We hear a lot about flu season.
It typically starts in late fall, peaks in mid-to-late winter, and can continue through early spring.
Cold and Flu Season Viruses
It’s important to understand that a lot more is going on, and going around, during flu season than just the flu.
That’s why it is likely more appropriate to think of flu season as just a part of the overall cold and flu season that we see during the late fall to early spring.
During cold and flu season, in addition to the multiple strains of the flu, we see diseases caused by:
- respiratory adenovirus – can cause bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
- Human metapneumovirus (HMPV) – can cause bronchiolitis, colds, and viral pneumonia
- Human parainfluenza viruses (HPIVs) – can cause bronchiolitis, bronchitis, colds, croup, or viral pneumonia
- rhinovirus – the classic common cold
- Respiratory syncytial virus (RSV) – can cause wheezing and bronchiolitis in younger children, but colds in older kids and adults
- seasonal coronavirus – can cause colds, bronchitis, and viral pneumonia
- norovirus – diarrhea and vomiting
- rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era
That there are so many different respiratory viruses that can cause bronchiolitis, colds, croup, and flu-like illnesses helps explain why some kids get sick so many times during cold and flu season.
It also helps explain why some folks think they might have gotten the flu despite having been vaccinated, especially in a year when the flu vaccine is very effective.
Is It a Cold or the Flu?
So how do you know if you have the flu or one of these flu viruses during cold and flu season?
While the symptoms can be similar, flu symptoms are usually more severe and come on more suddenly.
Can’t you just get a flu test?
While rapid flu tests are fast and easy to do, they are likely not as accurate as you think.
“This variation in ability to detect viruses can result in some people who are infected with the flu having a negative rapid test result. (This situation is called a false negative test result.) Despite a negative rapid test result, your health care provider may diagnose you with flu based on your symptoms and their clinical judgment.”
CDC on Diagnosing Flu
If your pediatrician is going to diagnose your child with the flu because of their symptoms, even if they have a negative flu test, then why do the test?
Can you test for all of the other viruses that are going around during cold and flu season?
The real question is should you.
Like the rapid flu test, many pediatricians can do an RSV test in their office. But like many other viruses, there is no treatment for RSV and the American Academy of Pediatrics actually recommends against routine RSV testing. Whether your child’s test is positive or negative, it is not going to change how he or she is treated.
And the other viruses? Not surprisingly, there are respiratory panels that can test for most or all of these viruses. They also usually include flu and RSV.
The problem with these tests is cost. They are not inexpensive, and again, in most cases, the results aren’t going to change how your pediatrician treats your child.
And they all involve sticking a nasal swab far up your child’s nose…
What About Strep?
While strep throat can occur year round, it does seem to be more common in the winter and spring.
And while you can certainly have two different infections at the same time, such as strep throat and the flu, it is important to remember that the rate of strep throat carriers is fairly high. These are kids who regularly test positive for strep, even though they don’t have an active group A strep infection.
During cold and flu season, if kids routinely get a “strep/flu” combo test, it is possible, or even likely, that many of the positive strep tests are simply catching these carriers.
Remember that a cough, runny nose, hoarse voice, and pink eye are not typical symptoms of strep throat and are more commonly caused by cold viruses. Adenovirus is especially notorious for causing a sore throat, fever, pink eye, runny nose, with swollen lymph nodes = pharyngoconjunctival fever.
Kids who are likely to have strep throat usually have a sore throat, with red and swollen tonsils, and may have swollen lymph nodes, fever, stomach pain, and vomiting, but won’t have typical cold symptoms.
Why does it matter?
Viral causes of a sore throat don’t need antibiotics, while a true strep infection does.
What to Know About Cold and Flu Season Viruses
Flu isn’t the only virus that is going around during cold and flu season. Many others can cause flu-like illnesses, croup, bronchiolitis, or just a cold.
More on Cold and Flu Season Viruses
- AAP – Antibiotic Prescriptions for Children: 10 Common Questions Answered
- CDC – Cold vs Flu Symptoms
- CDC – Diagnosing Flu
- AAP – Caring for Your Child’s Cold or Flu
- CDC – Information for Clinicians on Influenza Virus Testing
- CDC – Strep Throat Signs and Symptoms
- CDC – About Human Parainfluenza Viruses (HPIVs)
- The National Respiratory and Enteric Virus Surveillance System (NREVSS)
- RSV Trends and Surveillance
- Reporting and Surveillance for Norovirus
Last Updated on February 21, 2018 by Vincent Iannelli, MD