Showing papers by "Timothy M. Uyeki published in 2004"

Prevention and control of influenza : recommendations of the Advisory Committee on Immunization Practices (ACIP)

Abstract: This report updates the 2002 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51 [No. RR-3]:1-31). The 2003 recommendations include new or updated information regarding 1) the timing of influenza vaccination by age and risk group; 2) influenza vaccine for children aged 6-23 months; 3) the 2003-2004 trivalent inactivated vaccine virus strains: A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Hong Kong/330/2001-like antigens (for the A/Moscow/10/99 [H3N2]-like antigen, manufacturers will use the antigenically equivalent A/Panama/2007/99 [H3N2] virus, and for the B/Hong Kong/330/2001-like antigen, manufacturers will use either B/Hong Kong/330/2001 or the antigenically equivalent B/Hong Kong/1434/2002); 4) availability of certain influenza vaccine doses with reduced thimerosal content, including single 0.25 mL-dose syringes; and 5) manufacturers of influenza vaccine for the U.S. market. Although the optimal time to vaccinate against influenza is October and November, vaccination in December and later continues to be strongly recommended A link to this report and other information regarding influenza can be accessed at http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm.

Incidence of outpatient visits and hospitalizations related to influenza in infants and young children.

Abstract: Objective. The Advisory Committee on Immunization Practices currently encourages influenza vaccination for all children aged 6 to 23 months when feasible, based on studies that have demonstrated that young children have high hospitalization rates attributable to influenza. The Advisory Committee on Immunization Practices recently voted to recommend influenza vaccination for all children beginning during the 2004–2005 influenza season; information on the rate of outpatient visits due to influenza is needed to better evaluate the potential health impact and cost-effectiveness of the recommendation. We estimated the incidence of outpatient visits as well as hospitalizations for specific acute respiratory illnesses and for influenza-associated outpatient-visit and hospitalization rates among healthy infants and children in a Massachusetts health maintenance organization. Design/Methods. Surveillance data were used to identify when influenza viruses, respiratory syncytial viruses, and parainfluenza viruses were circulating in the greater Boston area during 1994–2000. Using computerized medical records, we identified outpatient visits and hospitalizations for selected respiratory illnesses. Outpatient-visit rates and hospitalizations attributed to influenza were calculated by subtracting the rate of visits during the periseasonal period from the rate of visits during the influenza period. Rates were stratified by age and risk for complications from influenza. Results. Between 1994 and 2000, there were 188 139 outpatient visits and 885 hospitalizations for respiratory illnesses in the study population. Among healthy children aged 6 to 23 months, the rate per 100 person-months for outpatient visits during influenza periods was 14.5 (95% confidence interval [CI]: 13.9 to 15.1), and the excess rate that could be attributed to influenza compared with the periseasonal period was 1.8 (95% CI: 1.1 to 2.4). Among healthy children, the rate of hospitalizations for acute respiratory disease was 10.4 per 10 000 person-months (95% CI: 6.0 to 17.0), and the rate that could be attributed to influenza when compared with the periseasonal baseline period was 3.9 (95% CI: −2.0 to 0.0). Among children who were at high risk for complications from influenza, the rate of outpatient visits per 100 person-months was 28.7 (95% CI: 26.6 to 30.9) during influenza periods. The rate of hospitalizations among high-risk children was 44.6 per 10 000 person-months (95% CI: 19.0 to 17.0). Conclusion. Influenza season is associated with a substantial increase in outpatient visits by healthy children. These estimates of outpatient visits for influenza will help quantify the potential health benefits and cost savings from influenza vaccination of healthy children aged 6 to 23 months.

Neurologic Complications Associated With Influenza A in Children During the 2003–2004 Influenza Season in Houston, Texas

Abstract: Objectives. Our objectives were to (1) describe the clinical characteristics of and viruses iso- lated from patients who presented with neurologic symptoms associated with influenza A infection and were hospitalized at Texas Children's Hospital during October and November 2003 and (2) to raise awareness of the neurologic complications of influenza among US children. Methods. We reviewed the medical and laboratory records of all children who were hospitalized with neu- rologic symptoms and who also had evidence of influ- enza virus infection by rapid antigen testing or viral isolation. Results. Eight children aged 5 months to 9 years with neurologic complications associated with influenza A were identified. None of the children had received the influenza vaccine. Four presented with seizures, 3 with mental status changes, and 1 with mutism. All but 1 of the patients had influenza A viral antigen detected in nasal wash samples. Influenza A virus was isolated in culture from nasal wash specimens obtained from 6 of the patients; influenza A virus was also isolated from the cerebrospinal fluid of 1 of these patients. None of the patients had serum metabolic abnormalities or other ce- rebrospinal fluid abnormalities. Three of the patients had brain imaging abnormalities. Five of the patients were treated with antivirals. All 8 of the patients sur- vived, 6 with complete recovery and 2 with sequelae (1 mild and 1 severe). Conclusions. Neurologic symptoms and sequelae were associated with influenza A virus infection in chil- dren during the 2003-2004 influenza season in Houston, Texas. Influenza should be considered in the differential diagnosis in patients with seizures and mental status changes, especially if they present with respiratory symptoms or during an influenza outbreak. Pediatrics 2004;114:e626-e633. URL: www.pediatrics.org/cgi/doi/ 10.1542/peds.2004-0143; encephalopathy, altered mental status, seizure, viral infection, infectious complication. ABBREVIATIONS. TCH, Texas Children's Hospital; RT-PCR, re- verse transcriptase-polymerase chain reaction; CSF, cerebrospinal fluid; EEG, electroencephalogram; MRI, magnetic resonance im- aging; CT, computed tomography; RSV, respiratory syncytial vi- rus; HSV, herpes simplex virus; ANE, acute necrotizing encepha- lopathy; CNS, central nervous system.

Clinical description of a completed outbreak of SARS in Vietnam, February-May 2003

Abstract: We investigated the clinical manifestations and course of all probable severe acute respiratory syndrome (SARS) patients in the Vietnam outbreak. Probable SARS cases were defined by using the revised World Health Organization criteria. We systematically reviewed medical records and undertook descriptive statistical analyses. All 62 patients were hospitalized. On admission, the most prominent symptoms were malaise (82.3%) and fever (79.0%). Cough, chest pain, and shortness of breath were present in approximately one quarter of the patients; 79.0% had lymphopenia; 40.3% had thrombocytopenia; 19.4% had leukopenia; and 75.8% showed changes on chest radiograph. Fever developed on the first day of illness onset, and both respiratory symptoms and radiographic changes occurred on day 4. On average, maximal radiographic changes were observed on day 10, and fevers subsided by day 13. Symptoms on admission were nonspecific, although fever, malaise, and lymphopenia were common. The complications of SARS included invasive intubation and ventilation (11.3%) and death (9.7%).