Influenza in the pediatric population

Influenza in the pediatric population Annual attack rates 10%-40% in children Hospitalization Increased risk in children <24 months of age Risk of complication Increases with chronic underlying conditions Increased occurrence of acute otitis media Treatment courses of antibiotics Increase by 10%-30% during influenza season Outpatient visits Especially increased in children <5 years of age COID Pediatrics 2008;121(4): e1016-e31 Neuzil KM et al. N Engl J Med 2000;342(4):225-31 Poehling KA et al. New Engl J Med 2006;355(1):31-40

Rates of outpatient visits and courses of antibiotics attributable to the treatment of influenza, according to age, during the influenza and peri-influenza seasons Neuzil KM et al. N Engl J Med 2000;342:225-231.

Influenza disease severity in children Respiratory tract complications Acute otitis media Bronchiolitis, sinusitis Secondary pneumococcal pneumonia Nonrespiratory complications Myositis, myocarditis Secondary staphylococcal infection (pneumonia, sepsis), including methicillin-resistant Staphylococcus aureus (MRSA) infections Central nervous system infections Encephalitis, febrile seizures Hospitalization rates in infants and young children are comparable to rates in the elderly! Bhat N et al. New Engl j Med 2005;353(24):2559-67 Principi N et al. Lancet Infect Dis 2004;4(2):75-83 CDC MMWR 2008;57(RR-7):6-7

Rates of hospitalization in children and adolescents with influenza (person-time and events during respiratory syncytial virus seasons excluded) Neuzil KM et al. N Engl J Med 2000;342:225-231.

Distribution of Hospitalizations and Rates of Disease Severity among Children with 2009 H1N1 Influenza in Buenos Aires Libster R et al. N Engl J Med 2010;362:45-55

Selected Underlying medical conditions in patients hospitalized with influenza, FluSurv-NET 2013 2014. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement Recommendations for Prevention and Control of Influenza in Children, 2014 2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

Influenza-Associated Mortality Rates According to Age Group United States, 2003-2004 Season Bhat N et al. N Engl J Med 2005;353:2559-2567

Almost half of children who die do not have a high-risk condition as defined by the Advisory Committee on Immunization Practices. http://www.cdc.gov/flu/weekly/fluactivitysurv.htm

Women who were hospitalized with or died from 2009 H1N1 influenza California Department of Public Health Louie J et al. N Engl J Med 2010;362:27-35

Effectiveness of Influenza Vaccine Given to Mothers During Pregnancy in Preventing Hospitalization for Influenza among Their Infants. Benowitz I et al. Clin Infect Dis. 2010;51:1355-1361

Influenza in infants whose mothers received influenza vaccine Bangladesh (August 2004-December 2005) Mothers received either influenza vaccine or pneumococcal vaccine (control) Followed infants for 24 weeks Zaman K et al. N Engl J Med 2008;359:1555-1564

CDC MMWR 2015;64(27):746-49.

Recommendations for influenza immunization in children and adolescents All persons 6 months and older should receive influenza vaccine annually. Influenza immunization should begin in September or as soon as the vaccine becomes available and continue into May or for as long as vaccine is available. Live attenuated influenza vaccine (LAIV) should be considered for healthy children 2 through 8 years of age who have no contraindications or precautions to the intranasal vaccine. This is based on a GRADE analysis performed by the CDC, which concluded that there is an increased relative efficacy of LAIV as compared with inactivated influenza vaccine (IIV) against laboratory-confirmed influenza among younger children. If LAIV is not readily available, IIV should be used; vaccination should not be delayed to obtain LAIV. IIV should be administered to children and adolescents with underlying medical conditions associated with an elevated risk of complications from influenza, including the following: Asthma or other chronic pulmonary diseases, such as cystic fibrosis Hemodynamically significant cardiac disease Immunosuppressive disorders or therapy; HIV infection; Sickle cell anemia and other hemoglobinopathies Diseases that necessitate long-term aspirin therapy, including juvenile idiopathic arthritis or Kawasaki disease Chronic renal dysfunction Chronic metabolic disease, including diabetes mellitus Any condition that can compromise respiratory function or handling of secretions or can increase the risk of aspiration, such as neurodevelopmental disorders, spinal cord injuries, seizure disorders, or neuromuscular abnormalities. COID. AAP Red Book 2015

Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010-2012 Ferdinands et al. JID 2014;210:674 83

Rates of influenza in the two childhood vaccine groups Belshe RB et al. N Engl J Med 2007;356:685-696

Influenza vaccination recommendations Beyond universal vaccination for everyone older than 6 months, special efforts should be made to vaccinate the following groups: Household contacts (i.e., parents, grandparents, others) and out-of-home care providers of children with high-risk conditions and children younger than 5 Healthcare personnel Women who are pregnant, are considering getting pregnant, are in the immediate postpartum period, or are breastfeeding during the flu season Close contacts of immunosuppressed people COID. AAP Red Book 2015

Cocooning a strategy to protect children by immunizing their caregivers with flu vaccine Vaccinate the caregiver Decreased infection in child s caregiver Reduce the child s exposure to influenza Decreased infection in the child

American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement Recommendations for Prevention and Control of Influenza in Children, 2014 2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

FIGURE 2 Number of 2014 2015 seasonal influenza vaccine doses for children 6 months through 8 years of age. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement Recommendations for Prevention and Control of Influenza in Children, 2014 2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

H1N1 Influenza #@*#&!! Thank you!