Management of Prevalent Infections in Children Following a Disaster

Post influenza complications are common. Influenza is an important cause of otitis media. Acute myositis characterized by calf tenderness and refusal to walk has been described especially with influenza type B. In infants, influenza can produce a sepsis-like picture and occasionally can cause croup, bronchiolitis, or pneumonia. Although the large majority of children with influenza recover fully after 3 to 7 days, previously healthy children can have severe symptoms and complications. Neurologic complications associated with influenza range from febrile seizures to severe encephalopathy and encephalitis with status epilepticus, with resulting neurologic sequelae or death. Reye syndrome has been associated with influenza infection and salicylate exposure. Death from influenza-associated myocarditis has been reported. Invasive secondary infections or coinfections with group A streptococcus, Staphylococcus aureus (including methicillinresistant S. aureus [MRSA]), Streptococcus pneumoniae, or other bacterial pathogens can result in severe disease and death.

Hospitalization rates among children younger than 2 years of age are similar to hospitalization rates among people 65 years of age and older. Children younger than 24 months of age consistently are at substantially higher risk of hospitalization than are older children, and the risk of hospitalization attributable to influenza infection is highest in the youngest children. Rates of hospitalization and morbidity attributable to complications, such as bronchitis and pneumonia, are even greater in children with high-risk conditions, including hemoglobinopathies, bronchopulmonary dysplasia, asthma, cystic fibrosis, malignancy, diabetes mellitus, chronic renal disease, and congenital heart disease. Influenza virus infection in neonates also has been associated with considerable morbidity, including a sepsislike syndrome, apnea, and lower respiratory tract disease. Fatal outcomes, including sudden death, have been reported in both chronically ill and previously healthy children. All influenza-associated pediatric deaths are nationally notifiable and should be reported to the CDC through state health departments.