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CURRENT INFLUENZA ACTIVITY (RED BOOK ONLINE SPECIAL ALERT, NOVEMBER 27, 2018)

Influenza activity has been low in the United States, but localized outbreaks have been reported to the Centers for Disease Control and Prevention (CDC). Two influenza-associated pediatric deaths have already been reported during the 2018-2019 season. Even one death is too many. This reinforces the need for clinicians to be vigilant in their flu immunization efforts. With family and friends gathering for the holidays, now is an ideal time to make sure that everyone is vaccinated for seasonal flu.

As with each influenza season, the American Academy of Pediatrics (AAP) urges all clinicians to take action to ensure that all children get vaccinated against flu. The CDC estimates that there were more than 960,000 hospitalizations and nearly 80,000 deaths from flu last season. 183 pediatric deaths were reported, many of these deaths were in previously healthy children but who were unvaccinated. This emphasizes just how important influenza prevention and control activities are each year.

BELOW ARE  THE MOST RECENT RECOMMENDATIONS:

• AAP recommends inactivated influenza vaccine as the primary choice for children. This recommendation was made because the live attenuated influenza vaccine (the nasal vaccine) showed inferior effectiveness during previous flu seasons, and its effectiveness against A/H1N1 is unknown.
• The nasal mist may be used for children who would not otherwise receive an influenza vaccine, if the child is at least 2 years old and healthy with no underlying chronic medical conditions. The nasal mist is currently unavailable at our office. A limited supply may be made available. 
• Children should receive the flu vaccine as soon as possible after it is available in their community, preferably by the end of October.
• All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. Egg allergy is not a contraindication for influenza vaccination, nor does it require special consideration.
• Pregnant women may receive the flu vaccine at any time during pregnancy, and infants of vaccinated mothers receive protection against influenza and its complications.
• Antiviral medications are important in the treatment and control of influenza, but are not a substitute for influenza vaccination

Groups Recommended for Vaccination

• Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications.
• A licensed, age-appropriate influenza vaccine should be used.
• Emphasis should be placed on vaccination of high-risk groups and their contacts/caregivers. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to (no hierarchy implied by order listed):
  • Children aged 6–59 months;
  • Adults aged ≥50 years;
  • Persons with chronic pulmonary (including asthma), cardiovascular (excluding isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);
  • Persons who are immunocompromised due to any cause, (including medications or HIV infection);
  • Women who are or will be pregnant during the influenza season;
  • Children and adolescents (aged 6 months through 18 years) receiving aspirin- or salicylate-containing medications and who might be at risk for Reye syndrome;
  • Residents of nursing homes and other long-term care facilities;
  • American Indians/Alaska Natives;
  • Persons who are extremely obese (BMI ≥40); and
  • Caregivers and contacts of those at risk:
    • Health care personnel in inpatient and outpatient care settings, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients;
    • Household contacts and caregivers of children aged ≤59 months (i.e., <5 years), particularly contacts of children aged <6 months, and adults aged ≥50 years; and
    • Household contacts and caregivers of persons with medical conditions that put them at high risk of severe complications from influenza.

SINCERELY,

LPA