Children with special health care needs especially vulnerable to flu
- Copyright © 2013 by the American Academy of Pediatrics
When children become ill with influenza, they experience longer periods of infection and more complications than adults. Children and youth with special health care needs (CYSHCN) are at an even greater risk of exacerbated flu illness and associated complications such as pneumonia, croup, bronchiolitis, bronchitis, sinus and ear infections, and even death. Therefore, it is important that they, as well as those in their household, are vaccinated to prevent infection.
Parents look to their child’s health care provider for information on vaccines.
Pediatricians and pediatric subspecialists, such as pulmonologists, cardiologists and neurologists, can play a vital role in communicating to parents of children with high-risk conditions the benefits of annual influenza vaccination. Such conditions include asthma, neurological and neurodevelopmental conditions, chronic lung disease, heart disease, blood disorders, endocrine disorders (e.g., diabetes mellitus), kidney disorders, liver disorders, metabolic disorders, HIV or AIDS, cancer, and those on chronic steroids or long-term aspirin therapy.
Children with special health care needs experienced increased health risks during the 2009 influenza A (H1N1) pandemic. Of the 227 children with underlying health conditions who died from flu-related complications, 64% had a neurologic disorder (Blanton L, et al. Pediatrics 2012;130(3):390-396OpenUrl).
Flu season usually lasts from October to May, but influenza viruses can circulate throughout the entire year. Influenza viruses are commonly transmitted through respiratory droplets spread from person-to-person (such as through coughs or sneezes) or contact with contaminated hands or surfaces. Once a person becomes infected, the virus can incubate from one to four days before symptom onset. An infected person can transmit the virus even before onset of symptoms. While most people are infectious for about five to seven days after they become ill, children younger than 5 years can be infectious for 10 days or more.
During the 2013-’14 flu season, several vaccines are available to protect against the influenza viruses that research suggests will be most common (www.cdc.gov/flu/professionals/acip/2013-interim-recommendations.htm), including an influenza A (H1N1), influenza A (H3N2) and influenza B virus.
The flu shot is approved for use in healthy children and those with a chronic health condition who are 6 months of age and older. The nasal spray vaccine should not be given to a child with a chronic health condition or any child younger than 2 years old.
It is important for health care professionals to talk with parents about the safety of flu vaccines. Pediatricians and other health care providers also should get vaccinated annually.
Pediatricians and subspecialists can take the following steps to help parents protect children with special health care needs from the flu:
Talk with parents about the importance of getting their child vaccinated each year against the flu virus if he or she is 6 months of age and older, and especially if the child has a chronic medical condition (e.g., asthma or neurodevelopmental disorder). Although children with certain conditions are at higher risk of complications, substantial proportions of seasonal influenza morbidity and mortality occur among healthy children.
Talk with parents about the importance of getting an annual flu vaccination for themselves, caregivers and other individuals who come in contact with their child.
Be strategic in meeting the needs of CYSHCN. Medical subspecialists can work with parents and primary care pediatricians to develop a plan to make sure CYSHCN receive the seasonal influenza vaccine as soon as it is available and treat them early and aggressively, if they develop influenza-like illness.
More information for health professionals about seasonal influenza vaccination, surveillance and prevention is available from the Centers for Disease Control and Prevention at www.cdc.gov/flu/professionals/index.htm.
The 2012 AAP Red Book Online: Influenza Resource Page provides information on AAP clinical guidelines for influenza. It is available at http://aapredbook.aappublications.org/site/flu/.
Additional AAP influenza guidance is available at www2.aap.org/immunization/pediatricians/influenzaguidance.html.
The AAP Council on Children with Disabilities’ website has information and resources for those interested in the care of children with special needs, http://medicalhomeinfo.org/about/cocwd/.
Influenza resources for parents are available on HealthyChildren.org, www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Flu-A-Guide-for-Parents-of-Children-or-Adolescents-With-Chronic-Health-Conditions.aspx.
Dr. Peacock is a liaison from the Centers for Disease Control and Prevention to the AAP Council on Children with Disabilities Executive Committee. Dr. Norwood is chair of the council’s executive committee.