eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Influenza: Follow-up
Updated: Aug 11, 2009
Follow-up
Deterrence/Prevention
- Handwashing with soap and water is the most appropriate way to prevent infection by an influenza virus.
- Touching of eyes or nose before washing hands should be avoided.
- Personal items should not be shared with another person during an influenza outbreak.
- Chemoprophylaxis is a less desirable alternative and is only effective against influenza A virus.
- Influenza vaccination in targeted high-risk populations is the best means of preventing severe disease caused by influenza virus. Guidelines regarding the prevention and control of influenza have been established by the Advisory Committee on Immunization Practices.7
- Vaccines made using inactivated influenza virus provide 60-90% protection against influenza when the vaccine matches the epidemic strain.
- The antigenic composition is reviewed annually so that the current vaccine contains the most recently circulating strains, usually one or more subtypes of influenza A virus and a subtype of influenza B virus.
- Vaccine efficacy for preventing infection in elderly persons is 30-40%. Efficacy in preventing hospitalization for pneumonia and influenza is 50-60% in elderly persons living in nursing homes and 30-70% in elderly persons living outside of nursing homes. Efficacy in preventing death in elderly patients who live in nursing homes is 80%.
- Indications for influenza vaccine include the following:
- Persons aged 65 years and older (and recommended for those aged 50-64 y)
- Residents of nursing homes and other long-term–care facilities
- Patients with chronic pulmonary (eg, asthma) or cardiac disorders (except hypertension)
- Patients with chronic metabolic disease (eg, diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression (eg, human immunodeficiency virus [HIV])
- Annual vaccination of all children aged 6 month to 18 years8
- Annual vaccination of children and teenagers (6 mo to 18 y) with long-term use of aspirin or other conditions that place them at incrased risk for complications from influenza9,7
- Persons who have any condition (eg, cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that may compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration
- Pregnant women who will be in their second or third trimester during influenza season
- Physicians, nurses, and other health care providers
- Employees of nursing homes and long-term care facilities
- Providers of home care to persons at high risk
- Household members (eg, children aged <5 years) of persons at high risk
- Providers of essential community services (eg, police, fire)
- International travelers
- Students and dormitory residents
- Anyone wishing to reduce risk of influenza
- The CDC recommends that the following groups receive priority for inactivated influenza vaccine:
- Persons aged 50 years and older
- Residents of long-term–care facilities
- Persons aged 2-64 years with comorbid conditions
- Children aged 6 months to 4 years (59 months)9,7
- Women who will be pregnant during the influenza season
- Health care providers who provide direct patient care
- Household contacts and out-of-home caregivers of children younger than 6 months
- Administration of influenza vaccine includes the following:
- For adults and older children, the recommended site of vaccination is the deltoid muscle.
- The preferred site for infants and young children is the anterolateral aspect of the thigh.
- Influenza vaccine should be administered during the autumn season.
- Vaccination is recommended in children aged 6 months or older.
- Two doses administered at least 1 month apart are recommended in children 6 months to 8 years who are receiving influenza vaccine for the first time. Other children or adults may be vaccinated with one shot.
- Annual immunization is recommended because of declining immunity during the year after immunization and because, in most years, at least one of the antigens is changed in the vaccine to increase the antigenic similarity between the vaccine and circulating strains. The optimal time for influenza vaccination is usually between October and November.
- Influenza vaccine should not be administered to persons known to have severe anaphylactic hypersensitivity to egg protein or to other components of the influenza vaccine.
- The presence of minor illnesses with or without fever is not a contraindication to the use of influenza vaccine.
- Influenza vaccine may be administered with pneumococcal vaccine and with other routine vaccinations of childhood.
- Influenza vaccine is also available as a nasal spray (FluMist) for healthy children aged 2 years or older, adolescents, and adults aged 49 years or younger. Children aged 2-8 years who have not previously received influenza vaccine as a nasal spray require 2 doses at least 1 month apart. Those who only received 1 dose in their first year of vaccination should receive 2 doses in the following year. Children who take aspirin, have asthma, or have had a wheezing episode in the preceding 12 months should not receive the FluMist vaccine.
Complications
- Primary influenza viral pneumonia
- Secondary bacterial pneumonia
- Croup
- Exacerbation of chronic pulmonary disease
- Myositis
- Myocarditis
- Toxic shock syndrome
- Guillain-Barré syndrome
- Reye syndrome
Prognosis
- The prognosis for recovery is excellent, although full return to normal levels of activity and freedom from cough usually requires weeks rather than days.
Patient Education
- For excellent patient education resources, visit eMedicine's Cold and Flu Center. Also, see eMedicine's patient education article Flu in Children.
Miscellaneous
Special Concerns
- In children younger than 16 years who have symptoms of influenza or colds, aspirin is not recommended because of an association with Reye syndrome.
More on Influenza |
| Overview: Influenza |
| Differential Diagnoses & Workup: Influenza |
| Treatment & Medication: Influenza |
 Follow-up: Influenza |
| References |
| « Previous Page |
References
HHS Declares Public Health Emergency for Swine Flu. US Department of Health and Human Resources. Available at http://www.hhs.gov/news/press/2009pres/04/20090426a.html. Accessed April 27, 2009.
Swine Influenza (Flu). Centers for Disease Control and Prevention. Available at http://www.cdc.gov/swineflu/. Accessed April 27, 2009.
Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans. N Engl J Med. Jun 3 2009;[Medline].
Update: Novel Influenza A (H1N1) Virus Infection-- Worldwide, May 6, 2009. MMWR. May 2009;58:453-8.
Guidance for Clinicians and Public Health Professionals. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/swineflu/guidance/. Accessed April 27, 2009.
[Best Evidence] Tappenden P, Jackson R, Cooper K, et al. Amantadine, oseltamivir and zanamivir for the prophylaxis of influenza (including a review of existing guidance no. 67): a systematic review and economic evaluation. Health Technol Assess. Feb 2009;13(11):iii, ix-xii, 1-246. [Medline].
Fiore AE, Shay DK, Broder K, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep. Aug 8 2008;57:1-60. [Medline].
[Guideline] Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. Jul 31 2009;58:1-52. [Medline]. [Full Text].
American Academy of Pediatrics Committee on Infectious Diseases. Prevention of influenza: recommendations for influenza immunization of children, 2007-2008. Pediatrics. Apr 2008;121(4):e1016-31. [Medline].
ALA Asthma Clinical Research Center. The safety of inactivated influenza vaccine in adults and children with asthma. N Engl J Med. Nov 22 2001;345(21):1529-36. [Medline]. [Full Text].
Esposito S, Marchisio P, Bosis S, et al. Clinical and economic impact of influenza vaccination on healthy children aged 2-5 years. Vaccine. Jan 30 2006;24(5):629-35. [Medline].
Gerberding JL. Faster... but fast enough? Responding to the epidemic of severe acute respiratory syndrome. N Engl J Med. May 15 2003;348(20):2030-1. [Medline].
Malhotra A, Krilov LR. Influenza and respiratory syncytial virus. Update on infection, management, and prevention. Pediatr Clin North Am. Apr 2000;47(2):353-72, vi-vii. [Medline].
McClellan K, Perry CM. Oseltamivir: a review of its use in influenza. Drugs. 2001;61(2):263-83. [Medline].
Montalto NJ, Gum KD, Ashley JV. Updated treatment for influenza A and B. Am Fam Physician. Dec 1 2000;62(11):2467-76. [Medline].
Pearson ML, Bridges CB, Harper SA, et al. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Feb 24 2006;55(RR-2):1-16. [Medline]. [Full Text].
Penn CR, Osterhaus A. Zanamivir: a rational approach to influenza B. Scand J Infect Dis. 2001;33(1):33-40. [Medline].
Stamboulian D, Bonvehi PE, Nacinovich FM, Cox N. Influenza. Infect Dis Clin North Am. Mar 2000;14(1):141-66. [Medline].
Stephenson I, Nicholson KG. Chemotherapeutic control of influenza. J Antimicrob Chemother. Jul 1999;44(1):6-10. [Medline].
Treanor JJ. Influenza virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill; 2000:1824-49.
WHO. Influenza A (H1N1): Special Highlights. World Health Organization. Available at http://www.who.int/en. Accessed June 11, 2009.
Further Reading
Keywords
influenza, flu, swine flu, swine influenza, H1N1, grip, grippe, acute catarrhal fever, respiratory infection, upper respiratory tract infection, viral infection, severe acute respiratory syndrome, SARS, pharyngitis, rhinitis, cervical lymphadenopathy, conjunctivitis, coup, pneumonia, chronic respiratory disease, chronic cardiac disease, chronic renal failure, diabetes mellitus, immunosuppression, treatment, diagnosis
