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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.

Prevention of Influenza Virus Infection Among Children

To provide physicians with current information and recommendations for the prevention of influenza virus infection among children.

This activity is designed for pediatricians and primary care physicians.

After reading this issue, the participant should be able to:

  • Describe the epidemiology of influenza infection in children.
  • Discuss the disease burden of influenza in children <2 years of age and among high-risk children.
  • Describe influenza vaccine usage among children.
  • Discuss the immunogenicity and efficacy of influenza vaccine in children.
  • Review approaches to improve future vaccination rates in children.

This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 2 hours in Category 1 credit toward the American Medical Association Physicians' Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of June 30, 2004.

This continuing education activity was produced under the supervision of Julia A. McMillan, MD, Professor of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

This program is supported by an unrestricted educational grant from Aventis Pasteur.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

The contents of this issue of Advanced Studies in Medicine include highlights from a Satellite Symposium, Supported by Aventis Pasteur, and the Scientific Sessions at the 2001 American Academy of Pediatrics National Conference and Exhibition held October 17-22, 2001, in San Francisco, California.


    Julia A. McMillan, MD
    Professor of Pediatrics
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr McMillan reports no financial or advisory relationship with any pharmaceutical company.


    Kathryn M. Edwards, MD
    Professor of Pediatrics
    Vanderbilt University School of Medicine
    Nashville, Tennessee
    • Dr Edwards reports receiving grant/research support from Aventis Pasteur and GlaxoSmithKline.

    W. Paul Glezen, MD
    Professor, Department of Molecular Virology and Microbiology
    Professor and Head
    Preventive Medicine Section
    Department of Pediatrics
    Baylor College of Medicine
    Houston, Texas
    • Dr Glezen reports serving on the speakers' bureaus for Roche, Wyeth-Lederle Vaccines, and Aventis Pasteur.

    Vincent J. Grant, MD
    Clinical Fellow
    Pediatric Emergency Medicine
    University of Ottawa
    Division of Emergency Medicine
    Department of Pediatrics
    Children's Hospital of Eastern Ontario
    Ottawa, Ontario, Canada
    • Dr Grant reports no financial or advisory relationship with any pharmaceutical company.

    Neal A. Halsey, MD
    Professor and Director
    Johns Hopkins University
    Division of Disease Control
    Baltimore, Maryland
    • Dr Halsey reports receiving grant/research support from SmithKlineBeecham and financial and material support from the Gates Foundation.

    Sharon Humiston, MD, MPH
    Assistant Professor of Emergency Medicine
    Department of Emergency Medicine
    University of Rochester
    School of Medicine and Dentistry
    Rochester, New York
    • Dr Humiston reports receiving research support from Aviron and lecture support from Aventis Pasteur.

    Jerome O. Klein, MD
    Professor of Pediatrics
    Boston University School of Medicine
    Vice-Chairman for Academic Affairs, Department of Pediatrics
    Boston Medical Center
    Boston, Massachusetts
    • Dr Klein reports serving as a consultant to Roche and Aventis Pasteur.

    Walter Orenstein, MD
    Assistant Surgeon General
    Director, National Immunization Program
    Centers for Disease Control and Prevention
    Department of Health and Human Services
    Atlanta, Georgia
    • Dr Orenstein reports no financial or advisory relationship with any pharmaceutical company.

    Melinda Wharton, MD
    Director, Division of Epidemiology and Surveillance
    National Immunization Program
    Centers for Disease Control and Prevention
    Department of Health and Human Services
    Atlanta, Georgia
    • Dr Wharton reports no financial or advisory relationship with any pharmaceutical company.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Prevention of Influenza Virus Infection Among Children
Kathryn M. Edwards, MD*; Jerome Klein, MD

Influenza infection remains a major health problem, causing substantial morbidity, particularly among children, who have high rates of inpatient and outpatient care during influenza season. Current recommendations for influenza immunization by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices target patients with underlying medical conditions associated with increased risk, such as asthma and other chronic pulmonary diseases. Nonetheless, national surveys suggest that no more than 10% to 30% of high-risk children are immunized each year, the lowest rate of immunization for any recommended vaccine in pediatrics.

Findings from recent studies indicate that previously healthy children younger than 2 years of age have high rates of influenza-associated hospitalization, approaching influenza hospitalization rates observed in patients who are older than 65 years of age, another group targeted for vaccination. The findings have led to debate about the need to expand influenza vaccination recommendations to include otherwise healthy children, especially very young children, as well as high-risk pediatric populations.

This issue of Advanced Studies in Medicine focuses on the health burden of influenza and the role that immunization can play in reducing that burden. The articles summarize relevant presentations from the AAP 2001 National Conference and from the continuing education symposium, "Prevention of Influenza Virus Infections Among Children," held in conjunction with the AAP annual meeting.

This issue begins with a discussion of the epidemiology and disease burden of influenza infection. This article, based on a presentation by W. Paul Glezen, MD, includes insights into how viruses that normally infect only birds and nonhuman mammals undergo alterations that enable them to infect humans, then discusses how viruses continue to evolve after invasion of human hosts.

Data from recent studies show that a fifth of children hospitalized for acute respiratory conditions have influenza virus infections, usually when the virus is prevalent in the community. In addition, a considerable portion of children with nonrespiratory conditions have an influenza virus infection. Studies also show that children at highest risk have the lowest uptake of influenza vaccine, despite compelling evidence vaccination protects not only the children themselves but parents, teachers, and others who come in contact with the children.

Numerous studies have documented the efficacy of the currently available inactivated influenza vaccines for prevention of influenza infection in children. Selected studies are reviewed in detail. Additionally, a survey provides some insights into reasons for low rates of influenza immunization among children, including the important contribution of physician encouragement and recommendations.

Various types of interventions can improve immunization rates. However, the commitment of the individual physician or health care provider can never be underestimated. That point is made by Sharon Humiston, MD, MPH, in her article, which illustrates how influenza immunization can be encouraged and provided without disruption to the clinic schedule or financial burden to the provider or parents of pediatric patients.

Another study presented by Vincent Grant, MD, compared knowledge and attitudes of parents whose children had been immunized against influenza with parents whose children had not been immunized. The survey results showed widespread lack of knowledge about the etiology and symptoms of influenza illness. The findings also emphasized the importance of a physician's recommendation and encouragement in parents' decision to have their children vaccinated.

A review of current issues affecting the national immunization program based on a presentation by Neal A. Halsey, MD, indicates that the delivery system has become increasingly complex. Vaccine shortages, poor reimbursement, and parental resistance and refusal represent just a few of the challenges faced by providers of immunization services.

Finally, representatives of the national immunization program discuss impending changes in recommended immunization schedules, strategies for providing immunizations during periods of vaccine shortage, and new safety requirements from the Occupational Safety and Health Administration. In their presentation, Walter Orenstein, MD, and Melinda Wharton, MD, provided a summary of the factors that have complicated delivery of immunization services in the United States.

Collectively, the articles included in this issue provide a snapshot of the current status of influenza infection and the national immunization program. Any health care provider involved in the delivery of immunization services will find the information insightful and useful. At the same time, health care professionals can obtain continuing education credits by completing the brief test that accompanies this publication.

*Professor of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Professor of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.

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