January 10, 2012 — Influenza symptoms may be missed in children and young adults with neurologic and neurodevelopmental conditions, despite their being at increased risk for severe illness from influenza, according to a new report from the Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health.
“Clinicians caring for patients with neurologic and neurodevelopmental conditions should be vigilant for signs and symptoms that might indicate early respiratory illness,” the authors write in the January 6, 2012, issue of the CDC’s Morbidity and Mortality Weekly Report. They “should initiate influenza antiviral treatment as soon as warranted, especially during influenza season,” the authors write.
The current report, authored by Mary DiOrio, MD, an epidemiologist with the Ohio Department of Health, in collaboration with the CDC, describes several cases of severe influenza-related illness resulting in 10 hospitalizations and 7 deaths among 130 people in a residential facility for children and young adults with neurologic and neurodevelopment conditions.
During the outbreak, 76 residents had acute onset of respiratory illness; 13 were severely ill; 7 had confirmed influenza; and 6 had suspected influenza. Median age of the severely ill residents was 22 years; ages ranged from 14 to 33 years. All had been vaccinated with the influenza vaccine recommended for the 2010 to 2011 influenza season.
Among the 13 residents with severe influenza, neurologic diagnoses included severe to profound neurologic and neurodevelopmental disabilities, including physical limitations (eg, scoliosis, hemiplegia or quadriplegia, or cerebral palsy); 9 had “do not resuscitate” orders.
“For some of these residents, underlying medical conditions might have hindered early diagnosis and treatment and contributed to the severity of illness,” Dr. DiOrio and colleagues write.
Of the 13 severely ill residents, 8 (62%) received oseltamivir treatment, but only 4 (31%) received treatment within 48 hours of illness onset, the optimal timeframe for oseltamivir efficacy.
The authors note that prompt testing and early empiric antiviral treatment in residents with respiratory symptoms in residential or long-term care facilities is important.
Challenges in diagnosing influenza in this population include the fact that influenza symptoms may represent only a subtle deviation from their baseline medical status and that these individuals may be unable to communicate symptoms effectively, they write.
They may also be more at risk because they may be “less able to clear pulmonary secretions and be at increased risk for subsequent lower respiratory tract infection,” the authors note.
“Clinicians who care for these patients should be alert to potential signs and symptoms of influenza during influenza season and administer early and aggressive antiviral treatment if influenza is suspected,” they write. “Because influenza can appear as a nonspecific respiratory infection, clinicians should consider coadministration of empiric antiviral and antibiotic treatment, if warranted.”
The authors also suggest that personnel of residential care facilities continue to be vaccinated and that they should encourage influenza vaccination in these patients.
