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Pandemic Influenza Planning for Pediatric Patients

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Created by experts at Childrens Hospital Los Angeles as a deliverable for the U.S. Department of Health and Human Services Healthcare Facilities Emergency Care Partnership Program Grant, the Information included in this document is based on learnings from the 2009 H1N1 Influenza outbreak that began in early 2009. The information is intended to provide supplementary recommendations for pediatric pandemic influenza planning and can be used as an addendum to a larger pandemic planning document
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H1N1 Flu Considerations in Obstetric Settings

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The Centers for Disease Control and Prevention (CDC) released interim guidance on July 6, 2009 for preventing and managing novel H1N1 infections in obstetric settings. Severe illnesses in pregnant women and infants have been a feature of the flu pandemic, though experts don't have a firm grasp on the epidemiology and illness spectrum.

Pandemic (H1N1) 2009: Treating Children

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Little is currently known about how H1N1 may affect children. However, we know from seasonal influenza and past pandemics that young children, especially those younger than 5 years of age and children who have high risk medical conditions, are at increased risk of influenza-related complications.

Tamiflu Antiviral Flu Medication: Availability, Mixing and Dosing Options

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Tamiflu is one of two antiviral medications that are effective against the H1N1 pandemic virus. Tamiflu is available in capsule and liquid (oral suspension) formulations. There are millions of treatment courses of Tamiflu in the U.S., and Roche continues to make all formulations of Tamiflu. However, deliveries of the liquid form to some locations are going to be sporadic this fall.

To ensure that Roche can meet public health needs during the H1N1 pandemic, they have increased production of the 75 mg capsules that can be used by adults OR converted to a liquid for children. This allows for the antiviral to be available to whomever may need it. By doing this, the medicine will be available to 25 times the number of children in the same amount of time it would normally take to make liquid version for one child.

Pharmacists may need to compound a liquid suspension using Tamiflu capsules and instructions were approved by the FDA in 2006. Instructions are included in the Tamiflu package insert.

To assist pharmacists and physicians, Roche developed these materials:

1. For pharmacists-- Instructions for emergency compounding of oral suspension from 75 mg capsules (to be used when liquid suspension is not available).

2. For physicians/prescribers -- Dosing card with overview of available formulations and dosing recommendations for adults and children.

Roche distributed a letter to U.S. pharmacists and other healthcare professionals to remind them to ensure that the units of measure written on the prescription for liquid formulations of Tamiflu are consistent with the units of measure on the device used to administer the medicine. Get more information here.

Health professionals may direct questions to the Roche Pharmaceuticals Service Center at 1-800-526-6367.

Tamiflu is recommended by the CDC for treatment and prevention of seasonal influenza as well as pandemic H1N1 influenza. Get more information here.

CDC also recently issued specific information for pharmacists regarding antivirals. Get more information here.

Pediatric Disaster Resource and Training Center

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The Pediatric Disaster Resource and Training Center provides training, resources and new models of virtual linkage with health care centers throughout Los Angeles County. By providing a unique environment that marshals all the forces of pediatric disaster training, they provide excellent resources and training for the health care community.

As a multi-disciplinary team, they come together to serve children facing crises. Their subject matter experts work in partnership with nurses and staff leaders to facilitate dialogue with community leaders about best practices in regard to children in disasters.

Pediatric Surge Pocket Guide

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Clinical checklists, guides, and just-in-time references to manage a surge of pediatric patients. This resource is being shared from Los Angeles County.

Pediatrics During Disasters

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All hospitals should plan for pediatric patients arriving during a disaster. The following document addresses the issues surrounding pediatric emergency care during a disaster.

It is presented under the supposition that all hospitals need to recognize the potential for receiving pediatric patients during a disaster and appropriately plan for pediatric mass casualty care. This resource is brought to you courtesy of New York City of Department of Health:

 
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