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Advisory Issued Regarding Infections with H1N1

by Sue Hubbard, M.D.

The Centers for Disease Control and Prevention (CDC) sent a Health Advisory out to physicians today with an update on H1N1 disease and risk of secondary bacterial infections.It has recently been found that there have been more cases than expected of invasive pneumococcal disease (a bacterial infection) and pneumonia coincident with increases in influenza and influenza associated hospitalizations.

As we have talked about previously, the CDC as well as other health surveillance systems in the U.S. continue to monitor disease outbreaks, trends and recommendations for disease prevention as new data is received and evaluated. It is an active system.

Since the emergence of H1N1 last April, and the increased activity throughout the U.S. in the past two to three months, the CDC has continued to monitor hospitalized patients and also those who have died from influenza. Recently, pneumococcal infections have been identified as an important complication in severe and fatal cases of 2009 H1N1 viral infection. A causal relationship between 2009 H1N1 and this increase in pneumococcal infections has not yet established, but the CDC continues to work with state and local health departments on this issue.

Due to this there are new recommendations for use of pneumococcal vaccine in children. It is currently recommended that all children receive Prevnar (pneumococcal conjugate vaccine) beginning at two months of age. For children two years of age and older, who have underlying chronic diseases it is now recommended that they receive a single dose of pneumococcal polysaccharide vaccine, which contains different serotypes than the vaccine used in infants. This vaccine had previously been recommended to use in all adults beginning at the age of 65 years. But is it now recommended that children with diabetes, congestive heart failure or cardiomyopathies, chronic liver disease, cochlear implants, sickle cell disease, nephrotic syndrome, immunocompromising conditions (including HIV, leukemia, lymphoma and Hodgkin’s disease) as well as other malignancies and for those on immunosuppressive chemotherapy including steroids. It is also recommended for those children who have had an organ or bone marrow transplant.

So, if your child falls within any of these new guidelines, call your pediatrician to discuss this and their advice about administering a pneumococcal vaccine. This is also a good time to remember that the H1N1 vaccine is the best way to prevent getting swine flu and any of the complications secondary to that. 2009 H1N1 vaccine is becoming more widely available, and all children between six months and 24 years of age are in the high-risk category and should be immunized in a timely manner once vaccine is available.

That’s your daily dose, we’ll chat again tomorrow.

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