FIGURE 1 Selected underlying medical conditions in patients hospitalized with influenza, FluSurv-NET 2013–2014. Source: Centers for Disease Control and Prevention. FluView 2013–2014 Preliminary Data as of August 23, 2014. Available at: http://gis.cdc.gov/grasp/fluview/FluHospChars.html. Asthma includes a medical diagnosis of asthma or reactive airway disease. Cardiovascular diseases include conditions such as coronary heart disease, cardiac valve disorders, congestive heart failure, pulmonary hypertension, and aortic stenosis. It does not include hypertension disease only. Chronic lung diseases include conditions such as chronic obstructive pulmonary disease, bronchitis obliterans, chronic aspiration pneumonia, and interstitial lung disease. Immune suppression includes conditions such as immunoglobulin deficiency, leukemia, lymphoma, HIV/AIDS, and the use of immunosuppression medications. Metabolic disorders include conditions such as diabetes mellitus, thyroid dysfunction, adrenal insufficiency, and liver disease. Neurologic disorders include conditions such seizure disorders, cerebral palsy, and cognitive dysfunction. Neuromuscular diseases include conditions such as multiple sclerosis and muscular dystrophy. Obesity was assigned if indicated in patients’ medical chart or if BMI was >30 kg/m2. Pregnancy percentage was calculated using number of female cases aged between 15 and 44 years as the denominator. Renal diseases include conditions such as acute or chronic renal failure, nephrotic syndrome, glomerulonephritis, and impaired creatinine clearance. No known condition indicates that the case did not have any known underlying medical condition indicated in the medical chart at the time of hospitalization. FIGURE 1 Selected Underlying medical conditions in patients hospitalized with influenza, FluSurv-NET 2013–2014. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

Figure 2 Number of 2014–2015 seasonal influenza vaccine doses for children 6 months through 8 years of age. For simplicity, this algorithm takes in to consideration only doses of seasonal influenza vaccine received since July 1, 2010. As an alternative approach in settings where vaccination history from before July 1, 2010 is available, if a child aged 6 months through 8 years is known to have received 2 or more doses of seasonal influenza vaccine from any previous season and at least 1 clearly documented dose of a pH1N1-containing vaccine (ie, any seasonal vaccine since July 1, 2010 or a monovalent pH1N1 vaccine during the 2009–2010 season), then the child needs only 1 dose for 2014–2015. FIGURE 2 Number of 2014–2015 seasonal influenza vaccine doses for children 6 months through 8 years of age. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

American Academy of Pediatrics, Committee on Infectious Diseases American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

Sources: American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2013–2014. Pediatrics. 2013;132(4):e1089–e1104; and Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–2015 influenza season. MMWR Recomm Rep. 2014;63(32):691–697. a Age indication per package insert is ≥5y; however, the Advisory Committee on Immunization Practices recommends Afluria not be used in children 6 mo through 8 y of age because of febrile reactions reported in this age group. If no other age-appropriate, licensed inactivated seasonal influenza vaccine is available for a child 5 through 8 y of age who has a medical condition that increases the child’s risk of influenza complications, Afluria can be used; however, pediatricians should discuss with the parents or caregivers the benefits and risks of influenza vaccination with Afluria before administering this vaccine. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

Sources: American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2013–2014. Pediatrics. 2013;132(4):e1089-e1104; and Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 influenza season. MMWR Recomm Rep. 2014;63(32):691–697. a The preferred site of IIV intramuscular injection for infants and young children is the anterolateral aspect of the thigh. b See Fig 2 for decision algorithm to determine number of doses of seasonal influenza vaccine recommended for children during the 2014–2015 influenza season. c LAIV4 is not recommended for children with a history of asthma. In the 2- through 4-year age group, there are children who have a history of wheezing with respiratory illnesses in whom reactive airway disease is diagnosed and in whom asthma may later be diagnosed. Therefore, because of the potential for increased wheezing after immunization, children 2 through 4 years of age with recurrent wheezing or a wheezing episode in the previous 12 months should not receive LAIV4. When offering LAIV4 to children in this age group, a pediatrician should screen those who might be at higher risk of asthma by asking the parents/guardians of 2-, 3-, and 4-year-olds (24-through 59-month-olds) the question: “In the previous 12 months, has a health care professional ever told you that your child had wheezing?” If the parents answer “yes” to this question, LAIV4 is not recommended for these children. d LAIV4 coadministration has been evaluated systematically only among children 12 to 15 months of age with measles-mumps-rubella and varicella vaccines. IIV coadministration has been evaluated systematically only among adults with pneumococcal polysaccharide and zoster vaccines. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

Sources: Centers for Disease Control and Prevention Sources: Centers for Disease Control and Prevention. Antiviral agents for the treatment and chemoprophylaxis of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-1):1–24; Kimberlin DW, Acosta EP, Prichard MN, etal. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Oseltamivir pharmacokinetics, dosing, and resistance among children aged <2 y with influenza. J Infect Dis. 2013;207(5):709–720. a Oseltamivir is administered orally without regard to meals, although administration with meals may improve gastrointestinal tolerability. Oseltamivir is available as Tamiflu in 30-mg, 45-mg, and 75-mg capsules and as a powder for oral suspension that is reconstituted to provide a final concentration of 6 mg/mL. For the 6-mg/mL suspension, a 30-mg dose is given with 5 mL of oral suspension, a 45-mg dose is given with 7.5 mL oral suspension; a 60-mg dose is given with 10 mL oral suspension, and a 75-mg dose is given with 12.5 mL oral suspension. If the commercially manufactured oral suspension is not available, a suspension can be compounded by retail pharmacies (final concentration also 6 mg/mL), based on instructions on the package label. In patients with renal insufficiency, the dose should be adjusted on the basis of creatinine clearance. For treatment of patients with creatinine clearance 10 -- 30 mL/min: 75 mg once daily for 5 days. For chemoprophylaxis of patients with creatinine clearance 10 -- 30 mL/min: 30mg, once daily, for 10 days after exposure or 75 mg, once every other day, for 10 days after exposure (5 doses). See http://www.cdc.gov/flu/professionals/antivirals/antiviral-drug-resistance.htm. b Approved by the FDA down to 2 wk of age. Given its known safety profile, oseltamivir can be used to treat influenza in both term and preterm infants from birth because benefits of therapy are likely to outweigh possible risks of treatement. c Oseltamivir dosing for preterm infants. The weight-based dosing recommendation for preterm infants is lower than for term infants. Preterm infants may have lower clearance of oseltamivir because of immature renal function, and doses recommended for full-term infants may lead to high drug concentrations in this age group. Limited data from the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group provide the basis for dosing preterm infants using their postmenstrual age (gestational age + chronological age): 1.0 mg/kg/dose, orally, twice daily, for those <38 wk postmenstrual age; 1.5 mg/kg/dose, orally, twice daily, for those 38 through 40 wk postmenstrual age; 3.0 mg/kg/dose, orally, twice daily, for those >40 wk postmenstrual age. For extremely premature infants (<28 wk postmenstrual age), consult a pediatric infectious disease physician. d Zanamivir is administered by inhalation using a proprietary “Diskhaler” device distributed together with the medication. Zanamivir is a dry powder, not an aerosol, and should not be administered using nebulizers, ventilators, or other devices typically used for administering medications in aerosolized solutions. Zanamivir is not recommended for people with chronic respiratory diseases, such as asthma or chronic obstructive pulmonary disease, which increase the risk of bronchospasm. American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.

Source: Centers for Disease Control and Prevention Source: Centers for Disease Control and Prevention. Antiviral agents for the treatment and chemoprophylaxis of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-1):1–24 American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2014–2015. Pediatrics. doi: 10.1542/peds.2014-2413. Available at: http://pediatrics.org/cgi/doi/10.1542/peds.2014-2413.