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The wrath of influenza


There are two articles in the March 2018 issue of Contemporary Pediatrics that merit your attention: Dr. Bass’ article on “Is it the flu?” and Ms. Zimlich’s article on “Major vaccines addressed in updated ACIP guidelines.”

There are two articles in the March 2018 issue of Contemporary Pediatrics that merit your attention: Dr. Bass’ article on “Is it the flu?” and Ms. Zimlich’s article on “Major vaccines addressed in updated ACIP guidelines.” Dr. Bass describes the use of rapid testing for influenza in office practices and emergency departments as part of the decision making to test and treat children presenting with flu symptoms. In her article, Ms. Zimlich takes a look ahead at the next year’s potential flu season. There are advantages to reading both articles and then reviewing your current office practices to determine both primary and secondary prevention strategies to combat the wrath of influenza.

The grim toll

A study in Pediatrics by Shang, Blanton, Brammer, Olsen and Fry (2018) analyzed deaths in children under 18 years of age for the 2010-2011 to the 2015-2016 influenza seasons.1  They cited 677 reported deaths, with a median age of 6 years, with the highest death rates in infants younger than 6 months old. Other data of significance included information that one half of the children who died had no known pre-existing medical conditions, over 65% of the children died within 7 days of symptom onset, and only 31% of infants older than 6 months had received any influenza vaccinations.

3 steps towards change

To look forward with a determination to change the future requires an analysis of past and present trends during the influenza season. Shang et al. (2018) provide the evidence, the analysis, and the results for the past which are disconcerting. So, we must ask ourselves, what can we do in the present and future to create a significant change?

Dr. Bass’ discussion on office-based diagnostic testing for clinical decision making and prescribing of antiviral drugs is Step One. As influenza symptom onset to death was reported as a mere 7 days (Shang et al.), obtaining the diagnosis, using the evidence-based guide for flu testing, and beginning treatment may alter both current and future seasonal influenza rates.

The consequence of refusal

Is Step Two, to change from ACIP guidelines and recommendations to required and mandated flu vaccines for all infants, children, adolescents, and pregnant women?  Actions to change the future require not only the scientific evidence, but equally as important, a passionate, emotional response by healthcare providers who no longer want to hear that even one infant, child, or adolescent lost their life to the wrath of influenza because they did not have access to the flu vaccine. Lack of access because the parent said no to a vaccine is unacceptable!  

Efficacy, analysis and passion

Step Threeis comprised of the continued efforts to refine the flu vaccine to improve effectiveness, to further analyze the immune responses of pediatric patients to the flu vaccine, and to harness the passionate, emotional responses of healthcare providers to foster changes in public health policy and mandate flu vaccines.


1. Shang, M., Blanton, L., Brammer, L., Olsen S.J., and Fry, A. M. (2018). Influenza-associated pediatric deaths in the United States, 2010-2016. Pediatrics, 141, 1-9. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2018/02/09/peds.2017-2918.full.pdf

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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