Good Morning andWelcome Applicants!

February 11, 2011

Influenza Complications

• Otitis media• Lower respiratory tract

• Interstitial PNA• Croup• Bronchitis• Bacterial tracheitis• Asthma exacerbation

Influenza Complications

• PNA• Sinusitis• Neurologic

• Aseptic meningitis• Acute cerebellar ataxia• Transverse myelitis• Guillian-Barre• Encephalitis

Influenza Complications

• Myositis

• Less common• Myocarditis• Pericarditis• Toxic Shock Syndrome

Influenza

• Transmission• Person to person primarily through

large-particle respiratory droplet • Close contact between source and

recipient persons• droplets generally travel only short

distances (approximately ≤6 feet) through the air

• Other• Indirect contact transmission via hand

transfer

Influenza

• Incubation• 1-4 days

• Shedding• Day before symptoms begin through

5-10 days after onset• Decreases rapidly by 3-5 days after

illness onset• Children typically shed longer

Symptoms

• Fever• Myalgia• Headache• Malaise• Nonproductive cough• Sore throat• Rhinitis

Symptoms

• Children • Otitis media• Nausea/vomiting

• Resolution• 3-7 days for the majority of persons• Cough and malaise can persist for >2

weeks

Testing

• Rapid antigen tests• Low sensitivity (20%-70%)

• Particularly for H1N1• Nasal swab is more sensitive• Should not be used to rule out

influenza

• Viral Culture or RT-PCR

Treatment

Treatment

Treatment

• Who gets treated?• Any hospitalized child• High risk• Healthy children whom a decrease in

duration of clinical symptoms is felt to be warranted

• Start ASAP• Use clinical judgment

Prophylaxis

• Children at high risk for whom influenza vaccine is contraindicated

• Children at high risk during the 2 weeks after immunization

• Family members or health care providers who are unimmunized and are likely to have ongoing, close exposure to:• Unimmunized children at high risk• Infants and toddlers <24 months

Prophylaxis

• Control of influenza outbreaks for unimmunized staff and children in a closed institutional setting with pediatric residents at high risk

• Supplement to immunization for immunocompromised

• PEP for family members and close contacts of an infected individual

• Children at high risk and their family members and close contacts when circulating strains are not matched with the vaccine

Immunization• Annual vaccination for all children

and adolescents 6 months of age and older

• Specifically• Conditions that increase the risk of

complications• Chronic medical conditions

Immunization

• Increased risk of complications• Asthma or other chronic pulmonary disorders• Hemodynamically significant cardiac disease• Immunosuppressive disorders or therapy• HIV• Sickle cell anemia or other hemoglobinopathies• Long-term aspirin therapy• Chronic renal dysfunction• Chronic metabolic disease (DM)• Any condition that can compromise respiratory

function or handling of secretions

Immunization

• Specifically• Household contacts and out-of-home

providers of • Children with high-risk conditions• Healthy children <5y

• Pregnant women• Health care personnel• Close contacts of immunosuppressed

Immunization

• This year• Trivalent

• H1N1• H3N2• B/Brisbane/60/2008

• How many this year??

Immunization• TIV

• Inactivated vaccine• Viral antigens but no virus• IM• Adverse effects

• Local pain• Tenderness• Fever • Mild systemic

• Nausea, lethargy, headache, muscle aches, chills

Immunization• LAIV

• Live-attenuated influenza vaccine• Intranasal• Ages 2-49• Not recommended

• Wheezing, high risk medical condition, nasal congestion

• Adverse effects• Runny nose, HA, wheezing, vomiting,

muscle aches and fever

Immunization

• Contraindications to TIV• Anaphylactic rxn to chicken, egg, or

vaccine• <6 months• Moderate to severe febrile illness• GBS within 6 weeks after a flu vaccine

Immunization

• Contraindications to LAIV• Same as TIV plus:• <2y• Other live vaccines within past 4

weeks• Can give other vaccines on same day

• Chronic medical conditions• Pregnancy• Contact with severely

immunocompromised

When in doubt . . .

• Check with the CDC!• www.cdc.gov

• Standard and Droplet precautions• Wash your hands• Get vaccinated

Don’t forget . . .