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Good Morning and Welcome Applicants!

Good Morning and Welcome Applicants!. February 11, 2011. Influenza Complications. Otitis media Lower respiratory tract Interstitial PNA Croup Bronchitis Bacterial tracheitis Asthma exacerbation. Influenza Complications. PNA Sinusitis Neurologic Aseptic meningitis

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Good Morning and Welcome Applicants!

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  1. Good Morning andWelcome Applicants! February 11, 2011

  2. Influenza Complications • Otitismedia • Lower respiratory tract • Interstitial PNA • Croup • Bronchitis • Bacterial tracheitis • Asthma exacerbation

  3. Influenza Complications • PNA • Sinusitis • Neurologic • Aseptic meningitis • Acute cerebellar ataxia • Transverse myelitis • Guillian-Barre • Encephalitis

  4. Influenza Complications • Myositis • Less common • Myocarditis • Pericarditis • Toxic Shock Syndrome

  5. Influenza • Transmission • Person to person primarily through large-particle respiratory droplet • Close contact between source and recipient persons • droplets generally travel only short distances (approximately ≤6 feet) through the air • Other • Indirect contact transmission via hand transfer

  6. Influenza • Incubation • 1-4 days • Shedding • Day before symptoms begin through 5-10 days after onset • Decreases rapidly by 3-5 days after illness onset • Children typically shed longer

  7. Symptoms • Fever • Myalgia • Headache • Malaise • Nonproductive cough • Sore throat • Rhinitis

  8. Symptoms • Children • Otitis media • Nausea/vomiting • Resolution • 3-7 days for the majority of persons • Cough and malaise can persist for >2 weeks

  9. Testing • Rapid antigen tests • Low sensitivity (20%-70%) • Particularly for H1N1 • Nasal swab is more sensitive • Should not be used to rule out influenza • Viral Culture or RT-PCR

  10. Treatment

  11. Treatment

  12. Treatment • Who gets treated? • Any hospitalized child • High risk • Healthy children whom a decrease in duration of clinical symptoms is felt to be warranted • Start ASAP • Use clinical judgment

  13. Prophylaxis • Children at high risk for whom influenza vaccine is contraindicated • Children at high risk during the 2 weeks after immunization • Family members or health care providers who are unimmunized and are likely to have ongoing, close exposure to: • Unimmunized children at high risk • Infants and toddlers <24 months

  14. Prophylaxis • Control of influenza outbreaks for unimmunized staff and children in a closed institutional setting with pediatric residents at high risk • Supplement to immunization for immunocompromised • PEP for family members and close contacts of an infected individual • Children at high risk and their family members and close contacts when circulating strains are not matched with the vaccine

  15. Immunization • Annual vaccination for all children and adolescents 6 months of age and older • Specifically • Conditions that increase the risk of complications • Chronic medical conditions

  16. Immunization • Increased risk of complications • Asthma or other chronic pulmonary disorders • Hemodynamically significant cardiac disease • Immunosuppressive disorders or therapy • HIV • Sickle cell anemia or other hemoglobinopathies • Long-term aspirin therapy • Chronic renal dysfunction • Chronic metabolic disease (DM) • Any condition that can compromise respiratory function or handling of secretions

  17. Immunization • Specifically • Household contacts and out-of-home providers of • Children with high-risk conditions • Healthy children <5y • Pregnant women • Health care personnel • Close contacts of immunosuppressed

  18. Immunization • This year • Trivalent • H1N1 • H3N2 • B/Brisbane/60/2008 • How many this year??

  19. Immunization • TIV • Inactivated vaccine • Viral antigens but no virus • IM • Adverse effects • Local pain • Tenderness • Fever • Mild systemic • Nausea, lethargy, headache, muscle aches, chills

  20. Immunization • LAIV • Live-attenuated influenza vaccine • Intranasal • Ages 2-49 • Not recommended • Wheezing, high risk medical condition, nasal congestion • Adverse effects • Runny nose, HA, wheezing, vomiting, muscle aches and fever

  21. Immunization • Contraindications to TIV • Anaphylactic rxn to chicken, egg, or vaccine • <6 months • Moderate to severe febrile illness • GBS within 6 weeks after a flu vaccine

  22. Immunization • Contraindications to LAIV • Same as TIV plus: • <2y • Other live vaccines within past 4 weeks • Can give other vaccines on same day • Chronic medical conditions • Pregnancy • Contact with severely immunocompromised

  23. When in doubt . . . • Check with the CDC! • www.cdc.gov • Standard and Droplet precautions • Wash your hands • Get vaccinated Don’t forget . . .

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