Pediatric Flu
Ilene Claudius, MD and Mel Herbert, MD
- Flu vaccine is recommended for all infants over 6 months of age
- No longer is a reaction to eggs a contraindication to the vaccine
- Influenza A vaccine is against - H1N1 and H3N2 and there are also 2 Influenza B serotypes covered
- Vaccine appears to reduce pediatric mortality (low to begin with) by about 65%
- 80% of pediatric flu deaths are in unvaccinated patients
- Immunity post vaccine might decline by 6-16% per month
- Despite this a second vaccination late in the season is not yet recommended
- Only test for flu if it will change management
- Flu tests tend to be more specific than sensitive
- High risk children include:
- Under age 2
- Chronic pulmonary disease
- Cardiovascular disease
- Any end organ disease
- Diabetes, immune suppression sickle cell
- Pregnancy
- Neurodevelopmental conditions
- BMI > 40
- Generally treatment is best within 48 hours of onset
- Treat any child admitted for flu, progressive disease or at high risk regardless of duration
- Treatment recommended for children with influenza who have a household contact that is high-risk
- The efficacy of treatment has unclear benefit despite the recommendations
- Treatment might reduce symptoms by 17-36 hours
- Oseltamivir is considered first line therapy
- For children over a year the treatment is weight based
- < 15 kg - 30 mg
- 15-23 kg - 45 mg
- > 23 kg - 60 mg
- Adult sized patients get 75 mg
- 5 day course
- For Children < a year
- 9-11 months - 3.5mg/kg/dose bid
- 0-8 months - 3 mg/kg/dose bid
- Preterm 1mg/kg/dose bid
- For prophylaxis the dosing is similar but just once a day rather than twice a day for 10 days rather than 5)
- Zanamivir (inhaled)
- Recommended in children age 7 and over
- Peramivir
- Recommended for children age 2 and above
- Prophylaxis should be considered in:
- High risk children that cannot get the vaccine
CDC Information for Health Care Professionals 2020-2021 Flu Season
Recommendations for Prevention and Control of Influenza in Children, 2020–2021
Committee on Infectious Diseases
Pediatrics Oct 2020, 146 (4) e2020024588; DOI: 10.1542/peds.2020-024588
mike p. - December 10, 2020 7:29 AM
offered treatment with high risk kids. Can you elaborate on the conversation in general you have with parents re risks and benefits? How strongly are you offering these in the non-hospitalized patient group with maybe one or two risk factors that otherwise appear relatively well. Is it enough to document "offered" since the benefits are questionable at best for the majority of kids? Is this mostly defensive because of guidelines recommendations alone or are you actually aggressively recommending in all or only very high risk groups and hospitalized patients? Thank you!
ilene c. - December 11, 2020 9:52 AM
Sorry if I misstated! I prescribe for high-risk kids. I guess offer is a nice way of saying that, but I usually offer in the way of writing a Rx. I have never had a parent refuse, but if they did, I would have a risk benefit conversation and document. For non-high-risk kids within the first 48 hours, if they are pretty sick and I am worried about them coming back with dehydration, then I will discuss risks and benefits with the parents. Other kids, I really don't offer. Benefits are small, esp in healthy kids, and many kids with the flu have alot of GI sx at baseline. To test and treat a bunch of healthy kids so that they can come back with MORE vomiting!