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AAP releases prevention, treatment recommendations for influenza season
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The American Academy of Pediatrics released today its policy statement on the prevention and control of influenza in children for the 2012-2013 influenza season.
The statement called for influenza immunization of patients, physicians/nurses and all other health care personnel, along with identification of influenza infections to enable rapid treatment with antiviral medications.
“The best way to protect children from influenza is through vaccination. Even though the 2011-2012 influenza season was mild compared with recent years, providers must remain vigilant,” Henry H. Bernstein, DO, of the Hofstra North Shore – Long Island Jewish Health System, told Infectious Diseases in Children.
Additional efforts should be made to vaccinate children who have conditions that could increase the risk for influenza-related complications; all household contacts/care providers of children with high-risk conditions; all children aged younger than 5 years; all health care personnel; all pregnant woman, and those who are considering pregnancy; and those who just delivered or are breast-feeding during influenza season, according to the AAP recommendations.
The key points for this year’s recommendations include: 1) the trivalent influenza vaccine contains A/California/7/2009 (H1N1)-like antigen, which is derived from influenza A/H1N1 2009 pandemic virus (pH1N1), along with the influenza A/Victoria/ 361/2011 (H3N2)-like antigen and influenza B/Wisconsin/1/2010-like antigen; 2) annual universal influenza immunization is indicated for all children aged 6 months and older; and 3) an updated dosing algorithm for influenza immunization for children aged 6 months to 8 years.
“The influenza A (H3N2) and B antigens are different than those contained in the 2010-2011 and 2011-2012 seasonal vaccines,” said Bernstein, who is the AAP Red Book online associate editor and a member of the Infectious Diseases in Children Editorial Board.
The number of trivalent seasonal influenza vaccine doses to be administered during this influenza season will depend on the child’s age at the time the first dose was given and the child’s vaccine history. The algorithm is designed to guide pediatricians through this potentially complex process.
The intramuscular formulation of the trivalent season influenza vaccine can be given to infants as young as 6 months. The live-attenuated influenza vaccine can be given to healthy patients aged 2 to 49 years. The intradermal formulation of the influenza vaccine can only be administered to patients aged 18 to 64 years.
The egg allergy algorithm is unchanged, and “the safety and efficacy of vaccinating egg allergic children should continue to be emphasized,” Bernstein said.
Regarding antiviral treatment, the AAP recommended against the use of amantadine and rimantadine because of persisting high levels of resistance but recommends the use of oseltamivir (TamiFlu, Genentech) and zanamivir (Relenza, GlaxoSmithKline) when indicated.
Antiviral treatment should be offered for children who are hospitalized with presume influenza or with severe, complicated or progressive illness attributable to influenza, regardless of influenza immunization status. Treatment should also be offered to children with influenza who are at high risk for complications of influenza infection.
Antiviral treatment should be considered for all healthy children with influenza infection if treatment can be initiated within 48 hours of illness onset, according to the policy statement.
For implementation guidance on supply, payment, coding, and liability issues, go to http://aapredbook.aappublications.org/site/implementation/. — Cassandra A. Richards
- Henry H. Bernstein, DO, can be reached at: 269-01 76th Avenue, New Hyde Park, N.Y. 11040; Hbernstein@NSHS.edu.
Disclosure: Bernstein reports no relevant financial disclosures.
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