Course Management of Prevalent Infections in Children Following a Disaster

Influenza is spread from person to person primarily by respiratory droplets created by coughing or sneezing. Contact with respiratory droplet-contaminated surfaces or fomites is another possible mode of transmission. During community outbreaks of influenza, the highest attack rates occur among school-aged children. Secondary spread to adults and other children within a family is common. Incidence and disease severity depend, in part, on immunity developed as a result of previous experience (by natural disease) or recent influenza immunization with the circulating strain or a related strain. In temperate climates, seasonal epidemics usually occur during winter months. Peak influenza activity in the United States can occur anytime from November to May but most commonly occurs in January and February. Community outbreaks can last 4 to 8 weeks or longer. Circulation of 2 or 3 influenza virus strains in a community may be associated with a prolonged influenza season of 3 months or more and bimodal peaks in activity. Influenza is highly contagious, especially among semi-enclosed institutionalized populations.

Attack rates in healthy children generally have been found to be 10% to 40% each year, but illness rates as low as 3% also have been reported. Children younger than 5 years of age visit clinics or emergency departments for influenza illness at the rate of 1 to 2 children per 100 annually. Influenza and its complications have been reported to result in a 10% to 30% increase in the number of courses of antimicrobial agents prescribed to children during the influenza season. These medical care encounters for children with influenza result in considerable costs and likely are an important cause of inappropriate antimicrobial use.