Influenza Update from the Clinical/Quality Subcommittee

Clinical/Quality Subcommittee

Influenza is a relatively common, usually self-limited and seasonal illness. The influenza season this year has seen quite an impact on multiple populations throughout various parts of the United States. The Center for Disease Control (CDC) has reported that 2018 in particular has been one of the worst in recent history. As we see the confluence of our peak respiratory season for infants, children and teenagers merge with this influenza epidemic, we thought it appropriate to review influenza facts, tips and recommendations.

Influenza is a contagious respiratory-borne illness that is clinically recognized by its sudden onset of fevers, chills, mylagias, headaches, cough, sore throat, rhinorrhea, fatigue, vomiting or diarrhea. Younger patients tend to have less prominent respiratory findings and more gastrointestinal burden of disease (e.g. nausea, vomiting and diarrhea and decreased appetite). As providers of healthcare interact with pediatric patients and their caregivers, it is important to remind those who seek care that for most this is a self-limited disease in which recovery is expected in <7 days. Supportive measures such as ensuring adequate hydration and use of appropriate doses of antipyretic medications should be encouraged. Despite an ultimately positive outcome in most cases, it is also important to highlight the complications that can develop as a result of the flu and prepare these caregivers to recognize symptoms of and progression of such diseases.

Pneumonia and asthma, both of which can lead to respiratory failure, are the most common complications seen as a result of influenza. Although central nervous system complications are relatively rare in the pediatric population, increased risk has been noted in younger children (those <5 years old) with preexisting neurological conditions. Myositis is a well-documented musculoskeletal complication of influenza, noted by elevated serum creatinine phosphokinase and myoglobinuria.

Complications from influenza are more likely in certain high-risk populations. The CDC has identified the patients most likely to develop serious flu-related sequelae as those who are <5 years old, those with asthma, neurological and neurodevelopmental conditions, chronic lung diseases, heart diseases, hematological disorders, endocrine disorders, metabolic disorders, kidney or liver disorders, the immune-deficient, obese patients and those taking long term aspirin therapy. In these groups, antiviral medications may be used to reduce the risks of complications, severe illness or death. Most studies have shown maximal benefit from antiviral medications if started within 48 hours of symptom onset.

Although diagnosing influenza strictly on clinical grounds can be challenging, particularly in infants and young children, laboratory testing should not be routinely performed. Testing should be strongly considered in those suspected of having influenza and are in the higher risk categories for complications, those hospitalized with severe respiratory illnesses or neurological complications. In patients who have clinical features of influenza without these higher risk medical histories, testing should be performed when the results will affect management, as routine testing could lead to reduced availability of treatment medications for those in the higher risk categories.

Regardless of one’s medical history, caregivers should be encouraged to seek further care should their children develop tachypnea or signs of respiratory distress, dehydration, irritability or influenza-like symptoms that improve but then recur with fever and worsened cough.

A helpful handout for patients and families can be found on the CDC website:

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