10 things your patients should know for the 2014-2015 influenza season

There are approximately 36,000 influenza-related deaths and over 200,000 hospitalizations due to influenza reported in the United States each year. These numbers vary annually and depend on various factors including circulating influenza strains and fluctuating vaccination rates.

While it is not possible to predict what this influenza season will be like, early data from the CDC suggests that the 2014-2015 season could be moderately severe due to the high prevalence of a drifted influenza A(H3N2) strain, which has been responsible for the three seasons with the highest mortality.

“Flu always has the potential to be serious, but H3N2 viruses tend to be associated with more severe seasons,” CDC Director Thomas R. Frieden, MD, MPH said.“The rate of hospitalization and death can be twice as high or more than flu seasons where H3N2 doesn’t dominate. People with certain health conditions such as asthma, diabetes, heart disease, lung disease and pregnancy are also at high risk.”

In this report, Infectious Diseases in Children highlights 10 issues for pediatricians to consider for their patients (and parents), as well as the new guideline revisions and research regarding the identification, treatment and management of influenza.

1. FDA approves Rapivab for treatment of influenza

The FDA has approved the IV drug peramivir (Rapivab, BioCryst Pharmaceuticals), a neuraminidase inhibitor, for patients aged 18 years or older with acute uncomplicated influenza who have been symptomatic for no more than 2 days.

Rapivab is the most recent influenza treatment approved by the FDA, but the first neuraminidase inhibitor administered intravenously. Other antiviral treatments recommended by the CDC include oseltamivir (Tamiflu, Roche), which is administered orally, and zanamivir (Relenza, GlaxoSmithKline), which is inhaled. Read more

2. Influenza activity low but rising nationwide

From Sept. 28 to Dec. 6, almost 125,000 respiratory specimens in the United States were tested for influenza and 10.9% were positive, according to a CDC report published in MMWR.

The majority (89.3%) were influenza A viruses, and among those, 42.1% were subtyped. Almost all of the subtyped specimens (99.1%) were influenza A (H3) viruses. The remainder were influenza A (H1N1)pdm09 viruses. All 50 states, plus the District of Columbia, Guam and Puerto Rico, have reported positive influenza tests. Read more

3. Despite increase, full influenza vaccination coverage remained below 50%

From 2000 to 2001 through 2010 to 2011, influenza vaccination increased among children living in Tennessee, but the proportion of fully vaccinated children remained less than 50%.

Astride Jules, MD, MPH, a clinical instructor at Vanderbilt University School of Medicine, and colleagues assessed influenza-related hospitalization, ED visits and vaccination rates for children hospitalized with acute respiratory illness or fever in Davidson County, Tenn. Study participants were aged 6 to 59 months. Read more

4. FDA approves Sanofi's quadrivalent flu vaccine

The FDA has approved the Fluzone Intradermal Quadrivalent vaccine (Sanofi Pasteur) for patients aged 18 to 64 years for active immunization and prevention of influenza caused by influenza A subtype viruses and type B viruses.

“Influenza B is a common cause of influenza-related morbidity and mortality across all age groups,” David P. Greenberg, MD, vice president of scientific and medical affairs and chief medical officer of Sanofi Pasteur US, said. “Fluzone Intradermal Quadrivalent vaccine will offer another influenza vaccination option for health care providers and their adult patients with broad coverage against influenza viruses that may be predominant, coupled with the efficiency of using the intradermal microinjection system.” Read more

5. CDC: Unprotected influenza strain prevalent; severe season expected

The high prevalence of a drifted influenza A(H3N2) strain could lead to a worse influenza season, CDC Director Thomas R. Frieden, MD, MPH, announced recently.

Ninety-one percent of approximately 1,200 influenza-positive tests reported to the CDC this year were influenza A virus, and 9% were influenza B, according to Frieden. Nearly all reported influenza A virus were H3N2, about half of which were antigenically different from the corresponding component included in the 2014 vaccine. This is a result of the drifted strain first being detected in March, Frieden said, after vaccine development had already begun. Read more.

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6. ACAAI recommends flu vaccine for children with egg allergies, asthma

Influenza vaccine is safe for children with egg allergies, according to the American College of Allergy, Asthma and Immunology, and it recommends the vaccine for those children, along with those who have asthma.

“Because the influenza vaccine is grown in eggs, it contains trace amounts of egg,” Michael Foggs, MD, ACAAI president, said in a press release. “Despite that, we know that administration is safe, and children with egg allergies should be vaccinated. We recommend that, as with any vaccine, all personnel facilities administering flu shots have procedures in place for the rare instance of anaphylaxis.” Read more

7. AAP publishes recommendations for seasonal influenza vaccination

The AAP recommends all individuals aged 6 months and older receive an annual seasonal influenza vaccination, according to a recent policy statement published in Pediatrics.

The statement echoes recommendations from the CDC’s Advisory Committee on Immunization Practices on seasonal influenza vaccination for the 2014-2015 season, which were established at the committee’s meeting in June and recently published in MMWR. Read more

8. Nearly half of children who died of influenza had no prior medical conditions

According to new data published in a recent MMWR report and presented at a National Foundation for Infectious Diseases press conference, 47% percent of the 107 pediatric influenza-related deaths reported last year occurred in children with no prior medical conditions. This news, along with the latest influenza vaccination coverage estimates, was presented by Tom Frieden, MD, MPH, director of the CDC, and Paul A. Offit, MD, an Infectious Diseases in Children Editorial Board member, among other panel members.

According to the report, 46.2% of Americans aged at least 6 months were vaccinated during the 2013-2014 influenza season, an increase of 1.2 percentage points. Children aged younger than 5 years were vaccinated at a 70.4% rate. Read more

9. Influenza vaccinations urged for young, middle-aged adults

Influenza vaccination rates have increased overall, but rates among healthy adults younger than 65 years remain less than 40%, according to new data presented at a National Foundation for Infectious Disease press conference.

According to the report, 46.2% of Americans aged at least 6 months were vaccinated during the 2013-2014 influenza season, an increase of 1.2 percentage points. Children younger than 5 years and adults aged at least 65 years had the highest rates of vaccination, at 70.4% and 65%, respectively. Read more

10. LAIV well tolerated among children with cystic fibrosis

Receipt of the nasal live-attenuated influenza vaccine did not increase risk for respiratory deterioration or all-cause hospitalization among children with cystic fibrosis, study data showed.

Constantina Boikos, MScPH, of McGill University in Montreal, and colleagues assessed vaccine tolerance among 168 children, aged 2 to 18 years, with cystic fibrosis who received LAIV between October 2012 and January 2013. Study participants were followed for 56 days after initial vaccination. Days 0 to 28 after LAIV were considered the at-risk period and days 29 to 56 were considered the non-at-risk period. Read more