Seasonal and Pandemic Influenza: Children, Immunocompromised Hosts, Pregnant Women and Nursing Home Residents Richard Whitley, MD Professor of Pediatrics, Microbiology, Medicine and Neurosurgery UAB Center for Biodefense and Emerging Infections University of Alabama at Birmingham Birmingham, AL
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Richard Whitley, MD Professor of Pediatrics, Microbiology, Medicine and Neurosurgery
Seasonal and Pandemic Influenza: Children, Immunocompromised Hosts, Pregnant Women and Nursing Home Residents. Richard Whitley, MD Professor of Pediatrics, Microbiology, Medicine and Neurosurgery UAB Center for Biodefense and Emerging Infections University of Alabama at Birmingham - PowerPoint PPT Presentation
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Seasonal and PandemicInfluenza: Children,
Immunocompromised Hosts, Pregnant Women and Nursing Home Residents
Richard Whitley, MDProfessor of Pediatrics, Microbiology, Medicine
and NeurosurgeryUAB Center for Biodefense and Emerging Infections
University of Alabama at BirminghamBirmingham, AL
NVSN Influenza Laboratory-Confirmed Cumulative Hospitalization Rayes for Children 0-4 Years, 2004-05
and Previous 4 SeasonsP
olul
atio
n-B
ased
Rat
e pe
r 10
,000
Chi
ldre
n
2004-05 Influenza Season 2 Week Reporting Period
14
12
10
8
6
4
2
040-4142-43 44-4546-4748-49
2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
50-5152-1 2-3 4-5 6-7 8-9 10-11 12-1314-15 16-17
Hospitalization Rates for Patients by Age and Risk Groups (Interpandemic Years)
Hospitalization rates per 100,000
Age, y High risk Low risk
<4 3,562 509
5–14 274 39
15–64 873 125
65–74 4,235 605
>75 8,797 1,257
www.cdc.gov.
Influenza In Children…
• Flu symptoms in school-age children and adolescents are similar to those in adults.– Temperature of 101°F or above – Cough – Muscle ache – Headache – Sore throat – Chills – Tiredness – Feeling lousy all over
• Children tend to have higher temperatures than adults, ranging from 103°F to 105°F.
• Flu in preschool children and infants is hard to pinpoint, since its symptoms are so similar to infections caused by other viruses.
• If the symptoms mentioned above are present and the flu is in your area, please contact your doctor immediately.
CNS Effects of Influenza
• Encephalitis
• Myelitis
• Guillain Barré Syndrome
• Post Infectious Encephalitis
Influenza Associated Pneumonia
• Primary Viral Pneumonia
• Bacterial Pneumonia (“superinfection”)
– S. pneumonia
– H. influenzae
– S. aureus
• Mixed Viral/Bacterial Pneumonia
Timing of 153 Cases of Fatal Influenza in Children - United States, 2003-2004 Season
Bhat, N. et al. N Engl J Med. 2005;353:2559-2567.
No.
of
Cas
es
2004-05 Influenza Season 2 Week Reporting Period9
8
6
5
2
0
Date of Onset of Illness
1
3
4
7
Oct-4
Nov 1
Nov 2
9
Dec 2
7
Jun
24
Jun
24
Mar
20
Apr 1
7
Distribution of Cases and Mortality Rates According to Geographic Location and Age Group among 153 Children
with Fatal Influenza - United States, 2003-2004 Season
Variable No. of Children (%) Deaths per 100,000Children (95% CI)*
Age group†<6 mo 18 (12) 0.88 (0.52-1.39)6-11 mo 12 (8) 0.59 (0.30-1.02)1 yr 31 (20) 0.77 (0.52-1.09)2 yr 14 (9) 0.35 (0.19-0.58)3 yr 9 (6) 0.23 (0.11-0.44)4 yr 12 (8) 0.31 (0.16-0.54)5-10 yr 26 (17) 0.11 (0.07-0.16)11-17 yr 31 (20) 0.11 (0.07-0.15)
*CI denotes confidence interval.†Ages are those on the date of the onset of the illness or, if that information was unavailable, at the date of death. P for trend <0.001 by a chi-square test of age-specific mortality rates.Bhat, N. et al. N Engl J Med. 2005;353:2559-2567.
Influenza-Associated Mortality Rates According to Age Group - United States,
2003-2004 Season
Influ
enza
-Ass
ocia
ted
Mor
talit
y(d
eath
s pe
r 10
0,00
0 ch
ildre
n)
Age Group
1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00<6 mo 6-11 mo 1 yr 2 yr 3 yr 4 yr 5-10 yr 11-17 yr
Bhat, N. et al. N Engl J Med. 2005;353:2559-2567.
Underlying Health Status of 149 of 153 Children with Fatal Influenza - United
States, 2003-2004 Season
Underlying Health Status No. of Children
Age <6 Mo (N=17)
Age ≥6 Mo (N=132)
Chronic conditionsAll chronic conditions 10 (59) 54 (41)Chronic condition without a concurrent ACIP- defined high-risk condition