Flu season is upon us in force, once again, and so is the question of using Tamiflu for kids.
Young children and elderly people over the age of 65 prove the most susceptible to mortality from influenza. One of the biggest topics surrounding the treatment of the flu in children is the safety of Tamiflu for kids.
The Centers for Disease Control and Prevention (CDC) reports that, as of the second week in 2020, 32 children had died from the flu. That is down slightly from previous years, particularly 2017-2018. (See chart below.)
Tamiflu for kids: The rumors
Vague information spread on the internet tends to be more virulent than the flu itself. Reports of children experiencing hallucinations and self-harm after taking Tamiflu have run rampant. Some have even speculated that Tamiflu was the cause in all cases.
Part of the mystery lies in conflicting information coming from the CDC and Federal Drug Administration (FDA).
First, we have to remember that both organizations have different missions. The CDC reports on infectious diseases and solutions to them. The FDA is responsible for confirming the efficacy of particular drugs.
The CDC says antiviral medications, such as Tamiflu, have been shown to “reduce the incidence of ear infections and the need for antibiotic treatment in children between 1 and 12 years old.”
The label on Tamiflu, provided by the FDA, states that it has not been shown to prevent such complications.
In the PBS report, “Does Tamiflu Work? We asked a scientist,” the network asked both Peter Doshi, a drug safety researcher at the University of Maryland School of Pharmacy, and Elena Govorkova, laboratory director in the division of virology at St. Jude Children’s Research Hospital in Memphis, Tenn., to weigh in on the subject.
Studies on the safety of Tamiflu
In 2009, Doshi received information from a pediatrician indicating potentially biased data from Tamiflu clinical trials. According to the tip, the studies had received manufacturer funding. This prompted a three-year study by Doshi to analyze the FDA approval of Tamiflu. In 2014, he published his findings in a Cochrane review article. Doshi concluded that the claims about Tamiflu with regards to “preventing complications” could not be substantiated.
The team looked at clinical reports for 83 trials and found no improvement for admission-to-hospital rates, pneumonia or bronchitis. They did, however, see a 50% decrease in flu symptoms. Importantly, Doshi’s study relied on patients who had “influenza-like symptoms,” but had not necessarily had those symptoms confirmed as influenza.
Many different viral and bacterial infections can mimic influenza. Thus, any patient in Doshi’s study who did not actually have the flu would have made that specific data inadmissible. In Govorkova’s opinion, while Tamiflu cannot necessarily prevent pneumonia, it can reduce the chances of developing it. She notes that bacteria causes pneumonia, not the influenza virus itself. She did state, however, that “the flu virus, in some cases, can predispose receptors on the epithelial cells lining our throats and lungs to become infected with pneumonia-causing bacteria.”
Govorkova went on to explain:
“Tamiflu is not for the treatment of pneumonia. You must use antibiotics. But because Tamiflu is very specific for influenza virus, if you start early, you can eliminate influenza virus from the body. And because of that, pneumonia cannot occur.
Doshi worries that people may rely heavily on Tamiflu rather than getting the recommended vaccinations. As mentioned previously, Tamiflu works to lessen the flu’s longevity, not prevent it.
What pediatricians have to say
On the other side of the spectrum is the concern that using Tamiflu for kids presents serious risks. Very rarely side effects such as seizures, sudden confusion, delirium, hallucinations, unusual behavior, and self-injury have been seen.
Due to a lack of sufficient data, linking Tamiflu to these side effects isn’t possible. It is also important to recognize that the flu itself can cause hallucinations and abnormal behavior. Confirmed minor side effects associated with Tamiflu do exist, but most relate to gastrointestinal distress, like nausea, vomiting and diarrhea.
Physician Doug Carlson, MD, of St. Louis Children’s Hospital, says parents should really weigh their options. Parents must consider whether a child is better off managing the flu with fever reducers, rest and plenty of fluids. This is because, while Tamiflu works well, it can introduce GI effects.
According to Randy Sterkel, MD, community pediatrician and medical director for the St. Louis Children’s hospital:
“Tamiflu is not routinely given to prevent a person from getting the flu. In some cases, if a child with flu-like symptoms lives in the same household as an adult or child at high risk for influenza complications, a physician may prescribe Tamiflu. However, the CDC does not recommend widespread use of antiviral medications for prevention because of the potential for antiviral resistant viruses to emerge.
“The best way to prevent influenza is with an annual vaccination,” Sterkel continued. “We recommend that everyone ages 6 months and older get an annual flu shot or nasal spray vaccination as soon as they are available in the fall. It is not 100% effective, but is an excellent defense to help spare you and your child from discomfort and potential complications of influenza.”
Exercise caution when using Tamiflu for kids
The American Academy of Pediatrics shares the sentiment of safety for Tamiflu for kids and vaccination prevention.
In AAP’s position statement for the 2018-2019 influenza season, they express that annual influenza vaccinations remain the best available preventive flu measure for everyone 6 months and older. They also state that antiviral medications are important in the control of influenza. Remember, though, they are not a substitute for influenza vaccinations.
Whether or not your pediatrician recommends Tamiflu for kids will depend on many factors. For example, is your child at high risk due to underlying medical conditions? Such conditions include:
- lung or heart disease
- neuromuscular disorders
- weakened immune system
- sickle cell disease
- kidney disease
If so, the physician may want to prevent the flu’s progression. To do so, they may prescribe Tamiflu if symptoms occurred within the past 48 hours.
Physicians should discuss the rare and common side effects to determine if Tamiflu is right for your child. Carlson says it may be best to let the flu run its course. This is especially true if there are no comorbidities that could lead to progression to increased morbidity or mortality.
Ultimately, experts say prevention through proper hand washing, maintaining overall good health and getting annual vaccinations is the best defense.