October Week 1
Influenza
Articles:
Recommendations for Prevention and Control of Influenza in Children, 2012-2013. Pediatrics
Discussion/Questions:
CASE 1:
Guanine Nucleotide, an otherwise healthy 4 year old female with history significant only for a sick visit for wheezing several months ago presents to CYAS for well child check. She developed a fever of 100.8 last night along with cough, congestion, and runny nose.The maternal grandmother died of pandemic 2009 influenza A H1N1. “I didn’t really believe in the flu shot until then, but we’ve definitely been getting them since then!” mom explains.
1. Mom is concerned that her daughter could die from swine flu. Which of the following statements are TRUE and might help to reassure her that Guanine likely does not have influenza?
a. It typically starts with relatively sudden onset of fever, malaise, and myalgias with progression to respiratory symptoms.
b. Children <2 years of age are at an increased risk for hospitalization and complications from influenza.
c. Compared to over 200 pediatric deaths in the 2009-2010 flu season, there were less than 30 pediatric influenza-associated deaths in the 2011-2012 season.
d. All of the above.
You overhear a student asking about diagnosis and treatment of influenza, and, since you just read the 2012-2013 revised AAP policy statement on influenza, you seem intelligent when answering the following questions.
2. TRUE or FALSE. The influenza rapid antigen test is helpful to rule out influenza.
3. All children hospitalized for suspected influenza and those at highest risk for influenza-related complications should be treated. Which of the following children are NOT considered “highest risk”?
a. Age 2-5 years
b. Children with neurological conditions
c. Immunosuppressed
d. BMI >40
e. American Indian/Alaska Native
4. Which of the following would be appropriate treatment options?
a. Rimantadine (Flumadine)
b. Amantadine (Symmetrel)
c. Oseltamivir (Tamiflu)
d. Zanamivir (Relenza)
e. Only C and D
f. Any of the above
5. TRUE or FALSE. LAIV is contraindicated in health care personnel (HCP).
CASE 2:
After warding off hypoglycemia with a one-sixteenth slice of donut, you return to the patient’s room where mom tells you that Guanine’s twin sister, Adenine, and their 4 year old twin brothers, Cytosine and Thymine are in the waiting room. “Adenine and Cytosine need their well visits. You were going to see us next week, but it’s such pain to drag everyone back. Thymine was just here last week for his shots, but the rest of us had the crud then. Anyway, you don’t mind do you? Thanks, you’re the best!”
Since you are in Dr. Nelson’s clinic, you have no choice and agree to add them to your schedule.
6. Mom states that the medical student mentioned “the flu vaccine that goes up the nose,” and asks, “Is it safe?” Which of the following is FALSE about the side effects of influenza vaccine?
a. Compared to the shot (Fluzone), intranasal vaccine (FluMist) contains live-attenuated virus.
b. The most common side effect of Fluzone is a local site reaction.
c. Febrile seizures have been reported after coadministration ofFluzone with Prevnar-13.
d. Data suggests that FluMist is safe for egg-allergic patients.
e. There is a risk of Guillain-Barre Syndrome (GBS) with FluMist.
7. Mom tells you that Adenine has been doing well aside from developing a rash shortly after being introduced to eggs last month. Which of the following is the BEST recommendation for Adenine and Guanine today?
a. Offer FluMist to both.
b. Offer FluMist for Adenine and Fluzone for Guanine.
c. Offer FluMist for Guanine, Fluzone for Adenine, and observe Adenine for 30 minutes.
d. Offer FluMist for Guanine, and refer Adenine for an Allergy consultation.
e. They cannot be vaccinated for influenza today.
8. Mom would also like the 4 year old twins to be vaccinated for influenza. “You didn’t have flu shots yet last week, but since you have that Flovent orFluMist or whatever, they can just get that.” Which of the following is the BEST recommendation for Cytosine and Thymine today?
a. They can both get FluMist.
b. Cytosine can get FluMist, but Thymine can only get Fluzone.
c. Thymine can get FluMist, but Cytosine can only get Fluzone.
d. They can both get Fluzone but will have to come back for the 2nd dose in a month.
e. They cannot be vaccinated for influenza today.
CASE 3:
Aunt Uracil, mom’s 19 year old sister, is pregnant and here with her 21 year old fiancée, Xanthine, for an initial consultation. His parents do not approve of their relationship because he also has a 6 month old, Hypoxanthine, from another relationship, who, not surprisingly, is also here for an unscheduled well visit. Xanthine and Hypoxanthine have recently joined the Nucleotide household.
9. What do you tell the parents-to-be about influenza infection?
a. Children <24 months have the highest risk of influenza-associated hospitalization.
b. Cocooning is a particularly important strategy for protecting children <6 months from influenza-related complications.
c. All eligible adults and children who will be in close contact with the baby should be vaccinated.
d. All of the above.
10. Xanthine and Uracil would like to get influenza vaccine. Assuming they are both established patients seen in Adolescent Clinic, which of the following is the BEST recommendation for Xanthine and Uracil today?
a. They can both get FluMist.
b. FluMist for Xanthine but no influenza vaccine for Uracil.
c. FluMist for Xanthine and Fluzone for Uracil.
d. Neither can get FluMist.
e. Neither can be vaccinated against influenza today.
11. Xanthine admits that he has not gotten a flu shot in years because he is afraid of big needles. He is also concerned since he is already sick and does not want to get worse from the vaccine. “I’m so stuffed up that I have to breathe through my mouth.” Which of the following is TRUE?
a. Fluzone is the only choice.
b. FluMist would be a good option since there are no needles involved.
c. We can give you an intradermal (ID) shot which uses a 75% shorter needle.
d. ID administration has a slightly higher rate of local site reactions than IM administration.
e. Headache, myalgia, and malaise do not occur with ID administration.
12. What is the BEST recommendation for Hypoxanthine?
a. He is too young for influenza vaccine.
b. He can get FluMist.
c. He can get Fluzone but needs a 2nd dose in a month.
d. He can get Fluzone and come back for the 9-month visit.
By JP Vilai, MD