Abstract
Seasonal influenza is a leading cause of morbidity and mortality worldwide annually
while pandemic influenza, a unique entity, poses distinct challenges. The pediatric
population is the primary vector for epidemics and the main focus of this article.
While primary prevention with universal influenza vaccination is the best protection
against significant illness, the antigenic shift and drift unique to influenza viruses
leave a large population at risk even with universal vaccination. Early in an epidemic
various diagnostic tests are available and discussed here. However, once an epidemic
is established, testing is no longer necessary for diagnosis. Groups with particular
vulnerability to serious illness include those <6 mo of age, children with underlying
neuromuscular disease, pulmonary disorders, or other comorbid conditions. Early treatment
with neuraminidase inhibitors is recommended for those with influenza infection requiring
hospitalization. Respiratory failure and need for mechanical ventilation are the leading
indications for intensive care unit admission among children. Complications of influenza
such as pneumonia, empyema, myocarditis and neurologic involvement increase risk for
intensive care unit admission and will be discussed as will the use of extracorporeal
membrane support. An overview of the epidemiology of influenza with an emphasis on
risk factors for critical illness and poor patient outcomes in the pediatric population
as well as treatment strategies for critically ill children will be presented. Additionally,
we will address some of the unique challenges posed by pandemic influenza and mitigation
strategies.
Keywords
Critical illness - influenza - pandemic - surge capacity
