vaccine
under 6 month old
Who is not a candidate for the flu vaccine?
Anyone over 6 months old
Who is a candidate for the Flu vaccine?
(except if hx of anaphylaxis to flu vaccine)
dosing- 6 mo -under 9 yr, needs 2 doses - one month or more apart- if patient has never received a flu vaccine or received only one previous one in any prior season
one dose for everyone else
116
what was cost in life from flu in pediatric population 2018-2019?
50% were healthy children with no medical problems
Historically, 80-85% of pediatric deaths occur in unvaccinated 6 mo and older
2018-70% could have been vaccinated
The Spanish Flu
1918 H1N1 pandemic flu that caused 50 million deaths
CDC says estimates 291,000- 646,000 annual world death toll from flu
November to March dosing
What is the synagis administration schedule? (15mg/kg IM every 28 days for max 5 doses)
has an egg allergy, pregnant, breastfeeding , mild illness
Who does not have a contraindication to the flu vaccine?
local pain, tenderness and swelling
What is the most common side effect of the flu vaccine?
Most common systemic adverse events- drowsiness, irritability, loss of appetite, fatigue, muscle aches, HA, arthralgia and GI symptoms
systemic side effects possible but doesn't actually give you the Flu as some fear
$1500
What is the cost of one dose of Palivizumab (synagis)
most recent pandemic flu
What was the 2009 H1N1 Swine flu pandemic?
< 29 week premie born on or after 10/15/18
who is a candidate for synagis regardless of medical history?
A(H1N1) and A(H3N2)
what is new in the 2019-2020 flu vaccine?
A strains are new this season, B strains are unchanged from last season
Quadrivalent Inactivated Influenza vaccine (IIV) or
Quadrivalent Live Attenuated Influenza Vaccine (LAIV) in 2019
What is a 2019-2020 AAP change?
Both are options for influenza vaccination in children,with no preference, given eligibility criteria are met
February
What is the most common peak flu month?
What does this have to do with cost?
Influenza generally peaks Jan- March, but can circulate from October to May. And can have more than one peak
NYC daycare, Headstart and preschool attendees
Who is required to have one current flu vaccine by 12/31/19 to attend?
(second vaccine is needed for many but not required for daycare/school attendance)
10 mo old 31 week premie who needed supplemental oxygen for 2 weeks after birth
Who is NOT a candidate for Synagis this season
Household contacts getting the flu vaccine to protect high risk individual or under 6 mo old
What is cocooning?
By the end of October ideally
When should the flu vaccine have been given- both doses if indicated?
however, we offer it as soon as it is available and continue to May or even June
October- November ideally- for adequate coverage in Feb- March given waning immunity over time
Needs one dose of flu this season- .5 ml dose
Who is a 6 mo-under 9 yr old who has had 2 doses before this season or an over 9 yr old?
( all brands- Fluzone, Fluarix, Flulaval- offer .5 ml dosing for 6 mo and up- ie no more Fluzone .25 ml split dose for 6-36 mo olds necessary for Fluzone)
(Does this have anything to do with cost?)
less than 48 hours
What is the duration of symptoms during which Oseltamivir ( Tamiflu) is considered most effective?
But who should be treated?
any hospitalized child with suspected or confirmed flu disease regardless of duration of symptoms
any child, inpatient or outpatient with severe, complicated or progressive illness attributable flu regardless of sx duration
children with flu infection of any severity who are at high risk of complications of flu regardless of sx duration
consider treatment for
healthy symptomatic outpt w/o risk factors, with suspected or confirmed flu based on clin judgement if Tx can start w/in 48 hrs
otherwise healthy children with suspected or confirmed flu with sibs or household members younger than 6 mo or with high risk condition
7 mo old ( at the start of the RSV season) ex 31 week premie who needed oxygen for at least the first 28 days after birth
7 mo old FT infant with hemodynamically significant cong heart disease
Who is a candidate for Synagis?
Acyanotic heart disease on meds for CHF and will require surg procedures
and infants with mod-severe Pulm HTN
cyanotic heart disease in first year in consultation with cardiologist
Make it easy
What is a public health initiative to increase flu vaccination rates?
under 2, high risk chronic health condition- including asthma dx or hx of wheezing in past 12 mo , nasal congestion, immunocompromise, live vaccine in past one month, pregnant, close contacts and caregivers of those who are severely immunocompromised, those receiving ASA
Who is not a candidate for the Flumist or Live Attenuated Influenza Vaccine (LAIV)
Decrease of 3/4 risk of severe life threatening lab confirmed flu of PICU admits
Who is a kid who got the flu shot and got sick anyway?
Phuket, Colorado, Singapore, Michigan, Yamagata, Victoria
Where would you rather be now?
What is the geographic origin of A strains and B lineages?
18 month who gets synagis this season
Who is a child with immunocompromise, ex CF w/ severe lung disease?
Who is a child , <32 week premie with CLD requiring medical support after 4/1/19 (6 mo before second RSV season)?