October Week 1

RSV and INFLUENZA
References:

1. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011
2. Georgetown University Hospital 2011 RSV prophylaxis Consensus Statement
3. McCarthy C, et al.  Respiratory Syncytial Virus: Concerns and Control.  Peds in Review.  Vol 24, No 9. Sept 2003.

Case 1:

You are seeing a 5 week old in your office after an episode earlier in the morning when mom states the patient stopped breathing and her lips turned blue.  Mom reports she has had lots of nasal congestion and mucus for the last 2 days and “everyone in the family has a cold.”  On exam, her respiratory rate is 62, with subcostal and suprasternal retractions, and you hear transmitted coarse upper airway sounds.  Her pulse ox reads 90% in room air.
 
How is RSV transmitted? 
What are the clinical features of RSV
What are typical CXR findings in RSV?  
Which patients are at increased risk for severe disease?  
How (and when?) do you test for RSV?  
How will you treat this patient?

Case 2:

You are seeing an ex 25 week GA preemie in your office who is here for his 6 month well visit.  
 
What vaccines will you order today?
When will you have him return 
When is RSV season?  
What if he had been born at 29 weeks GA?
What about an 18 month old born at term with a cyanotic congenital heart defect? 

Case 3:

What is your recommendation for the following children regarding influenza vaccine?

A 2 yo who only received one dose of influenza vaccine last year (2010-11)  
A 6 month old seeing you for well visit 
A 5 yo who develops hives in response to eating eggs
A 3 yo with asthma