Más sobre vacunación contra la influenza en artículo remitido por mi prima Yanira Fernández, MD

Comparto este artículo sobre la vacuna de la influenza que me remitió mi querida prima Yanira Fernández, MD, que aunque suene subjetiva, considero que compone el mejor equipo de médicos de familia en Puerto Rico junto a su esposo, el Dr. Alberto Mulero. Además, son los padres de mis tres sobrinos que adoro, Albertito, Claudia y Javier.

Artículo en su texto original en inglés:

Pediatrics. Published online September 7, 2009.

Clinical Context

Given the current influenza pandemic, there is increased interest among patients and healthcare providers in the influenza vaccine this year. The current recommendations provide updates on the trivalent seasonal vaccine. The vaccine will contain the same 2 strains of influenza A as in 2008, but the B strain has been changed.

Clinicians need to be aware of potential complications of both the inactivated influenza vaccine and the live-attenuated influenza vaccine. Soreness at the injection site and fever are the most common adverse events associated with the trivalent inactivated vaccine, whereas the live-attenuated vaccine may produce mild symptoms consistent with influenza infection. The live-attenuated vaccine should be avoided among patients with a history of chronic pulmonary or cardiovascular disease; it is indicated for healthy individuals between the ages of 2 and 49 years.

The current policy statement was designed by an expert panel on infectious disease from the AAP. Their recommendations are summarized in the "Study Highlights" section.

Study Highlights

• Children from ages 6 months to 18 years should receive the influenza vaccine, regardless of their baseline risk for complications from infection.
• Household contacts and out-of-home care providers should also receive the vaccine if they are in contact with children younger than 5 years or with children at high risk for complications of influenza.
• Healthcare professionals and pregnant women should also receive the vaccine.
• The influenza vaccine may be administered as early as August and as late as May.
• Children 9 years and older may receive only 1 dose of the influenza vaccine. However, younger children receiving the vaccine for the first time should also receive a second dose at least 4 weeks after the first.
• Healthcare professionals and public health agencies should make vaccination as accessible as possible. Strategies to increase rates of vaccination include walk-in vaccination clinics and expanding venues for administering the vaccine.
• Children with moderate to severe febrile illness may delay influenza vaccination until their illness improves.
• Routine laboratory assessment does not differentiate between strains of influenza A, nor does it determine antiviral susceptibility.
• The accuracy of rapid tests for influenza A H1N1 virus has not been studied extensively, but 1 report suggested a sensitivity of 50%.
• Thus, if no testing is available, or a rapid test result confirms infection with influenza A, treatment should include both oseltamivir plus either amantadine or rimantadine. Among children 7 years or older, zanamivir may be used as single-drug therapy.
• Oseltamivir or zanamivir should be used when testing demonstrates infection with influenza B.
• Treatment of influenza should be considered for high-risk children regardless of immunization status.
• Antiviral treatment may also be considered among healthy children to reduce symptoms.
• Chemoprophylaxis with antiviral medications should be offered to high-risk children with potential exposure, even if they received the influenza vaccination. Chemoprophylaxis should also be considered for children younger than 24 months with a potential influenza exposure.
• Generally, chemoprophylaxis is not necessary for other individuals who received the vaccination.
• Clinicians should remain aware of new details and recommendations regarding the spread of the influenza A H1N1 virus, which is an evolving concern. Up-to-date information can be found on the CDC's Web site.

Clinical Implications

• The current recommendations call for vaccination against influenza among all children between the ages of 6 months and 18 years, regardless of the individual risk for complications of influenza. The vaccination season may run through May, and children 9 years or older may receive only 1 dose of the influenza vaccine.
• The current recommendations suggest that treatment of an unknown strain of influenza among young children should include both oseltamivir plus either amantadine or rimantadine