus often affects the lower respiratory tract as well, causing bronchiolitis, croup, or viral pneumonia, which is less common but can cause serious illness in infants. Adenovirus can also produce a dry, harsh cough that can resemble whooping cough (pertussis).

Gastroenteritis is an inflammation of the stomach and the small and large intestines. Symptoms include watery diarrhea, vomiting, headache, fever, and abdominal cramps.

Genitourinary infections: Urinary tract infections can cause frequent urination, burning, pain, and blood in the urine. Adenoviruses are also known to cause a condition called hemorrhagic cystitis, which is characterized by blood in the urine. Hemorrhagic cystitis usually resolves on its own.

Eye infections:

• Pinkeye (conjunctivitis) is a mild inflammation of the conjunctiva (membranes that cover the eye and inner surfaces of the eyelids). Symptoms include red eyes, discharge, tearing, and the feeling that there’s something in the eye.
• Pharyngoconjunctival fever, often seen in small outbreaks among school-age kids, occurs when adenovirus affects both the lining of the eye and the respiratory tract. Symptoms include very red eyes and a severe sore throat, sometimes accompanied by low-grade fever, rhinitis, and swollen lymph nodes.
• Keratoconjunctivitis is a more severe infection that involves both the conjunctiva and cornea (the transparent front part of the eye) in both eyes. This type of adenoviral infection is extremely contagious and occurs most often in older kids and young adults, causing red eyes, photophobia (discomfort of the eyes upon exposure to light), blurry vision, tearing, and pain.

Nervous system infections:

• Meningitis and encephalitis (inflammation of the lining of the brain and spinal cord) can sometimes happen due to adenovirus infection. Symptoms can include fever, headache, nausea and vomiting, stiff neck, or skin rash.

Contagiousness

Adenovirus is highly contagious, so multiple cases are common in close-contact settings like childcare centers, schools, hospitals, and summer camps.

The types of adenovirus that cause respiratory and intestinal infections spread from person to person through respiratory secretions (coughs or sneezes) or fecal contamination. Fecal material can spread via contaminated water, eating food contaminated by houseflies, and poor hand washing (such as after using the bathroom, before eating or preparing food, or after handling dirty diapers).

A child might also pick up the virus by holding hands or sharing a toy with an infected person. Adenovirus can survive on surfaces for long periods, so indirect transmission can occur through exposure to the contaminated surfaces of furniture and other objects.

The types of adenovirus causing pinkeye may be transmitted by water (in lakes and swimming pools), by sharing contaminated objects (such as towels or toys), or by touch.

Once a child is exposed to adenovirus, symptoms usually develop from 2 days to 2 weeks later.

Treatment

Adenoviral illnesses often resemble certain bacterial infections, which can be treated with antibiotics. But antibiotics don’t work against viruses. To diagnose the true cause of the symptoms so that proper treatment can be prescribed, your doctor may want to test respiratory or conjunctival secretions, a stool specimen, or a blood or urine sample.

The doctor will decide on a course of action based on your child’s condition. Adenoviral infections usually don’t require hospitalization. However, babies and young children may not be able to drink enough fluids to replace what they lose during vomiting or diarrhea and so might need to be hospitalized to treat or prevent dehydration. Also, young (especially premature) infants with pneumonia usually need to be hospitalized.

In most cases, a child’s body, with the help of the immune system, will get rid of the virus over time. Antibiotics cannot treat a viral infection, so it’s best to just make your child more comfortable. Children with weakened immune systems, transplants, HIV or AIDS, or congenital immunodeficiencies may have a more difficult time fighting adenovirus, so stronger treatment might be needed. (A congenital immunodeficiency is a condition a baby is born with that causes the immune system to not work properly.)

If your child has a respiratory infection or fever, getting plenty of rest and taking in extra fluids are essential. A cool-mist humidifier (vaporizer) may help loosen congestion and make your child more comfortable. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. If your child is under 6 months old, you may need to clear his or her nose with nasal saline drops and a bulb syringe.

Don’t give any over-the-counter (OTC) cold remedies or cough medicines without checking with your doctor. You can use acetaminophen to treat a fever (your doctor will tell you the proper dose); however, do not give aspirin because of the risk of Reye syndrome, a life-threatening illness.

If your child has diarrhea or is vomiting, increase fluid intake and check with the doctor about giving an oral rehydration solution to prevent dehydration.

To relieve the symptoms of pinkeye, use warm compresses and, if your doctor recommends them, a topical eye ointment or drops.

Duration

Most adenoviral infections last from a few days to a week. However:

• severe respiratory infections may last longer and cause lingering symptoms, such as a cough
• pneumonia can last anywhere from 2–4 weeks
• pinkeye can persist for another several days to a week
• more severe keratoconjunctivitis can last for several weeks
• adenovirus can cause diarrhea that lasts up to 2 weeks (longer than other viral diarrhea episodes)

Prevention

There’s no way to completely prevent adenoviral infections in kids. To reduce their spread, parents and other caregivers should encourage frequent hand washing, keep shared surfaces (such as countertops and toys) clean, and remove kids with infections from group settings until symptoms pass.

When to Call the Doctor

Most of these adenoviral conditions and their symptoms are also associated with other causes. Call your doctor if:

• a fever continues more than a few days
• symptoms seem to get worse after a week
• your child has breathing problems
• your child is under 3 months old
• any swelling and redness around the eye becomes more severe or painful
• your child shows signs of dehydration, such as appearing tired or lacking energy, producing less urine or tears, or having a dry mouth or sunken eyes

Remember, you know your child best. If he or she appears to be severely ill, don’t hesitate to call your doctor right away.

About Bronchiolitis

Bronchiolitis is a common illness of the respiratory tract. It’s caused by an infection that affects the tiny airways, called the bronchioles, that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, which can make breathing difficult.

Bronchiolitis:

• most often affects infants and young children because their noses and small airways can become blocked more easily than those of older kids or adults
• typically happens during the first 2 years of life, most commonly at about 3 to 6 months of age
• is more common in males, premature babies, children who have not been breastfed, and those who live in crowded conditions

Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus (RSV). RSV infections are responsible for more than half of all cases of bronchiolitis. Other viruses associated with bronchiolitis include rhinovirus (the common cold virus), influenza (flu), human metapneumovirus, adenovirus, coronavirus, and parainfluenza. Childcare attendance and exposure to cigarette smoke also can increase a child’s risk for bronchiolitis.

Although it’s often a mild illness, some babies are at risk for severe bronchiolitis — including those who were born prematurely, have a chronic heart or lung disease, or have a weakened immune system due to illness or medicines. Those infants need to be treated in a hospital.

Kids who have had bronchiolitis might be more likely to develop asthma later in life. It’s not yet clear whether the illness causes or triggers asthma, or whether kids who eventually develop asthma were just more prone to developing bronchiolitis as infants. Experts continue to study the relationship between bronchiolitis and the later development of asthma.

Signs and Symptoms

The first symptoms of bronchiolitis are usually the same as those of a common cold:

• stuff nose and congestion
• runny nose
• cough
• fever

These symptoms last a day or two and are followed by worsening of the cough and wheezing (high-pitched whistling noises when exhaling).

Sometimes, more severe respiratory difficulties gradually develop. Signs to watch for include:

• fast, shallow breathing
• a rapid heartbeat
• retractions — when the areas below the ribs, between the ribs, and in the neck sink in as a child inhales
• flaring of the nostrils
• irritability, with difficulty sleeping and signs of fatigue (tiredness) or lethargy
• vomiting after coughing
• poor appetite or not feeding well, causing decreased peeing and fewer wet diapers

Sometimes these symptoms can lead to dehydration. Less commonly, babies (especially preemies) may have episodes where they briefly stop breathing (called apnea) before developing other symptoms.

In severe cases, symptoms may worsen quickly. A child with severe bronchiolitis may get very tired from the work of breathing and have poor air movement in and out of the lungs due to the clogging of the small airways. The skin can turn blue (called cyanosis), which is especially noticeable in the lips and fingernails.

Contagiousness

The infections that cause bronchiolitis are contagious. The germs can spread in tiny drops of fluid from an infected person’s nose and mouth, which may become airborne via sneezes, coughs, or laughs, and also can end up on things the person has touched, such as used tissues or toys.

Infants in childcare centers have a higher risk of getting an infection that may lead to bronchiolitis because they’re in close contact with lots of other young children.

Prevention

The best way to prevent the spread of viruses that can cause bronchiolitis is washing hands well and often. It may help to keep infants away from others who have colds or coughs. Babies who are exposed to cigarette smoke are more likely to develop severe bronchiolitis compared with those from smoke-free homes. So it’s important to protect children from secondhand smoke.

There’s no bronchiolitis vaccine available yet, but a medication can be given to ease the severity of the disease. It’s recommended only for infants at high risk of severe disease, such as those born very prematurely or those with chronic lung or heart disease. The medicine, which contains antibodies to RSV, is given as an injection monthly during peak RSV season.

Incubation

The incubation period (the time between infection and the onset of symptoms) ranges from several days to a week, depending on the infection causing the bronchiolitis.

Duration

Cases of bronchiolitis usually last about 12 days, but kids with severe cases can cough and have wheezing for weeks. The illness generally reaches its peak on the second or third day after coughing begins, causing breathing difficulty before slowly getting better.

Professional Treatment

Fortunately, most cases of bronchiolitis are mild and don’t need specific professional treatment. Antibiotics aren’t useful because bronchiolitis is caused by a viral infection, and antibiotics are only effective against bacterial infections. Medicine may sometimes be given to help open a child’s airways.

Infants who have trouble breathing, are dehydrated, or appear fatigued should be checked by a doctor. Those who are moderately or severely ill may need to be hospitalized, watched closely, and given fluids and humidified oxygen. Rarely, in very severe cases, some babies are placed on respirators to help them breathe until they start to get better.

Home Treatment

The best treatment for most kids is time to recover and plenty of fluids. Making sure a child drinks enough fluids can be tricky, though, because infants with bronchiolitis may not feel like drinking. They should be offered fluids in small amounts often.

Indoor air, especially during winter, can dry out airways and make the mucus stickier. Some parents use a cool-mist vaporizer or humidifier in the child’s room to help loosen mucus in the airway and relieve cough and congestion. If you use one, clean it daily with household bleach to prevent mold build-up. Avoid hot-water and steam humidifiers, which can be hazardous and can cause scalding.

To clear nasal congestion, try a bulb syringe and saline (saltwater) nose drops. This can be especially helpful just before feeding and sleeping. Sometimes, keeping a child in a slightly upright position may help ease labored breathing.

Acetaminophen can be given to reduce fever and make your child more comfortable. Be sure to give the appropriate dose based on your child’s weight.

When to Call the Doctor

Call your doctor if your child:

• is breathing quickly, especially if this is accompanied by retractions or wheezing
• might be dehydrated due to vomiting or a poor appetite
• is sleepier than usual
• has a high fever
• has a cough that gets worse
• appears very tired or lethargic

Get immediate help if you feel your child is having difficulty breathing and the cough, retractions, or wheezing are getting worse, or if his or her lips or fingernails appear blue.

About Croup

Croup is a condition that swells and irritates the upper airways. The same viruses that cause the common cold also cause croup, and most cases happen in the fall and early winter.

Kids with croup have a telltale “barking” cough (often compared to the sound of a seal’s bark) and a raspy voice, especially when crying.

Croup usually affects kids 6 months to 3 years old, but sometimes older kids can get it. Most kids with croup can be comforted with humidified or cold air and by drinking lots of liquids.

There are two types of croup, viral croup and spasmodic croup, both of which cause the barking cough. Most cases of croup are viral.

Signs and Symptoms

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airways — the voice box (larynx) and windpipe (trachea) — become inflamed and swollen, a child may become hoarse and have the barking cough.

If the airways continue to swell, it becomes hard for a child to breathe. The child may make a high-pitched or squeaking noise while breathing in — this is called stridor. A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.

Symptoms of croup are often worse at night and when a child is upset or crying.

Diagnosis

Doctors usually diagnose croup by listening for the telltale cough and stridor. They will also ask questions — for example, whether the child has had any recent illnesses that caused a fever, runny nose, and congestion; and if the child has a history of croup or upper airway problems.

When croup is severe and slow to get better after treatment, the doctor might order a neck X-ray to rule out other reasons for the breathing problems, such as an object stuck in the throat, a peritonsillar abscess (collection of pus at the back of the mouth), or epiglottitis (swelling of the flap of tissue that covers the windpipe).

In cases of croup, an X-ray usually will show the top of the airway narrowing to a point, which doctors call a “steeple sign.”

Treatment

Most cases of croup are mild and can be treated at home. Breathing in moist air can help kids feel better. If they have a fever, medicine (ibuprofen or acetaminophen) may make them more comfortable. Ask your health care professional how much to give and follow the directions carefully.

To help your child breathe in moist air, use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop the severe coughing. In cooler weather, taking your child outside for a few minutes to breathe in the cool air may ease symptoms. You also can try taking your child for a drive with the car windows slightly lowered.

Your child should drink plenty of fluids to prevent dehydration. If needed, give small amounts of liquid more often using a spoon or medicine dropper. Kids with croup also should get lots of rest.

Some kids need a breathing treatment that can be given in the hospital or a steroid medicine to reduce swelling in the airway. Rarely, kids with croup might need to stay in a hospital until they’re breathing better.

When to Call the Doctor

Most kids recover from croup with no lasting problems. But some kids — especially those who were born prematurely, or have asthma or other lung diseases — can be at risk for complications from croup.

Call your doctor or get immediate medical care if your child:

• has trouble breathing, including very fast or labored breathing
• has pulling in of the neck and chest muscles when breathing
• has stridor that is getting worse
• is pale or bluish around the mouth
• is drooling or has trouble swallowing
• is very tired or sleepy or hard to awaken
• is dehydrated (signs include a dry or sticky mouth, few or no tears when crying, sunken eyes, thirst, peeing less)

About Diphtheria

Diphtheria is a bacterial infection that spreads easily and occurs quickly. It mainly affects the nose and throat. Children under 5 and adults over 60 years old are particularly at risk for contracting the infection. People living in crowded or unclean conditions, those who aren’t well nourished, and children and adults who don’t have up-to-date immunizations are also at risk.

Diphtheria is very rare in the United States and Europe, where health officials have been immunizing children against it for decades. However, it’s still common in developing countries where immunizations aren’t given routinely. In 1993 and 1994, more than 50,000 cases were reported during a serious outbreak of diphtheria in countries of the former Soviet Union.

Signs and Symptoms

In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms.

The toxin, or poison, caused by the bacteria can lead to a thick coating (or membrane) in the nose, throat, or airway, which makes a diphtheria infection different from other more common infections that cause sore throat (such as strep throat). This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing.

As the infection progresses, someone may:

• have difficulty breathing or swallowing
• complain of double vision
• have slurred speech
• even show signs of going into shock (skin that’s pale and cold, rapid heartbeat, sweating, and an anxious appearance)

In cases that progress beyond a throat infection, diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications that affect other organs, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys’ ability to clear wastes. It also can cause nerve damage, eventually leading to paralysis. Up to 40% to 50% of those who don’t get treated can die.

Prevention

Preventing diphtheria depends almost completely on giving the diphtheria/tetanus/pertussis vaccine to children (DTaP) and non-immunized adolescents and adults (Tdap). After a single dose of Tdap, adolescents and adults should receive a booster shot with the diphtheria/tetanus vaccine (Td) every 10 years. Most cases of diphtheria occur in people who haven’t received the vaccine at all or haven’t received the entire course.

The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given.

The immunization schedule calls for:

• DTaP vaccines at 2, 4, and 6 months of age
• booster dose given at 12 to 18 months
• booster dose given again at 4 to 6 years
• Tdap vaccine given at 11-12 years
• booster shots of Td given every 10 years after that to maintain protection
• Tdap vaccine during the second half of each pregnant woman’s pregnancy

Although most children tolerate it well, the vaccine sometimes causes mild side effects such as redness or tenderness at the injection site, a low-grade fever, or general fussiness or crankiness. Severe complications, such as an allergic reaction, are rare.

Contagiousness

Diphtheria is highly contagious. It’s easily passed from an infected person to others through sneezing, coughing, or even laughing. It also can spread to someone who picks up tissues or drinking glasses that have been used by an infected person.

People infected with the diphtheria bacteria, even if they don’t have any symptoms, can infect others for up to 4 weeks. The incubation period (the time it takes for a person to become infected after being exposed) for diphtheria is 2 to 4 days, although it can range from 1 to 6 days.

Treatment

Children and adults with diphtheria are treated in a hospital. After a doctor confirms the diagnosis through a throat culture, the infected person receives a special anti-toxin, given through injections or an IV, to neutralize the diphtheria toxin already circulating in the body, plus antibiotics to kill the remaining diphtheria bacteria.

If the infection is advanced, people with diphtheria may need a ventilator to help them breathe. In cases in which the toxins may have spread to the heart, kidneys, or central nervous system, patients may need intravenous fluids, oxygen, or heart medications.

A person with diphtheria must be isolated. Family members and other close contacts who haven’t been immunized, or who are very young or elderly, must be protected from contact with the patient.

When someone is diagnosed with diphtheria, the doctor will notify the local health department and treat everyone in the household who may have been exposed to the bacteria. Treatment includes assessment of immune status, throat cultures, and booster doses of the diphtheria vaccine. They will also receive antibiotics as a precaution.

Immediate hospitalization and early intervention allow most patients to recover from diphtheria. After the antibiotics and anti-toxin have taken effect, someone with diphtheria will need bed rest for a while (4 to 6 weeks, or until full recovery). Bed rest is particularly important if someone develops myocarditis (inflammation of the heart muscle), which can be a complication of diphtheria.

Those who have recovered should still receive a full course of the diphtheria vaccine to prevent a recurrence because contracting the disease doesn’t guarantee lifetime immunity.

When to Call the Doctor

Call your doctor immediately if anyone in your family has symptoms of diphtheria, if you observe symptoms in someone else, if anyone in your family is exposed to diphtheria, or if you think that you or a family member is at risk. It’s important to remember, though, that most throat infections are not diphtheria, especially in countries that have routine immunizations against it.

If you’re not sure if your kids have been vaccinated against diphtheria, make an appointment. Also make sure your own booster immunizations are current. International studies have shown that a significant percentage of adults over 40 years of age aren’t adequately protected against diphtheria and tetanus.

Influenza, commonly known as “the flu,” is a highly contagious viral infection of the respiratory tract. It affects all age groups, though kids tend to get it more often than adults.

In the United States, flu season runs from October to May, with most cases happening between late December and early March.

Signs and Symptoms

The flu is often confused with the common cold, but flu symptoms usually are more severe than the typical sneezing and stuffiness of a cold.

Symptoms, which usually begin about 2 days after exposure to the virus, can include:

• fever
• chills
• headache
• muscle aches
• dizziness
• loss of appetite
• tiredness
• cough
• sore throat
• runny nose
• nausea or vomiting
• weakness
• ear pain
• diarrhea

Infants with the flu also may seem fussy all of a sudden or just “not look right.”

How Long it Lasts

After 5 days, fever and other symptoms have usually disappeared, but a cough and weakness may continue. All symptoms usually are gone within a week or two. However, it’s important to treat the flu seriously because it can lead to pneumonia and other life-threatening complications, particularly in babies, senior citizens, and people with long-term health problems.

Contagiousness

The flu is contagious, spread by virus-infected droplets that are coughed or sneezed into the air. People who are infected are contagious from a day before they feel sick until their symptoms have ended (about 1 week for adults, but this can be longer for young kids).

The flu usually happens in small outbreaks, but epidemics — when the illness spreads rapidly and affects many people in an area at the same time — tend to happen every few years. Epidemics often peak within 2 or 3 weeks after the first cases are reported.

When an epidemic spreads worldwide, it’s called a pandemic.

The Flu Vaccine

The vaccine helps protect people from the flu viruses that experts think will be most common in the upcoming flu season. While the vaccine doesn’t completely guarantee against getting sick, someone who’s been vaccinated and still gets the flu will have fewer and milder symptoms.

Flu vaccines are available as a shot. Given as an injection, the flu shot contains killed flu viruses that will not cause the flu, but will prepare the body to fight off infection from that particular type of live flu virus if someone comes into contact with it. The flu shot is safe and effective.

Although the flu vaccine also came in a nasal spray (or mist) form in the past, the nasal spray is not currently recommended. The Centers for Disease Control and Prevention (CDC) found that it didn’t prevent cases of the flu between 2013 and 2016.

When & Where to Get the Vaccine

People who got the vaccine one year aren’t protected from getting the flu the next because the protection wears off and flu viruses constantly change. That’s why the vaccine is updated each year to include the most current strains of the virus.

So to have the best protection against the flu, it’s important to get the vaccine every year.

The seasonal flu vaccine becomes available each fall. It is given in places like hospitals, clinics, community centers, pharmacies, doctor’s offices, and schools. Many kids receive the flu vaccine at school.

Kids younger than 9 years old will receive two doses this flu season if they have received fewer than two doses of flu vaccine before July 2016. This includes kids who are getting the flu vaccine for the first time. Those under 9 who have received at least two doses of flu vaccine previously (in the same or different seasons) will only need one dose. Kids older than 9 only need one dose of the vaccine.

It can take about 2 weeks after the vaccine for the body to build up protection to the flu. Getting the vaccine before the flu season is in full force gives the body a chance to build up immunity to (protection from) the virus.

You can get a flu vaccine well into flu season, but it’s best to try to get it as early as possible so the body has time to build up immunity. However, even in January there are still a few months left in the flu season, so it’s still a good idea to get protection.

If you are traveling outside the country, be sure to check with your doctor because the flu season may be different in other countries. If you are traveling to a place with flu activity, make sure you are vaccinated at least 2 weeks before travel.

Possible Side Effects

While very few people get side effects from the flu shot, those who do may have soreness or swelling at the site of the injection or mild side effects, such as headache or low-grade fever.

Although these side effects might last for a day or so, flu viruses can potentially sicken someone for weeks and cause health problems that could require hospitalization, especially in young children or people with chronic diseases. So doctors believe that the benefits of getting the flu vaccine outweigh any potential risks.

Who Is Considered High Risk?

Although flu vaccine is recommended for everyone aged 6 months and older, it is especially important for people at higher risk of health problems from the flu to get vaccinated. They include:

• all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)
• anyone 65 years and older
• all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season
• anyone whose immune system is weakened from medications or illnesses (like HIV infection)
• residents of long-term care facilities, such as nursing homes
• any adult or child with chronic medical conditions, such as asthma
• kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu
• caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
• Native Americans and Alaskan natives

Certain things might prevent a person from getting the flu vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

• has ever had a severe reaction to a flu vaccination
• has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.

Still, a child with an egg allergy should get the flu shot in a doctor’s office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist’s office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu shot.

Preventing the Flu From Spreading

There’s no guaranteed way — including being vaccinated — to have 100% protection from the flu. But these practical steps make spreading the flu less likely:

• Wash your hands well and often with soap, especially after using the bathroom, after coughing or sneezing, and before eating or preparing food.
• Never pick up used tissues.
• Don’t share cups and eating utensils.
• Stay home from work or school when you’re sick with the flu.
• Cover your mouth and nose with a tissue when you cough or sneeze, then put it in the trash. If a tissue isn’t available, cough or sneeze into your upper arm, not into your hands.

Treatment

Cases of the flu rarely require specific medical treatment. But some kids with chronic medical conditions (such as asthma, diabetes, or HIV infection) or children under 2 years old might become sicker with the flu and may have a greater risk of complications. Some kids with the flu need to be hospitalized.

For a severely ill child or one with other special circumstances, a doctor may prescribe an antiviral medicine that can shorten the illness by 1-2 days and prevent potential problems of the flu. This medicine is only helpful if given within 48 hours of the start of the flu. Most healthy people who get the flu do not need to take an antiviral medicine. If an antiviral medication is prescribed, be sure to discuss any possible side effects with your doctor.

These at-home tips can help most otherwise healthy kids cope with the flu. Have them:

• drink lots of fluids to prevent dehydration
• get plenty of sleep and take it easy
• take acetaminophen or ibuprofen to relieve fever and aches (do not give aspirin to children or teens because of its association with Reye syndrome)
• wear layers, since the flu often makes them cold one minute and hot the next (wearing layers — like a T-shirt, sweatshirt, and robe — makes it easy to add or remove clothes as needed)

Kids who are sick should stay home from school and childcare until they feel better and have been fever-free for at least 24 hours without the use of a fever-reducing medicine. Some might need to stay home longer, depending on how they feel. If you have questions or concerns, talk to your doctor.

When to Call the Doctor

Call the doctor if your child:

• has flu symptoms
• has a high fever, or fever with a rash
• has trouble breathing or rapid breathing
• has bluish skin color
• is not drinking enough fluids
• seems very sleepy or lethargic
• seems confused
• has flu symptoms that get better, but then get worse

For the most part, though, the flu is usually gone in a week or two with a little rest and tender loving care.

About Measles

Measles, also called rubeola, is a highly contagious respiratory infection that’s caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Though rare in the United States, 20 million cases happen worldwide every year.

Since measles is caused by a virus, there is no specific medical treatment for it and the virus has to run its course. But a child who is sick should drink plenty of fluids, get lots of rest, and be kept from spreading the infection to others.

Signs and Symptoms

While measles is probably best known for its full-body rash, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. Children who get the disease also may have Koplik’s spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash breaks out 3-5 days after symptoms start, and can coincide with high fevers up to 104°F (40°C). The red or reddish-brown rash usually first shows up as flat red spots on the forehead. It spreads to the rest of the face, then down the neck and torso to the arms, legs, and feet. The fever and rash gradually go away after a few days.

Contagiousness

Measles is highly contagious — 90% of people who haven’t been vaccinated for measles will get it if they are near an infected person. Measles spreads when people breathe in or have direct contact with virus-infected fluid, such as the droplets sprayed into the air when someone with measles sneezes or coughs. A person who is exposed to the virus might not show symptoms until 8-10 days later.

People with measles are contagious (can spread the disease) from 4 days before the rash appears until about 4 days after it does, and are most contagious while they have a fever, runny nose, and cough. Those with weakened immune systems due to other conditions (like HIV and AIDS) may be contagious until they recover from measles.

Recent Outbreaks

Measles is very rare in the United States. Before measles vaccination became available in the 1960s, more than 500,000 cases were reported every year. Back then, about 500 people died of the disease each year, and around 4,000 people a year had encephalitis (swelling of the brain) from the disease.

Due to widespread immunizations, the number of U.S. measles cases declined steadily to a low of 37 people in 2004. From 2000 to 2007, only about 63 cases per year were reported.

But recent years have seen spikes in measles outbreaks, including 131 cases in the first half of 2008 and 644 cases in 2014. Most U.S. outbreaks begin with people who were infected outside of the country, with the disease spreading quickly in areas where too few people have received the vaccine. About 85% of people infected with measles were not immunized or their immunization status was unknown, although they were eligible to receive the vaccine.

The people at highest risk of getting measles during these outbreaks are infants (who aren’t old enough to get the vaccine), pregnant women, and people with poor nutrition or weakened immune systems.

Exposure

During a measles outbreak, an injection of measles antibodies (called immune globulin) can help protect people who haven’t been vaccinated if they come into contact with an infected person (called “exposure”). The injection is most effective if it’s given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe.

For women who are not pregnant and people not in one of the other at-risk groups, the measles vaccine may offer some protection if given within 72 hours of measles exposure.

Unvaccinated people who are exposed to measles and show symptoms of the virus should seek medical care. Otherwise, they should stay home and not return to childcare, school, or work until 21 days after they were exposed.

Prevention

The most important thing you can do to protect your kids from measles is to have them vaccinated according to the immunization schedule prescribed by your doctor.

Older kids are usually immunized against measles according to state and school health regulations. For most, measles protection is part of the measles-mumps-rubella vaccine (MMR) or measles-mumps-rubella-varicella vaccine (MMRV) given when they’re 12 to 15 months old and again when they’re 4 to 6 years old.

Infants are generally protected from measles for 6 months after birth due to immunity passed on by their mothers. Measles vaccine usually is not given to infants younger than 12 months old. But if there’s a measles outbreak, or a child will be traveling outside the United States, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years of age.

The measles vaccine sometimes causes side effects in kids who don’t have underlying health problems. The most common reactions are fever 6-12 days after vaccination (in about 15% of kids vaccinated) and a measles-like rash, which isn’t contagious and fades on its own (in about 5% of vaccinated kids).

As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information about vaccine recommendations.

The measles vaccine should not be given to these at-risk groups:

• pregnant women
• kids with untreated tuberculosis, leukemia, or other cancers
• people whose immune systems are weakened for any reason
• kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they could have serious reactions to the vaccine

Because certain people cannot receive the measles vaccine for health reasons, it’s all the more important to make sure that children who can get the vaccine get it on schedule. At-risk children depend on “herd immunity.” This means a high percentage of people have been immunized against a disease, which prevents the disease from spreading in a population and helps prevent outbreaks.

Treatment

There is no specific medical treatment for measles. To help manage symptoms, which usually last for about 2 weeks, give your child plenty of fluids and encourage extra rest. If a fever is making your child uncomfortable, you can give a non-aspirin fever medicine, such as acetaminophen or ibuprofen.

Remember, you should never give aspirin to a child who has a viral illness, as its use in such cases has been associated with the development of Reye syndrome.

Kids with measles should have their condition closely monitored by a doctor. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis, which may require antibiotics or hospitalization.

In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years old who are hospitalized with measles and its complications.

Also, all kids over 6 months old with certain risk factors — such as vitamin A deficiency, a weakened immune system, or malnutrition — might benefit from vitamin A supplementation.

Children with measles should be quarantined for 4 days after their rash appears. If they have a weakened immune system, they should stay in isolation until they make a full recovery and all symptoms are gone.

When to Call the Doctor

Call the doctor immediately if you suspect that your child has measles. Also, it’s important to get medical care after measles exposure, especially if your child:

• is an infant
• is taking medicines that suppress the immune system
• has tuberculosis, cancer, or a disease that affects the immune system

Most important: remember that measles, a once common disease, is preventable through routine childhood immunization.

Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci, a microscopic fungus that lives in the lungs of many people.

About PCP

PCP is a rare disease in healthy people. However, it can be serious in those who have AIDS, cancer, or other conditions that weaken the immune system.

PCP is one of the most common pediatric illnesses associated with AIDS, especially in babies younger than 6 months old. Its prevention is very important in AIDS care since it is a leading cause of death in people with AIDS.

In kids who are already seriously ill, symptoms of this form of PCP begin suddenly with a fever, a cough, and difficulty breathing. A child may not cough up any mucus because it is usually too thick to come up with the cough. Other symptoms can include weight loss and night sweats.

Babies who are already sick or have a weakened immune system also can develop PCP. In most cases, the baby is 3 to 6 months old and has no fever, but gradually begins to breathe faster than normal. As the lung infection gets worse, breathing becomes more difficult, and the baby’s chest muscles may begin to retract (pull in abnormally) with each breath. The child’s lips, fingernails, and skin also may turn blue or gray.

Diagnosing PCP

Doctors sometimes can diagnose pneumocystis pneumonia through an X-ray. Or they may suspect it in patients with a fever, cough, and difficulty breathing who also have very low oxygen levels in their bloodstream. This is confirmed by finding the fungus in lung fluid samples sent to a laboratory for testing.

Even if your child has no other medical problems, call your doctor immediately if your child has unusually fast breathing or difficulty breathing, is coughing, or has a blue or gray color to the nails, lips, or skin.

Treating PCP

Early treatment is key because PCP is a potentially life-threatening infection. Antibiotics, either alone or in special combinations, are usually used to treat it. These may be given by mouth or intravenously (into a vein) for at least 2 weeks. If a child has AIDS, antibiotic treatment will probably last about 3 weeks. Depending on the severity of the PCP infection, the doctor may add a steroid medicine.

If your child has any condition that severely weakens the immune system, talk to your doctor about whether your child should take antibiotics to prevent pneumocystis infection.

Infants born to HIV-infected mothers should begin treatment to prevent PCP at 1 month of age until it’s known for sure whether they have the HIV infection.

Because of the seriousness of this infection, most kids who have symptoms of pneumocystis infection are treated in the hospital. Some of the different antibiotics that may be used to treat it can have side effects, which are easier to watch for and manage in a hospital.

Pneumonia is a general term for lung infections that can be caused by a variety of germs (viruses, bacteria, fungi, and parasites). Most cases, though, are caused by viruses, including adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), human metapneumovirus, and parainfluenza virus (which causes croup).

Often, pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat), with symptoms starting after 2 or 3 days of a cold or sore throat. It then moves to the lungs. Fluid, white blood cells, and debris start to gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.

Signs and Symptoms

Symptoms vary depending on a child’s age and what caused the pneumonia, but can include:

• fever
• shaking chills
• cough
• stuffy nose
• very fast breathing (in some cases, this is the only symptom)
• breathing with grunting or wheezing sounds
• working hard to breathe; this can include flaring of the nostrils, belly breathing, or movement of the muscles between the ribs
• vomiting
• chest pain
• abdominal pain, which often happens because a child is coughing and working hard to breathe
• less activity
• loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration
• in extreme cases, bluish or gray color of the lips and fingernails

If the pneumonia is in the lower part of the lungs near the abdomen, a child might have a fever and abdominal pain or vomiting but no breathing problems.

Kids with pneumonia caused by bacteria usually become sick fairly quickly, starting with a sudden high fever and unusually fast breathing.

Kids with pneumonia caused by viruses probably will have symptoms that appear more gradually and are less severe, though wheezing can be more common.

Some symptoms give important clues about which germ is causing the pneumonia. For example, in older kids and teens, pneumonia due to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat, headache, and rash in addition to the usual symptoms of pneumonia.

In babies, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever. When pneumonia is due to whooping cough (pertussis), a child may have long coughing spells, turn blue from lack of air, or make the classic “whoop” sound when trying to take a breath.

Start of Symptoms

The length of time between exposure to the germ and when someone starts feeling sick varies, depending on which virus or bacteria is causing the pneumonia (for instance, 4 to 6 days for RSV, but just 18 to 72 hours for the flu).

Duration

With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks, although walking pneumonia may take 4 to 6 weeks to go away completely. Viral pneumonia may last longer.

Contagiousness

The viruses and bacteria that cause pneumonia are contagious. They’re usually found in fluid from the mouth or nose of someone who’s infected, so that person can spread the illness by coughing or sneezing. Sharing drinking glasses and eating utensils, and touching the used tissues or handkerchiefs of an infected person also can spread pneumonia.

Prevention

Some types of pneumonia can be prevented by vaccines. Kids usually get routine immunizations against Haemophilus influenzae and whooping cough (pertussis) beginning at 2 months of age. Vaccines are now also given against the pneumococcus, a common cause of bacterial pneumonia.

Children with chronic illnesses can be at special risk for certain types of pneumonia, so they might need additional vaccines or protective immune medication. (“Chronic” means an ongoing illness or one that goes away and keeps coming back.) The flu vaccine is recommended for all healthy kids ages 6 months through 19 years, but especially for kids with chronic illnesses such as heart or lung disorders or asthma.

Because they’re at higher risk for serious complications, babies born prematurely may get treatments that temporarily protect against RSV because it can lead to pneumonia in younger kids.

Doctors may give antibiotics to prevent pneumonia in kids who have been exposed to someone with certain types of pneumonia, such as pertussis. Those with HIV infection might be given antibiotics to prevent pneumonia caused by Pneumocystis jirovecii.

Antiviral medicine is now available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe.

In general, pneumonia is not contagious, but the upper respiratory viruses and bacteria that lead to it are. So it’s best to keep kids away from anyone with symptoms (stuffy or runny nose, sore throat, cough, etc.) of a respiratory infection.

If someone in your home has a respiratory infection or throat infection, keep his or her drinking glasses and eating utensils separate from those of other family members, and wash your hands often, especially if you are handling used tissues or dirty handkerchiefs.

When to Call the Doctor

Call your doctor immediately if your child has any of the signs and symptoms of pneumonia, but especially if he or she:

• is having trouble breathing or is breathing too fast
• has a bluish or gray color to the fingernails or lips
• has a fever of 102°F (38.9°C), or above 100.4°F (38°C) in babies younger than 6 months old

Professional Treatment

Doctors usually make a pneumonia diagnosis after a physical examination. They’ll check a child’s appearance, breathing pattern, and vital signs, and listen to the lungs for abnormal sounds. They might order a chest X-ray, blood tests, and (sometimes) bacterial cultures of mucus produced by coughing.

In most cases, pneumonia is treated with antibiotics taken by mouth at home. The type of antibiotic used depends on the type of pneumonia. In some cases, other members of the household might be treated with medication to prevent illness.

Children might be treated in a hospital if the pneumonia is caused by whooping cough, if another kind of bacterial pneumonia is causing a high fever and breathing problems, or if they:

• need oxygen therapy
• have a lung infection that may have spread to the bloodstream
• have a chronic illness that affects the immune system
• are vomiting so much that they cannot take medicine by mouth
• have frequent episodes of pneumonia

Hospital treatment can include intravenous (IV) antibiotics (given through a needle into a vein) and respiratory therapy (breathing treatments). More severe cases might be treated in the intensive care unit (ICU).

Home Care

Anyone with pneumonia needs to get plenty of rest and drink lots of fluids while the body works to fight the infection.

If your child has bacterial pneumonia and the doctor has prescribed antibiotics, give the medicine on schedule for as long as directed. This will help your child recover faster and help prevent the infection from spreading to other household members. For wheezing, the doctor might recommend using a nebulizer or an inhaler.

Ask the doctor before you use a medicine to treat your child’s cough because cough suppressants stop the lungs from clearing mucus, which isn’t helpful in some types of pneumonia. Over-the-counter cough and cold medications are not recommended for any kids under 6 years old.

Take your child’s temperature at least once each morning and each evening, and call the doctor if it goes above 102°F (38.9°C) in an older infant or child, or above 100.4°F (38°C) in a baby under 6 months of age.

Check your child’s lips and fingernails to make sure they are rosy and pink. Call your doctor if they are bluish or gray, which is a sign that the lungs are not getting enough oxygen.

About RSV

Respiratory syncytial (sin-SISH-ul) virus (RSV), which causes infection of the lungs and breathing passages, is a major cause of respiratory illness in young children.

Adults with RSV might have the symptoms of a common cold, such as a stuffy or runny nose, sore throat, mild headache, cough, fever, and a general feeling of being ill. But in premature babies and kids with diseases that affect the lungs, heart, or immune system, RSV infections can lead to other more serious illnesses.

RSV is highly contagious, and spreads through droplets containing the virus when someone coughs or sneezes. It also can live on surfaces (such as countertops or doorknobs) and on hands and clothing, so it can easily spread when a person touches something contaminated.

RSV can spread rapidly through schools and childcare centers. Babies often get it when older kids carry the virus home from school and pass it to them. Almost all kids are infected with RSV at least once by the time they’re 2 years old.

RSV infections often happen in epidemics that last from late fall through early spring. Respiratory illness caused by RSV — such as bronchiolitis or pneumonia — usually lasts about a week, but some cases may last several weeks.

Doctors usually diagnose RSV by taking a medical history and doing a physical exam. In most healthy kids, it’s not necessary to distinguish RSV from a common cold. But if a child has other health conditions, a doctor might want to make a specific diagnosis. In that case, RSV is identified by testing nasal secretions collected either with a cotton swab or by suction through a bulb syringe.

Preventing RSV

Because RSV can be easily spread by touching infected people or surfaces, washing hands well and often is key in stopping it. Try to wash your hands after having any contact with someone who has cold symptoms. And school-age kids who have a cold should be kept away from any younger siblings — especially babies — until their symptoms pass.

To prevent serious RSV-related respiratory disease, at-risk infants can get a monthly injection of a medicine with RSV antibodies during peak RSV season (roughly November to April). The protection it gives is short-lived, though, so the injections must continue in each RSV season until the child is no longer at high risk for severe RSV infection. Ask the doctor if your child is considered high risk.

Treating RSV

Fortunately, most cases of RSV are mild and require no specific treatment from doctors. Antibiotics aren’t used because RSV is a virus and antibiotics are only effective against bacteria. Medication may sometimes be given to help open airways.

RSV infection can be more serious in babies, though. Some infants might need treatment in a hospital, where they can be watched closely and receive fluids, if needed, and treatment for any breathing problems.

At home, make a child with an RSV infection as comfortable as possible, allow time for recovery, and provide plenty of fluids. The last part can be tricky, however, because babies may not feel like drinking. In that case, offer fluids in small amounts often.

To help your child breathe easier, use a cool-mist vaporizer during the winter months to keep the air moist — winter air can dry out airways and make mucus stickier. Avoid hot-water and steam humidifiers, which can be hazardous and can cause scalding. If you use a cool-mist humidifier, clean it daily with household bleach to discourage mold.

If your child is uncomfortable and too young to blow his or her own nose, use a nasal aspirator (or bulb syringe) to remove sticky nasal fluids.

Treat fever using a nonaspirin fever medicine like acetaminophen. Aspirin should not be used in children with viral illnesses — such use has been associated with Reye syndrome, a life-threatening illness.

When to Call the Doctor

Call the doctor if your child has any of these symptoms:

• a high fever and doesn’t look well
• thick nasal discharge
• a cough that gets worse or produces yellow, green, or gray mucus
• signs of dehydration
• trouble breathing

In infants, besides the symptoms already mentioned, call the doctor if your baby is unusually irritable or inactive, or refuses to breastfeed or bottle-feed.

Seek immediate medical help if you feel your child is having trouble breathing or is breathing very rapidly, is lethargic, or if his or her lips or fingernails appear blue.