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Articles

In a recent study, infants of mothers with an influenza infection during pregnancy were significantly more likely to experience febrile seizures, but not epilepsy.

Maternal influenza linked to offspring seizure risk

. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

Brittany Bruggeman, MD, highlights the importance of newer, easier-to-use glucagon formulations in treating severe hypoglycemia in patients with type 1 diabetes.

New glucagon formulations simplify emergency treatment for T1D patients

Octavio Ramilo, MD, highlights key developments in the effort to prevent RSV disease in recent years, highlights vaccines and monoclonal antibodies.

The evolution of RSV disease prevention in infants

This week, take a look at an approval for EDS, as well as highlights from IDWeek 2024, held in Los Angeles, California. 

Weekly review: sodium oxybate approval, highlights from IDWeek 2024

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Clinical Focus

Trivalent seasonal influenza vaccines include 2 influenza A viruses (H1N1) and 1 influenza B virus.

What to expect during the 2024-2025 flu season

Offspring seizure risk associated with maternal influenza

With this approval, FluMist becomes the first vaccine to prevent influenza that does not need to be administered by a health care provider. 

FDA approves FluMist for self- or caregiver-administration

IIV3s, RIV3, and LAIV3 influenza vaccines are expected to be available. 

ACIP's seasonal influenza vaccine recommendations 

Courtney Nelson, MD, highlights the session she presented at the PAS annual meeting discussion racial and ethnic disparities for influenza vaccine delivery.

Emergency department serves as equitable location for influenza vaccine delivery

interview, Courtney Nelson, MD, attending physician, director of Quality Division of Emergency Medicine, Nemours Children's Hospital Delaware; assistant professor of Pediatrics, Sidney Kimmel Medical College, discussed racial and ethnic disparities of influenza vaccination in an emergency department (ED) delivery setting. 

Nelson was the presenting author of the session "Racial and Ethnic Disparities in an Emergency Department-Based Influenza Vaccine Delivery Model," held at the 2024 Pediatric Academic Societies meeting in Toronto, Canada. 

Since there are known racial and ethnic disparities in morbidity due to influenza, Nelson and colleagues sought to describe racial and ethnic differences in influenza vaccine acceptance and administration in an ED-based vaccine delivery model. 

"We know that nationally, Black children are much less likely to be vaccinated against the flu, whereas Asian families are much more likely to be vaccinated against the flu, so there's definitely a disparity in vaccination rates, and we see that same disparity within our institution," said Nelson in the interview.

According to the presentation abstract, a multidisciplinary team in 2020 consisting of ED nurses, physicians, educators, and analysts developed a vaccine delivery model "whereby nurses screen for vaccine eligibility during triage and vaccines are administered by the nurse upon discharge from the ED."

The vaccine delivery programs took place over 4 seasons:

Patients who had not received an influenza vaccine that season, who had no contraindications for the vaccine, and whose parents agreed to them receiving the influenza vaccine in the ED were considered eligible. 

Vaccine acceptance was defined as the percent of patients whose parents agreed to the influenza vaccination in the ED among those who did not have a flu shot that season. The percent of patients who received the vaccine among those who were eligible was vaccine administration. 

Across all 4 seasons, there were 33,678 patients screened who had not received their influenza vaccine for that influenza season. A total of 4782 (14.2%) parents agreed to have the influenza vaccine administered in the ED.

Of the 3231 eligible patients for the flu vaccine, 1608 (49.7%) received it. According to investigators, there was a significant difference in vaccine acceptance among racial and ethnic groups.

Data revealed that Hispanic patients were most likely to accept the influenza vaccine (16-28%), followed by patients classified as "other" (11-22%). Black, non-Hispanic patients were the least likely to accept the vaccine (9-15%), followed by White, non-Hispanic patients (10-19%) (

Among all groups, there was no statistically significant difference in the rate of influenza vaccine administration (

> 0.05, each season, respectively), according to the investigators. 

"What was sort of interesting to see over the years is vaccine acceptance actually decreased within our White population as well. So that gap is really narrowing between White and Black patients," added Nelson. 

"We probably need to do some more thoughtful thinking about why our acceptance rates are so low, especially among our Black children and their families, and how do we target that population to make sure that they're getting vaccinated at the same rates that everybody else is." 

Liboma C, Chara K, Wilson K, et al. Racial and Ethnic Disparities in an Emergency Department-Based Influenza Vaccine Delivery Model. Session presented at: Pediatric Academic Societies. May 2-6, 2024. Toronto, Canada.

Videos

Courtney Nelson, MD, highlights the session she presented at the PAS annual meeting discussing racial and ethnic disparities for influenza vaccine delivery. 

News

A review and reminder of the CDC immunization recommendations and schedule. 

CDC immunization recommendation updates with Mary Koslap-Petraco

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP:

Hi my name is Dr. Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP. I'm a pediatric nurse practitioner. I am a clinical assistant professor at Stony Brook University School of Nursing, and I have a private practice, and I'm a nurse consultant for immunize.org. My job is to synthesize the information that CDC puts out every year that they update on the annual ACIP or Advisory Committee on Immunization Practices schedule. So I go through and I pick out all of the things that are new and then I tell everybody what the new changes are, how it'll affect their practice, and then I show them where to find the information on the schedules. Because, the schedules can be very, very confusing, and I put it in a format that's easy to understand. I also listen to what CDC has done recently, so that I can highlight the important points for anyone who hears my talk.

Can you provide your update related to pediatric influenza?

I'd love to start with influenza, because honestly, there have been over 100 children who died in the United States, this influenza year, and the saddest part is most of those children were not vaccinated. So, we talked about some of the things that are new for influenza vaccine. Number one is egg allergy is no longer a contraindication. Another thing that we talked about was the new cell-based influenza vaccines that are looking extremely promising and offering even better immune response than our old egg-based technologies. So we will want to stay tuned to that to hear whether, all of the vaccines are going to go that way, but those cell based vaccines are already available.


What vaccines have been removed from the schedule?

There were several vaccines that were eliminated from the schedule. The previous versions of COVID vaccine were eliminated from the schedule, we now have the new one that's available. We're asking everybody to get that vaccine. We eliminated the pediatric DT from the schedule. Honestly haven't used that in years, that was for children who had an allergy, more specifically had recently had an encephalopathy following a DTaP. And specifically, it's the pertussis component, so that vaccine is no longer available and now we've been advised to use the adults strength tetanus diphtheria vaccine is a substitute with an off label recommendation from ACIP for those children, which is a very, very small number of children who can no longer take the diphtheria tetanus acellular pertussis vaccine. We've also now added a meningococcal combination vaccine. It's now meningococcal ABCWY vaccine that is wonderful for our older children who are getting the 2 vaccines that. We discussed a new schedule on how to give them subsequent doses of meningococcal B vaccine. We talked about where to find things. We talked about polio vaccine, because now the polio vaccine has really been more standardized and we have guidance for adults, because we're seeing immigrants. We may have immigrants or people traveling to endemic countries who were not vaccinated. But on another note, just about every adult in the United States has been vaccinated against polio, but our most recent vaccines over the last 20 years have been the killed virus vaccine. So now there's a recommendation for anyone who received killed virus vaccine, traveling to an endemic area to get a a polio booster. So that's been simplified. We also simplified the tetanus diphtheria, acellular pertussis the number of doses that are required if a child receives a fourth dose on or after the fourth birthday no more doses would be due. There was a simplification of the HPV vaccine because there was some question if some people have received the 2-strain vaccine or was a repeat series of of doses with the updated vaccine was that required for them? CDC has clarified that now and if they received, no matter what vaccine they received with the number of strains they received, as long as they received them at the appropriate intervals with the appropriate vaccine at those intervals, they're good, because we do have some cross data that shows any of the HPV vaccines do offer very high protection against cancer. We had a lot of discussion about RSV because we have two distinct products. For infants, we have a monoclonal antibody and mono means it covers one strain of RSV, and this is specifically for the babies. The optimal time to give it is in the hospital, especially for children who don't live in an area where it's easy to get to providers, the baby would leave the hospital with that protection on board already. But we also have the RSV vaccine for the pregnant moms, and the CDC has been very specific with the windows to give these vaccines within the the RSV season here in the United States. But Alaska really doesn't fall in that, so the recommendation is if you have a question whether or not you should be giving the vaccine to the mom, or the monoclonal antibody to the baby, check with your local health department. I also reminded people that if they have any questions about infectious diseases, especially now that measles has reared its ugly head again, and many of the providers today have not seen measles, please call your local health department they are ready willing and able to advise you help you, whatever support you need, they're there for you.

What resources are there for providers looking for clarification or refreshers when it comes to updated recommendations
on immunizations?

I highlighted immunize.org, which isthe go-to place for us as healthcare providers for information, it's really CDC information, but they synthesize it so well and make it so easy to find it. They have terrific handouts, because I did talk about making sure with COVID vaccine, that we're giving the right dose, the right amount to the right child, and CDC has come up with some terrific job aids to help them because I do follow the vaccine errors. There have been tons and tons of errors. The wrong vaccine given to the wrong age, the wrong volume given to the wrong age. To go back to the RSV vaccine, there's been, unfortunately, an awful lot of errors being made. The vaccine for adults for the older adults is being given to pregnant ladies, the vaccine for pregnant ladies is being given to the babies, the monoclonal antibodies been given to either pregnant ladies or older people. So we have to be very, very careful and make sure that we're reading those labels carefully. Having the guidelines right in front of us to make sure that we're giving the right dose to the right child in the right volume. The CDC has some really wonderful job aids and remember that the babies are getting the .25 dose that's appropriate for the babies and we have to just remember that and remember using the right, vaccine, but I pointed out the CDC's job aids. There are pictures with color coding on them, and to have those right in front of them when they're giving the vaccines because those job aids note the appropriate vaccine with the appropriate dose. So to have a visual like that is very, very helpful. I'm a visual learner and I liked having the colors I think is really very helpful. You can put them on the refrigerator door where the vaccines are stored, stick them on the countertop where you're drawing up the vaccines, but always keeping top of mind, [that] these are very confusing vaccines, it's very easy to make a mistake. Utilize every tool that we have in our toolbox to make sure that we're doing the right thing.

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, provided a review and reminder of the CDC immunization recommendations and schedule during her session at the 45th National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care in Denver, Colorado. 

Synthesizing CDC immunization recommendations with Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP

Ashley Gyura, DNP, CPNP-PC, provides updates presented at the 2024 NAPNAP National Conference, highlighting antiviral therapeutics.

Antiviral therapeutics for pediatric influenza, COVID-19, herpes

Hi, I'm Ashley Gyura, I am a pediatric nurse practitioner and I specialize in infectious diseases Children's Minnesota. 

Can you tell us about your session, “Antiviral Therapeutics for Pediatric Primary and Acute Care (Rx),”presented at NAPNAP 2024?

I presented this year on antivirals, there seemed to be a gap this year on some of the sessions, and so I wanted to make sure that anyone new to practice or even people who have been practicing for a long time got the updates that were needed for antivirals within pediatric primary and acute care. [My session was] an overview of the ones that we've been using for many years, but sometimes people can forget about them or are not sure how to use them. 

We went over pretty much the basic antivirals that you might use for normal viral infections that you might see in pediatrics. We looked at the safety and efficacy and dosing guidelines for those, and then looked at which medications we might use for specific viral infections. We also did a little bit of talking about what we see for emerging trends and future directions within antiviral therapeutics. 

One of the things that we initially focused on was 

 and the antivirals that are available, which are oseltamivir, or Tamiflu, and baloxavir. One of the questions I received from several people was the neuropsychiatric effects that can happen with oseltamivir. 

I think that, especially in social media, we certainly know that oseltamivir can have neuropsychiatric side effects, but there was also a study done in 2023 [that] looked at how many serious neuropsychiatric events happened in kids who have influenza, both with and without antivirals. 

It was interesting because these events do happen in kids who aren't taking antivirals and so I think that will help us know how to move forward looking at the events with oseltamivir. 

In a healthy kiddo, it's a conversation that you have with your patients. In kiddos who have a high risk of having severe influenza, the risk generally does not outweigh the benefit of getting oseltamivir, so we talked about that quite a bit.

Starting to seem more states test for congenital CMV, within their newborn blood spots, Minnesota was the first state to do that, which is where I'm based, and we started doing it early last year. Soon, Connecticut will follow in 2025 and New York is doing a pilot study for one year on testing DBS for congenital CMV. Remembering how we treat CMV and what kids are qualifying for treatment was another thing that we talked about, I think one of the biggest things that I'd like to impress is that there will be changes on this information and the 2024 red book. So I won't really get into exactly what the recommendations are now, because that will probably change come May when their 2024 red book comes out. But as more and more states start to test for congenital CMV, that will become more and more important for pediatric primary care providers to know the recommendations for medication, who qualifies for medication and the workup that's needed if they get a positive on that test.

We talked a little bit about the antivirals that we use right now for COVID, which specifically for children, we use primarily Paxlovid and remdesivir. Nothing specific has changed with those two medications other than with 

, there was a letter in January that changed the authorization for the emergency use authorization for Paxlovid, but it didn't actually affect using the medication under the EUA for those age groups. So the age groups that is under EUA for are greater than 12 years or greater than 40 kilos and then it is FDA approved for 18 and older. So really, that affects our kiddos but it doesn't change how we can prescribe it. It just changes, how the pharmacy kind of uses up what they had and then what they're supposed to use moving forward. So I think sometimes people can be a little bit confused about the what that meant. But clinically, it really didn't change anything about who we can prescribe it to. 

The other few things we talked about were what antiviral drugs that we use in herpes infections. There's haven't been a ton of changes there. There are a lot of different options based on patient preference, timing, what kind of episode they're having for herpes, whether it's a genital first outbreak, stomatitis, or recurrent outbreaks and that is for the provider and the patient to determine what would be the best option because there are several options. We also talked a little bit about pre-exposure prophylaxis for HIV. PrEP is something that I think can easily be done and encouraged in primary care. The only big update is we now have an injectable pre-exposure prophylaxis medication, which is great. So that makes 3 options that providers can use to try to prevent their adolescent patients from getting HIV, which includes Truvada, Descovy, and Apretude, which is the injectable medication and only needs to be given every 2 months, which is amazing. So those are the big updates and some of the things that we reviewed as well.

Ashley Gyura, DNP, CPNP-PC, provides updates presented at the 2024 NAPNAP National Conference, highlighting antiviral therapeutics for influenza, COVID-19, and herpes, among others.

Samantha Olson, MPH, explains the important role of a strong recommendation for maternal influenza vaccination.

Importance of maternal influenza vaccination recommendations

Following positive results from a study published in 

, study investigator Samantha Olson, MPH, epidemiologist, Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, joined 

to explain the importance of maternal influenza vaccination and its association with infant protection. 

"We know that infants have a high risk of hospitalization for influenza and other serious influenza complications," Olson said. "Infants are not eligible to receive that flu vaccine until they're 6 months of age, so really, mothers getting vaccinated during pregnancy provide that protection for both themselves and their infants until they're eligible for vaccination." 

Click here to watch Samantha Olson, MPH, explain her study with full results on maternal influenza vaccination and its respective association with influenza-related hospitalizations in infants.

Olson also reminds providers that influenza is still in season. 

"We expect flu cases to remain elevated over the next couple of weeks," said Olson. "So it's not too late to get vaccinated for pregnant persons, for those considering becoming pregnant, or those who are postpartum. It's not too late to receive that flu vaccine to provide protection to both themselves and their babies." 

"Also to the pediatricians, children 6 months and older are eligible for flu vaccination, so it is not too late for them to get vaccinated." 

In Olson and colleagues' study published in 

, results revealed that maternal vaccination was associated with a reduction in influenza-associated hospitalizations and ED visits in infants, providing protection until vaccine eligibility for infants at 6 months of age. 

This is the second video interview with Samantha Olson, MPH. 

Sahni LC, Olson SM, Halasa NB, et al. Maternal vaccine effectiveness against influenza-associated hospitalizations and emergency department visits in infants. 

 2024;178(2):176–184. doi:10.1001/jamapediatrics.2023.5639

Breakdown of a CDC study highlighting the effectiveness of a maternal influenza vaccine and its association with influenza-related hospitalizations in infants. 

Maternal influenza vaccination and associated infant hospitalizations

, maternal influenza vaccination during pregnancy resulted in protection for the infant during the first months of life, prior to influenza vaccination eligibility at 6 months of age. 

Samantha Olson, MPH, study investigator; epidemiologist, Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, joins 

 to break down the purpose of the study and provide detailed results. 

Results revealed that vaccine effectiveness was, "highest among hospitalized infants, those younger than 3 months, and those born to mothers vaccinated in the third trimester." 

"We saw that infants born to mothers that received influenza vaccination during pregnancy saw a reduction in hospitalizations in emergency department visits by approximately a third," Olson told 

Data from the 2016 to 2017 influenza season through the 2019 to 2020 influenza season, just prior to the start of the COVID-19 pandemic, was used in the study.

Since the pandemic, Olson noted, there has been a decline in pregnant persons who have received the influenza vaccine. 

"As of December 2023, in the current influenza season, we've seen about a 3% reduction since the last flu season." Olson said.

"When we compare to prior seasons, those prior to [the COVID-19 pandemic], we see about a 17% reduction from the current season to December 2019."

Samantha Olson, MPH, breaks down a study highlighting the effectiveness of maternal influenza vaccination and its respective association with influenza-related hospitalizations in infants. 

Todd Wolynn, MD, stresses the need for effective communication within the pediatric physician community to combat misinformation influenza vaccination.

Remaining Knowledge Gaps in Influenza Vaccines

This is a video synopsis/summary of a panel discussion involving Todd Wolynn, MD.

The speaker highlights the emergence of cell-based technology in vaccine development, emphasizing that a better match leads to improved vaccine efficacy. While hemagglutinin usually takes center stage in discussions, the speaker advocates for a deeper focus on neuraminidase, citing its stability and potential to reduce shedding and clinical symptoms.

Addressing a communication gap, the speaker urges healthcare providers to enhance their skills in effectively conveying vaccine safety and efficacy information. In the era of pervasive digital devices, the speaker points out that misinformation and disinformation, especially through social media, significantly impact individuals' vaccine-related choices. The speaker stresses the need for healthcare providers to be well-trained not only in traditional face-to-face communication but also in leveraging digital platforms to counter misinformation.

Highlighting the urgency of the matter, the speaker mentions the constant influence of devices in people's lives and emphasizes the importance of healthcare providers adapting to the digital landscape. They urge providers to seek resources for better training in both in-person and online communication to combat misinformation and ensure that individuals make informed decisions regarding vaccine safety and effectiveness.

Todd Wolynn, MD, stresses the need for effective communication within the pediatric physician community to combat misinformation, particularly about influenza vaccination.

Influenza

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