Back to class… with contagious respiratory infections

Over the course of the school year, children are exposed to a variety of infections, with respiratory infections being the most common. These include colds, flu (influenza), pneumonia, COVID-19 and respiratory syncytial virus (RSV). More recently, there has been an upsurge in measles (rubeola) and whooping cough (pertussis) in Quebec and elsewhere in Canada, likely a sign of vaccine fatigue or hesitancy [2,3].
In the long term, whooping cough and measles can be prevented through vaccination. On the other hand, infections such as flu and COVID-19 require annual re-vaccination for optimal protection; the viral strains change from year to year.

What about colds? There is no vaccine because they are caused by too many different viruses, making prevention by vaccine practically impossible. As for RSV, school-aged children are not eligible for vaccination [4].

Even though the symptoms are sometimes dramatic, there are not the same complications with the common cold as there are with measles or whooping cough [5,6]. So, when should you contact a healthcare provider? Santé Québec recommends contacting a healthcare provider or going to the emergency department if a school-aged child has the following signs [7]:

• Rectal temperature ≤ 36°C (sign of hypothermia);
• Fever lasting over 48 hours despite the use of fever medication;
• Paleness or abnormal skin colour;
• Rapid or difficulty breathing despite frequent nasal irrigation with salt water;
• Retracting of the skin under or between the ribs or nasal flaring when breathing;
• Difficulty feeding;
• Moderate to severe signs of dehydration;
• No reaction to stimulation, acting sluggish and less alert;
• Temperature above 38.5°C in a child living with a chronic disease or weakened/deficient immune system.

• Long-lasting coughing spells that make the skin or lips turn red, purple, or blue
• Coughing followed by vomiting
• Whooping sound when your child breathes in after coughing
• Difficulty breathing or brief periods of not breathing (apnea)
• Lethargy (no energy).

• Severe breathing difficulties;
• Persistent, very high fever;
• Mental confusion or altered consciousness;
• Difficulty staying hydrated or dizziness when standing;
• Febrile seizures (fits or convulsions which occur when your child has a high fever);
• Excessive drowsiness, making it hard to wake the child up;
• Wheezing, rapid and irregular breathing or a cough which lasts longer than usual.

There are many different types of respiratory infections, and their symptoms can be similar. In some cases, it’s helpful to identify the specific cause of the infection so you can provide appropriate care.

A number of laboratory techniques are available for this. Some identify microscopic organisms (microorganisms) directly from cultured secretions while others test for microorganism-specific antigens or antibodies produced by the body in response to infection.

The respiratory multiplex PCR test can distinguish over 20 microorganisms from a single sample, including the ones that cause COVID-19, RSV, flu (influenza A and B) and whooping cough.

Other tests are also available for diagnosing streptococcal and tuberculosis infections.

Between 10% and 15% of children live with asthma and the back-to-school season is a special challenge for many of them. It is widespread enough that there is a recognized asthma peak at back-to-school time. Respiratory viruses can trigger asthma attacks, but at the same time, children with asthma also have a higher risk of complications when they catch a viral infection.

Going back indoors, to spaces which have often not been ventilated well during the summer, can lead to an increase in mites in the air, a significant factor for asthma attacks. And finally, the stress caused by going back to school can also trigger asthma attacks [10].

The diagnosis of asthma in children is based on a combination of variable respiratory symptoms and objective evidence of expiratory flow limitation. This limitation is generally assessed by pre-post bronchodilator spirometry, which are respiratory function tests. Spirometry, which can be performed from the age of 7, is an essential tool for confirming asthma.

There are two main types of spirometry: simple spirometry and methacholine bronchial challenge spirometry; methacholine is an agent which temporarily narrows the airways (bronchi) in order to assess their sensitivity.

Regular monitoring is important to adjust treatment and monitor changes in respiratory function.

A few preventive measures can help children reduce the risk of catching an infection, while at the same time fully enjoying school and protecting their classmates: * Check your child’s vaccination record and get it updated right away; * Teach your children to wash their hands regularly and properly, and to avoid touching their faces; * Encourage them to cough or sneeze into their elbow to limit the spread of viruses; * Make sure you have good ventilation at home and wipe surfaces down frequently; * Encourage them to stay active outdoors to build their lung capacity; * Keep your home smoke-free; * Follow your healthcare provider’s instructions exactly, especially if your children are living with asthma, have a chronic disease or have an immunodeficiency, since they have a higher risk of respiratory infections.

It’s normal to wonder how to best protect our children from respiratory infections. Fortunately, most of the time, these infections are minor. Following hygiene rules at home and at school can be very helpful.
However, it’s important to contact a healthcare provider quickly if your child has more worrying or persistent symptoms. With prevention and your vigilance, your child can enjoy heading back to school with no worries… and a big grin!

Biron provides access to the most common vaccines.

• Vaccination services
• Respiratory multiplex PCR
• Streptococcus throat by PCR

For more information on our services or to make an appointment, contact Biron Groupe Santé customer service at 1 833 251-6006.