Influenza causes approximately 20,000 deaths each year in the United States in annual winter epidemics.1 During pandemic periods, the death rate increases severalfold. Mortality is greatest in the elderly and in those with certain underlying medical conditions.
Why should general pediatricians be concerned about influenza? Rates of influenza infection are highest among children. As discussed by Ms. Arden, schoolchildren are the 'Typhoid Marys" of influenza, frequently bringing the disease home to their families.
Most of mese children recover uneventfully, although otitis media has been reported in 20% to 50% of preschool children infected with influenza.2'3 However, as described by Dr. Siberry, serious complications can occur, and pediatricians need to be able to recognize and treat them. In addition, two recent reports document high rates of hospitalization for very young children with influenza.4'5
What can pediatricians do to prevent and to treat influenza? The trivalent inactivated influenza vaccine is safe and effective, should be given to children with underlying high-risk conditions, and, as discussed by Dr. King, may be given to other groups of children. A live attenuated influenza vaccine administered by nasal spray has been shown to be safe and highly effective, and may be licensed in the next few years. Because it avoids another "shot," this vaccine may be more acceptable than the conventional vaccine to many families with young children.
As Dr. McMillan reminds us, immunization of health care workers may also help prevent disease in vulnerable patient contacts.
Although not a substitute for vaccination, several influenza antiviral agents may be used in children. As discussed by Drs. Casería and Hall, amantadme and rimantadine can be used for the prevention and treatment of influenza A infections, and the neuraminidase inhibitors zanamivir (approved for use in children 7 years and older) and oseltamivir (approved for those 18 years and older) may be used for the treatment of influenza A and B infections. Recommendations for the use of these new agents in children will undoubtedly evolve over time.
When will the next influenza pandemic occur? As stated by Drs. Subbarao and Bridges, "although timing is unpredictable, Oie occurrence of another pandemic is probably inevitable." International collaboration between the public health sectors and veterinary and agricultural authorities will be needed to ensure early detection of novel strains and implementation of prevention and control strategies.
I am grateful to my coauthors for their contributions regarding this illness of global importance. I would like to dedicate this issue to the memory of Dr. Mary Lou Clements-Mann, who first educated me about influenza and influenza vaccine development.
1. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations .of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000;49(RR03):l-38.
2. Henderson FW, Collier AM, Sanyal MA, et al. A longitudinal study of respiratory viruses and bacteria in the etiology of acute otits media with effusion. N Engl J Med. 1982^06:13771383.
3. Belshe RB, Gruber WC. Prevention of otitis media in children with live attenuated influenza vaccine given intranasally. Pediatr Infect Dis }. 2000; 19(suppl 5):S66-S77.
4. Neuzü KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Mea. 2000:342:225-231.
5. Izurieta HS, Thompson WW, Kramarz P, et al. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl } Mea, 2000;342:232239.