Management of Prevalent Infections in Children Following a Disaster

Treatment is mostly supportive with rest, fluids, and antipyretics such as acetaminophen or ibuprofen. Aspirin and other salicylate-containing products should be avoided as it is associated with a rare severe complication called Reye Syndrome. Antivirals administered within 2 days of illness onset may have the greatest benefit to reduce the duration of uncomplicated influenza illness and should be considered for those who are at increased risk of severe or complicated influenza infection. Other candidates for antiviral therapy include healthy children with moderate to severe illness and people with special environmental, family, or social situations where ongoing influenza illness would be detrimental. Antiviral treatment should be continued for 5 days and be discontinued approximately 24 to 48 hours after symptoms resolve. Children with severe influenza should be evaluated carefully for possible coinfection with bacterial pathogens, such as Staphylococcus aureus, that might require antimicrobial therapy.

In the United States, two classes of antiviral medications are available for treatment or prophylaxis of influenza infections: neuraminidase inhibitors (oseltamivir and zanamivir) and adamantanes (amantadine and rimantadine). Treatment has been shown to decrease the duration of flu-related symptoms by 1 to 1.5 days. Oseltamivir has been approved for chemoprophylaxis and treatment of patients older than one year old. Zanamivir has been approved for treatment in patients 7 years and older and chemoprophylaxis of patients age 5 years and older.

Influenza B viruses intrinsically are resistant to adamantanes and since 2005 all H3N2 strains in the United States have been resistant to adamantanes. During the 2008–2009 influenza season, virtually all H1N1 influenza strains were resistant to oseltamivir but remained susceptible to zanamivir, amantadine, and rimantadine. The most recent pandemic 2009–2010 H1N1 strain was once again susceptible to oseltamivir.

These resistance patterns among circulating influenza A virus strains present challenges in selecting antiviral medications for treatment and chemoprophylaxis of influenza and provide additional reasons for clinicians to test patients for influenza virus infection and to consult surveillance data in their community when evaluating people with acute respiratory tract illnesses during the influenza season. Specific drug recommendations for treatment and chemoprophylaxis may vary by season, geographic location, and level of circulating viral resistance. The CDC website provides current recommendations for treatment and chemoprophylaxis of influenza.

Zanamivir (Relenza®) is available as a dry powder administered via oral inhalation with a plastic device. The dose is two breath-activated inhalations (one 5 mg blister per inhalation = 10 mg) bid for 5 days. Zanamivir is not recommended for use in patients with underlying airway disease including asthma or COPD, because of a lack of safety and efficacy data in these patients. Oseltamivir (Tamiflu®) is available as pills or liquid and is given twice daily for 5 days, with dose adjustments required in renal impairment. Pediatric dosing of oseltamivir for 1–12 years is 2 mg/kg/dose bid x 5 days (max. dose = 75 mg) and for 13 years and older: 75 mg bid x 5 days.