Joseph A. Bocchini Jr., MD, FAAP

There is much good news in the efforts to keep the H1N1 pandemic from worsening, but the main message from the Academy is to stay current on the latest news.

"It is important to stay up to date. This is a rapidly evolving pandemic," Joseph A. Bocchini Jr., MD, FAAP, chair of AAP Committee on Infectious Diseases, said during the October 20 plenary session.

The disease is considered "widespread" in more than 40 states, according to the Centers for Disease Control, with which the AAP has worked closely to develop recommendations for pediatricians because H1N1 is such a threat to children. The 2009-2010 treatment algorithm for children with influenza is available on the AAP website.

Dr Bocchini reviewed the key epidemiologic findings and data related to H1N1 during his plenary presentation, "2009 H1N1 Influenza A Update."

The highest incidence of laboratory-confirmed cases is in school-age children, with the greatest hospitalization rate among children less than age 2. The hospitalization rates for children ages 2 to 17 are at or above the usual rates for seasonal influenza.

In the first data regarding H1N1 this season, published in the New England Journal of Medicine, 60 percent of patients have underlying risk factors, the greatest of which is asthma, with 21 percent, Dr Bocchini said.

Also worth noting is that 11 percent of the cases were pregnant women, even though they normally make up only 1 percent of the general population, he said.

According to the initial CDC report on H1N1, of the first 36 pediatric deaths, 67 percent had one or more high-risk medical conditions. Of that 67 percent, 92 percent had neurodevelopmental conditions, such as cerebral palsy, and 41 percent had chronic pulmonary conditions.

In the same report, 22 percent of the deaths were children age 5 or older with no high-risk conditions, and 43 percent had laboratory tests confirming a secondary bacterial infection, including MRSA.

"It is very important to remember to include antibiotic therapy when indicated, and that should include coverage for MRSA," Dr Bocchini said.

Key recommendations for the use of antivirals for treatment of H1N1 in children:

• The majority of previously healthy children over age 2 will not require antiviral therapy.
• Prompt empiric antiviral therapy with oseltamivir and zanamivir is recommended for severe illness, evidence of clinical deterioration regardless of previous health, symptoms of lower respiratory tract involvement and illness requiring hospitalization.

Antiviral therapy is recommended for children under age 2, pregnant women, persons with chronic medical or immunosuppressive conditions, persons under age 19 receiving long-term aspirin therapy or those age 65 or older.

Dr Bocchini also reminded physicians to take care to have the right dose of oseltamivir pediatric suspension, which is pre-packaged in specific mg/mL doses.

Other notes regarding H1N1:

• The H1N1 vaccine does not provide cross-protection against seasonal flu.
• There have been no significant antigenic changes in the virus since April.
• The H1N1 vaccine can be administered simultaneously with the season flu vaccine.
• Children aged 6 months through 9 years (to the 10th birthday) will need two doses, approximately four weeks apart for the H1N1 vaccine.