Treatment of Swine-Origin Influenza Virus Infection in Young Children

No vaccine is currently available to prevent S-OIV infection and it is thought unlikely that seasonal influenza vaccine will provide protection against this new virus. While not a substitute for a vaccine, a number of other interventions may be used to decrease the risk of infection and possible complications from S-OIV infection in children.

Influenza antiviral medications for use in children age 1 year and older

Antiviral treatment with oseltamivir or zanamivir is recommended for children with confirmed or probable S-OIV infection. See www.cdc.gov/swineflu/casedef_swineflu.htm for case definitions. Empiric antiviral treatment is also recommended for children with suspected cases of swine influenza A (H1N1) virus infection, especially those with severe illness. Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset. Recommended duration of treatment is five days. Recommendations for use of antivirals may change as data on antiviral effectiveness, side effects and antiviral susceptibilities become available. Antiviral doses recommended for treatment of S-OIV infection in children 1 year of age or older are the same as those recommended for seasonal influenza (Table 1).

Table 1. Recommended doses of zanamivir and oseltamivir antiviral medications for the treatment and prevention of influenza in children 1-18 years-old

Antiviral agent Age group (yrs)
1-6 7-9 10-12 13-18
Zanamivir* Treatment, influenza A and B N/A† 10 mg (2 inhalations) twice daily 10 mg (2 inhalations) twice daily 10 mg (2 inhalations) twice daily
Chemoprophylaxis, influenza A and B Ages 1-4
N/A
Ages 5-9
10 mg (2 inhalations) once daily
10 mg (2 inhalations) once daily 10 mg (2 inhalations) once daily
Oseltamivir Treatment†, influenza A and B Dose varies by child’s weight§ Dose varies by child’s weight§ Dose varies by child’s weight§ 75 mg twice daily
Chemoprophylaxis, influenza A and B Dose varies by child’s weight¶ Dose varies by child’s weight¶ Dose varies by child’s weight¶ 75 mg/day
Duration of Treatment Treatment Recommended duration for antiviral treatment is 5 days.
Chemoprophylaxis Recommended duration is 10 days after the last known exposure.

Children Younger than 1 Year of Age

Children less than one year of age are at higher risk for complications associated with seasonal human influenza virus infections compared to older children, and the risk of influenza complications is especially high for children less than 6 months of age. The characteristics of human infections with S-OIV are still being studied, and it is not known whether infants are at higher risk for complications associated with S-OIV infection compared to older children. However, children less than 1 year old are known to be at increased risk of complications from seasonal influenza infection and during previous pandemics. Limited safety data on the use of oseltamivir (or zanamivir) is available from children less than one year of age, and oseltamivir is not licensed for use in children less than 1 year old. Available data comes from use of oseltamivir for treatment of seasonal influenza. However, these data suggest that severe adverse events are rare, and the Infectious Diseases Society of America recently noted that “… limited retrospective data on the safety and efficacy of oseltamivir in this young age group have not demonstrated age-specific drug-attributable toxicities to date.”.

Because infants typically have higher rates of morbidity and mortality from influenza compared to healthy older children, infants with S-OIV infections may benefit from treatment using oseltamivir. Oseltamivir use for children less than 1 year old was recently approved by the FDA under an Emergency Use Authorization (EUA), and dosing for these children is age-based. (Table 2).

Table 2. Recommended doses of oseltamivir antiviral medication for the treatment of S-OIV influenza for children less than 1 year of age.

Age Recommended treatment dose for 5 days
❤ months 12 mg twice daily
3-5 months 20mg twice daily
6-11 months 25 mg twice daily

Use of fever-reducing medications in children

Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of swine influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.

Antiviral Chemoprophylaxis

For antiviral chemoprophylaxis of S-OIV infection, either oseltamivir or zanamivir are recommended for children 1 year of age or older (Table 1). Oseltamivir can be used for chemoprophylaxis under the EUA for children less than 1 year-old (Table 3). Under this EUA, chemoprophylaxis is not recommended for infants less than 3 months old unless the situation is judged to be critical. Duration of antiviral chemoprophylaxis post-exposure is 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. For pre-exposure protection, chemoprophylaxis should be given during the potential exposure period and continued for 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection.
Table 3. Recommended doses of oseltamivir antiviral medication for the prevention of swine influenza for children less than 1 year of age.
TABLE 3 HERE

Age Recommended prophylaxis dose for 10 days
❤ months Not recommended unless situation judged critical
3-5 months 20mg once daily
6-11 months 25 mg once daily

Antiviral chemoprophylaxis with either oseltamivir or zanamivir is recommended for the following children:

  1. Household close contacts who are at high-risk for complications of influenza (children younger than 5 years old , pregnant women, persons ≥65 years-old and those with certain chronic medical conditions) of a confirmed or suspected case.
  2. School children or daycare attendees who are at high-risk for complications of influenza (children younger than 5 years old, pregnant women, persons ≥65 years-old and those with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable, or suspected case.
  3. Children who traveled to Mexico who are at high-risk for complications of influenza (children younger than 5 years old pregnant women, persons ≥65 years-old and those with certain chronic medical conditions).

 

 

Supported  by
CLINIC FOR CHILDREN

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

http://childrenclinic.wordpress.com/

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

 

 

 

 

 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

Logo WordPress.com

You are commenting using your WordPress.com account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s