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Section 2
Section 3
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Section 5
Appendices

The first 300 words of the full text of this section appear below.

Section 3. Summaries of Infectious Diseases

Influenza

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS

Influenza typically begins with the sudden onset of fever, often accompanied by chills or rigors, headache, malaise, diffuse myalgia, and nonproductive cough. Subsequently, respiratory tract signs including sore throat, nasal congestion, rhinitis, and cough become more prominent. Conjunctival injection, abdominal pain, nausea, vomiting, and diarrhea less commonly are associated with influenza illness. In some children, influenza can appear as an upper respiratory tract infection or as a febrile illness with few respiratory tract signs. Influenza is an important cause of otitis media. Acute myositis characterized by calf tenderness and refusal to walk has been described. In infants, influenza can produce a sepsis-like picture and occasionally can cause croup, bronchiolitis, or pneumonia. Although the large majority of children with influenza recover fully after 3 to 7 days, previously healthy children can have severe symptoms and complications. Neurologic complications associated with influenza range from febrile seizures to severe encephalopathy and encephalitis with status epilepticus, with resulting neurologic sequelae or death. Reye syndrome has been associated with influenza infection. Death from influenza-associated myocarditis has been reported. Invasive secondary infections or coinfections with group A streptococcus, Staphylococcus aureus (including methicillin-resistant S aureus [MRSA]), Streptococcus pneumoniae, or other bacterial pathogens can result in severe disease and death.


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ETIOLOGY

Influenza viruses are orthomyxoviruses of 3 genera or types (A, B, and C). Epidemic disease is caused by influenza virus types A and B, and both influenza A and B virus antigens are included in influenza vaccines. Type C influenza viruses cause sporadic mild influenza-like illness in children, and type C antigens are not included in influenza vaccines. Influenza A viruses are subclassified into subtypes by 2 surface antigens, hemagglutinin (HA) and neuraminidase . . . [Go to Full Text]


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  • Hall, C. B., Lieberthal, A. S. (2007). Viral Testing and Isolation of Patients With Bronchiolitis. Pediatrics 120: 893-894 [Full Version]  
  • Meropol, S. B. (2008). Valuing Reduced Antibiotic Use for Pediatric Acute Otitis Media. Pediatrics 121: 669-673 [Abstract] [Full Version]  
  • Shinall, M. C. Jr, Plosa, E. J., Poehling, K. A. (2007). Validity of Parental Report of Influenza Vaccination in Children 6 to 59 Months of Age. Pediatrics 120: e783-e787 [Abstract] [Full Version]  
  • Shuler, C. M., Iwamoto, M., Bridges, C. B., Marin, M., Neeman, R., Gargiullo, P., Yoder, T. A., Keyserling, H. L., Terebuh, P. D. (2007). Vaccine Effectiveness Against Medically Attended, Laboratory-Confirmed Influenza Among Children Aged 6 to 59 Months, 2003-2004. Pediatrics 119: e587-e595 [Abstract] [Full Version]  
  • Eisenberg, K. W., Szilagyi, P. G., Fairbrother, G., Griffin, M. R., Staat, M., Shone, L. P., Weinberg, G. A., Hall, C. B., Poehling, K. A., Edwards, K. M., Lofthus, G., Fisher, S. G., Bridges, C. B., Iwane, M. K., and the New Vaccine Surveillance Network, (2008). Vaccine Effectiveness Against Laboratory-Confirmed Influenza in Children 6 to 59 Months of Age During the 2003-2004 and 2004-2005 Influenza Seasons. Pediatrics 122: 911-919 [Abstract] [Full Version]  
  • Groom, A. V., Washington, M. L., Smith, P. J., Bryan, R. T. (2008). Underimmunization of American Indian and Alaska Native Children. Pediatrics 121: 938-944 [Abstract] [Full Version]  
  • Piedra, P. A., Gaglani, M. J., Kozinetz, C. A., Herschler, G. B., Fewlass, C., Harvey, D., Zimmerman, N., Glezen, W. P. (2007). Trivalent Live Attenuated Intranasal Influenza Vaccine Administered During the 2003 2004 Influenza Type A (H3N2) Outbreak Provided Immediate, Direct, and Indirect Protection in Children. Pediatrics 120: e553-e564 [Abstract] [Full Version]  
  • Pickering, L. K., Wallace, G., Rodewald, L. (2006). Too Hot, Too Cold: Issues With Vaccine Storage. Pediatrics 118: 1738-1739 [Full Version]  
  • Cummings, J. R., Lavarreda, S. A., Rice, T., Brown, E. R. (2009). The Effects of Varying Periods of Uninsurance on Children's Access to Health Care. Pediatrics 123: e411-e418 [Abstract] [Full Version]  
  • Moore, D. L., Vaudry, W., Scheifele, D. W., Halperin, S. A., Dery, P., Ford-Jones, E., Arishi, H. M., Law, B. J., Lebel, M., Le Saux, N., Grimsrud, K., Tam, T. (2006). Surveillance for Influenza Admissions Among Children Hospitalized in Canadian Immunization Monitoring Program Active Centers, 2003-2004. Pediatrics 118: e610-e619 [Abstract] [Full Version]  
  • (2009). Statement of Endorsement. Pediatrics 123: 1610-1610 [Full Version]  
  • Ampofo, K., Bender, J., Sheng, X., Korgenski, K., Daly, J., Pavia, A. T., Byington, C. L. (2008). Seasonal Invasive Pneumococcal Disease in Children: Role of Preceding Respiratory Viral Infection. Pediatrics 122: 229-237 [Abstract] [Full Version]  
  • Allison, M. A., Crane, L. A., Beaty, B. L., Davidson, A. J., Melinkovich, P., Kempe, A. (2007). School-Based Health Centers: Improving Access and Quality of Care for Low-Income Adolescents. Pediatrics 120: e887-e894 [Abstract] [Full Version]  
  • Vesikari, T., Fleming, D. M., Aristegui, J. F., Vertruyen, A., Ashkenazi, S., Rappaport, R., Skinner, J., Saville, M. K., Gruber, W. C., Forrest, B. D., for the CAIV-T Pediatric Day Care Clinical Trial N, (2006). Safety, Efficacy, and Effectiveness of Cold-Adapted Influenza Vaccine-Trivalent Against Community-Acquired, Culture-Confirmed Influenza in Young Children Attending Day Care. Pediatrics 118: 2298-2312 [Abstract] [Full Version]  
  • Vohra, S., Johnston, B. C., Laycock, K. L., Midodzi, W. K., Dhunnoo, I., Harris, E., Baydala, L. (2008). Safety and Tolerability of North American Ginseng Extract in the Treatment of Pediatric Upper Respiratory Tract Infection: A Phase II Randomized, Controlled Trial of 2 Dosing Schedules. Pediatrics 122: e402-e410 [Abstract] [Full Version]  
  • Vesikari, T., Karvonen, A., Smith, H. M., Dunning, A., Razmpour, A., Saville, M. K., Gruber, W. C., Forrest, B. D. (2008). Safety and Tolerability of Cold-Adapted Influenza Vaccine, Trivalent, in Infants Younger Than 6 Months of Age. Pediatrics 121: e568-e573 [Abstract] [Full Version]  
  • Nolan, T., Bernstein, D. I., Block, S. L., Hilty, M., Keyserling, H. L., Marchant, C., Marshall, H., Richmond, P., Yogev, R., Cordova, J., Cho, I., Mendelman, P. M., for the LAIV Study Group, (2008). Safety and Immunogenicity of Concurrent Administration of Live Attenuated Influenza Vaccine With Measles-Mumps-Rubella and Varicella Vaccines to Infants 12 to 15 Months of Age. Pediatrics 121: 508-516 [Abstract] [Full Version]  
  • Suntarattiwong, P., Thongtip, P., Sian-nork, C., Thawatsupha, P., Kitphati, R., Chotpitayasunondh, T. (2008). SURVEILLANCE OF INFLUENZA IN CHILDREN YOUNGER THAN 5 YEARS IN A TERTIARY CARE HOSPITAL IN BANGKOK, THAILAND. Pediatrics 121: S131-S131 [Abstract]  
  • Sandora, T. J., Shih, M.-C., Goldmann, D. A. (2008). Reducing Absenteeism From Gastrointestinal and Respiratory Illness in Elementary School Students: A Randomized, Controlled Trial of an Infection-Control Intervention. Pediatrics 121: e1555-e1562 [Abstract] [Full Version]  
  • Committee on Infectious Diseases, (2007). Recommended Immunization Schedules for Children and Adolescents--United States, 2007. Pediatrics 119: 207-208 [Full Version]  
  • Committee on Infectious Diseases, (2008). Recommended Immunization Schedules for Children and Adolescents United States, 2008. Pediatrics 121: 219-220 [Full Version]  
  • Committee on Infectious Diseases, (2009). Recommended Childhood and Adolescent Immunization Schedules--United States, 2009. Pediatrics 123: 189-190 [Full Version]  
  • Wagner, C. L., Greer, F. R., and the Section on Breastfeeding and Committee on, (2008). Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics 122: 1142-1152 [Abstract] [Full Version]  
  • Committee on Infectious Diseases, (2008). Prevention of Influenza: Recommendations for Influenza Immunization of Children, 2008-2009. Pediatrics 122: 1135-1141 [Abstract] [Full Version]  
  • Committee on Infectious Diseases, (2008). Prevention of Influenza: Recommendations for Influenza Immunization of Children, 2007-2008. Pediatrics 121: e1016-e1031 [Abstract] [Full Version]  
  • Committee on Infectious Diseases, (2007). Prevention of Influenza: Recommendations for Influenza Immunization of Children, 2006-2007. Pediatrics 119: 846-851 [Abstract] [Full Version]  
  • Kim, J. S., Sun Jo, D., Go, U., Park, B. H., Cho, H., Oh, D.-K. (2008). NATIONAL VACCINE INJURY COMPENSATION PROGRAM IN KOREA: A 12-YEAR EXPERIENCE. Pediatrics 121: S165-S165 [Abstract]  
  • Bailey, S. J. (2006). Missed Opportunities for Influenza Vaccination in Children With Chronic Medical Conditions. Pediatrics 118: S53-S53 [Abstract]  
  • Carpenter, L. R., Lott, J., Lawson, B. M., Hall, S., Craig, A. S., Schaffner, W., Jones, T. F. (2007). Mass Distribution of Free, Intranasally Administered Influenza Vaccine in a Public School System. Pediatrics 120: e172-e178 [Abstract] [Full Version]  
  • Finelli, L., Fiore, A., Dhara, R., Brammer, L., Shay, D. K., Kamimoto, L., Fry, A., Hageman, J., Gorwitz, R., Bresee, J., Uyeki, T. (2008). Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection. Pediatrics 122: 805-811 [Abstract] [Full Version]  
  • Poehling, K. A., Miller, E. K., Weinberg, G. A., Hall, C. B., Fairbrother, G. (2008). Influenza Virus and Acute Asthma in Children: In Reply. Pediatrics 121: 1080-1080 [Full Version]  
  • Jartti, T., Ruuskanen, O. (2008). Influenza Virus and Acute Asthma in Children. Pediatrics 121: 1079-1080 [Full Version]  
  • Krief, W. I., Levine, D. A., Platt, S. L., Macias, C. G., Dayan, P. S., Zorc, J. J., Feffermann, N., Kuppermann, N., for the Multicenter RSV-SBI Study Group of the Ped, (2009). Influenza Virus Infection and the Risk of Serious Bacterial Infections in Young Febrile Infants. Pediatrics 124: 30-39 [Abstract] [Full Version]  
  • Walter, E. B., Neuzil, K. M., Zhu, Y., Fairchok, M. P., Gagliano, M. E., Monto, A. S., Englund, J. A. (2006). Influenza Vaccine Immunogenicity in 6- to 23-Month-Old Children: Are Identical Antigens Necessary for Priming?. Pediatrics 118: e570-e578 [Abstract] [Full Version]  
  • Verani, J. R., Irigoyen, M., Chen, S., Chimkin, F. (2007). Influenza Vaccine Coverage and Missed Opportunities Among Inner-city Children Aged 6 to 23 Months: 2000-2005. Pediatrics 119: e580-e586 [Abstract] [Full Version]  
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  • Committee on Infectious Diseases, (2007). Infection Prevention and Control in Pediatric Ambulatory Settings. Pediatrics 120: 650-665 [Abstract] [Full Version]  
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  • Sittig, D. F., Teich, J. M., Osheroff, J. A., Singh, H. (2009). Improving Clinical Quality Indicators Through Electronic Health Records: It Takes More Than Just a Reminder. Pediatrics 124: 375-377 [Full Version]  
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  • Fiks, A. G., Hunter, K. F., Localio, A. R., Grundmeier, R. W., Bryant-Stephens, T., Luberti, A. A., Bell, L. M., Alessandrini, E. A. (2009). Impact of Electronic Health Record-Based Alerts on Influenza Vaccination for Children With Asthma. Pediatrics 124: 159-169 [Abstract] [Full Version]  
  • Chiu, S. S., Peiris, J.S. M., Chan, K. H., Wong, W. H. S., Lau, Y. L. (2007). Immunogenicity and Safety of Intradermal Influenza Immunization at a Reduced Dose in Healthy Children. Pediatrics 119: 1076-1082 [Abstract] [Full Version]  
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  • Lambert, S. B., Allen, K. M., Sloots, T. P., Nissen, M. D., Nolan, T. M. (2008). Human Metapneumovirus and Human Coronavirus NL63: In Reply. Pediatrics 121: 446-447 [Full Version]  
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  • Harris, J.-A. S., Huskins, W. C., Langley, J. M., Siegel, J. D., for the Pediatric Special Interest Group of the So, (2007). Health Care Epidemiology Perspective on the October 2006 Recommendations of the Subcommittee on Diagnosis and Management of Bronchiolitis. Pediatrics 120: 890-892 [Full Version]  
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  • Melendi, G. A., Laham, F. R., Monsalvo, A. C., Casellas, J. M., Israele, V., Polack, N. R., Kleeberger, S. R., Polack, F. P. (2007). Cytokine Profiles in the Respiratory Tract During Primary Infection With Human Metapneumovirus, Respiratory Syncytial Virus, or Influenza Virus in Infants. Pediatrics 120: e410-e415 [Abstract] [Full Version]  
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  • James, J. M. (2007). Cost of Influenza Hospitalization at a Tertiary Care Children's Hospital and Its Impact on the Cost-Benefit Analysis of the Recommendation for Universal Influenza Immunization in Children Age 6 to 23 Months. Pediatrics 120: S161-S161 [Abstract]  
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