Immunize Georgia, Vol. 2 (Aug. 2006)

What's Inside

2Mumps Outbreak 4Influenza Season 2006-2007 5GRITS Kids First Champion Immunization Registry Insert Parent Pages
Immunize 2006vol.2
Georgia
A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND DHR'S GEORGIA IMMUNIZATION PROGRAM
Pneumococcal Vaccination Georgia Has Room for Improvement and Much to Gain
Pneumococcal bacteria are a leading cause of ear infections, as well as serious and sometimes deadly invasive diseases, such as meningitis, pneumonia and sepsis.
The highest rates of disease are in children less than 2 years of age. Invasive pneumococcal diseases (IPD) are also an important cause of disease and death in older adults and those with certain chronic medical conditions.
In 2000, the 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in the United States for children less than five years of age. This vaccine has significantly reduced IPD rates among children, as well as reducing antibiotic resistance among invasive pneumococcal bacteria. Between 2000 and 2002 in Atlanta, Georgia, children younger than 2 years old experienced an 82 percent decrease in invasive disease, and children 2 to 4 years old had a 71 percent decrease.1 The early benefits of PCV7 use have also included reduced transmission of disease to others. In addition to significant reductions in IPD within the targeted childhood age group, rates of IPD have fallen among older children and adults who were not vaccinated, a form of "herd immunity."2
Despite evidence that PCV7 provides valuable protection; some Georgia children are not receiving this vaccination in a timely manner. The 2004 National Immunization Survey reported that Georgia ranked 40th out of 51 states in providing three or more doses of PCV by 36 months of age, with an immunization rate of only 67.9 percent.3 Better childhood vaccination rates for PCV7 could benefit Georgia's children, as well as improving protection for adults by reducing pneumococcal transmission.
The 2006 Recommended Childhood and Adolescent Immunization Schedule recommends four doses of PCV for all children aged 2 to 23 months of age and for children aged 24 through 59 months who are at
continued on page 4

Spot Light

Mumps Outbreaks Exemplify the Need to Recognize and Report Vaccine-Preventable Diseases
Two mumps outbreaks have been identified in the United States within the past year.

In December of 2005, an outbreak of mumps began in Iowa and spread to several surrounding states during the spring of this year. Between January 1 and May 2, 2006, 11 states reported 2,597 cases of mumps to the Centers for Disease Control and Prevention (CDC).1 In the summer of 2005, the New York Department of Health (NYDOH) investigated an outbreak of mumps among campers and staff at a summer camp, identifying 31 cases.2 Even though measles, mumps, rubella and other vaccine-preventable diseases (VPDs) are rarely seen in the United States, sporadic outbreaks of such diseases can and do occur. These outbreaks illustrate the need for healthcare providers to be aware of vaccine-preventable diseases in their daily practice and report suspect cases to the Georgia Division of Public Health immediately.
The first mumps cases in the Iowa outbreak were identified among college students. The source of these cases is unknown; however, the virus genotype is documented to be the same responsible for a large outbreak in the United Kingdom in 2004-2005.3 In the U.S. outbreak, multiple factors potentially contributed to the spread of mumps. First, campus dormitory living, settings in which students are in close contact with each other for extended periods of time, facilitates transmission of infectious diseases. Second, delayed recognition, diagnosis and reporting of mumps cases may have also contributed to the spread of mumps. Third, many states do not have a college admission requirement for two doses of measles, mumps and rubella (MMR), and even two doses of MMR are not 100 percent effective in preventing disease.1 Other possible contributing factors are discussed in the May 18, 2006 Morbidity and Mortality Weekly Report (MMWR) Dispatch.
In the New York outbreak last summer, the index patient was identified as a 20-year-old man who came to the United States from the United Kingdom (UK) on June 19, 2005 to work as a camp counselor.2 He had not been vaccinated for mumps, and there was a large ongoing outbreak of mumps in the UK. On June 30, he developed left-sided parotitis, sore throat and a low-grade fever. The healthcare staff did not consider mumps as a diagnosis, so he was not isolated and continued to work among the camp population. Twenty-five additional cases of parotitis were identified among campers and staff between July 15-23, consistent with exposure beginning June 28. Mumps was not recognized by the healthcare staff at the infirmary or community healthcare providers until July 24.
These outbreaks emphasize the need for prompt recognition, diagnosis and reporting of vaccine-preventable diseases. All VPDs are reportable in Georgia, excluding influenza and varicella. A report of a VPD leads to a prompt public health investigation.

Public Health collaborates with healthcare providers and their patients to recommend and implement prevention and control measures, such as patient isolation, immunization and/or post-exposure prophylaxis. These efforts are often successful in minimizing disease transmission among close contacts and household members and can therefore prevent outbreaks.
Outbreaks of VPDs are ongoing where immunization coverage is poor and can occur in highly vaccinated populations, as no vaccine is 100 percent effective. Disease outbreaks are widespread in areas of the world where resources are limited. Today, air travel permits access to far-reaching and remote areas of the world within hours, significantly increasing the risk for exposure to vaccinepreventable disease. Healthcare providers are urged to keep current on the clinical presentations and diagnostic methods for vaccine-preventable diseases, especially those that are rare in the United States.
When your practice suspects a vaccine-preventable disease: Take action immediately by calling Public Health at
866-782-4584 to report a suspect case or clusters. Collaborate with Public Health to collect appropriate laboratory
specimens and implement prevention and control measures.
The Georgia Division of Public Health has a Web-based disease reporting system, the State Electronic Notifiable Disease Surveillance System (SendSS). Providers can report cases of notifiable disease conveniently from an office computer. To register, please go to http://sendss.state.ga.us. However, the Division of Public Health encourages providers to call immediately when they suspect a vaccine-preventable disease since collaboration and coordination of diagnostics and prevention measures are often necessary.
To review the Updated Recommendations for the Control and Elimination of Mumps, please go to the June 9, 2006 MMWR Report at http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5522a4.htm.
1.Centers for Disease Control and Prevention. Update: Multistate Outbreak of Mumps -- United States, January 1 -- May 2, 2006. MMWR. 2006; 55 (No. 20): 559-563.
2.Centers for Disease Control and Prevention. Mumps Outbreak at a Summer Camp -- New York, 2005. MMWR. 2006; 55 (No. 7): 175-177.
3.Centers for Disease Control and Prevention. Mumps Epidemic -- Iowa, 2006. MMWR. 2006; 55 (No. 13).
This article was contributed by Julie Gabel, DVM, MPH, Medical Epidemiologist with the Georgia Division of Public Health. n
Immunize Georgia / 2006 / VOL. 2 2

Immunize Georgia Welcomes Michelle Conner New Program Director for DHR's Georgia Immunization Program

Michelle Conner, BSN, MS, MBA, began her position as Director of the Georgia Immunization Program in January 2006. Conner received her Bachelor of Science Degree in nursing from Auburn University in 1990. Up to 1993, Conner worked as a pediatric nurse in a hospital setting. Starting in 1993, she served as a public health nurse in Troup County for seven years. From 2000 to 2002, Conner was the Child Health/Immunization Coordinator in a 12-county public health district. In 2002, she became the Vaccine Manager/Vaccines for Children (VFC) Coordinator for the Georgia Immunization Program, and served in this position until she was appointed Director of the Immunization Program. In May 2006, Conner received, after much hard work, a Master's Degree in Business Administration and a Master of Science Degree in Healthcare Administration from Auburn University all with a 4.0 GPA!!!
Immunize Georgia spoke with Conner recently as she discussed her goals, concerns and vision for the Georgia Immunization Program as she embarks on this new position.
Q: What are the top three goals for your first year as
Program Director of the Georgia Immunization Program?
A: I would like to maintain a focus on continuing the excellent
work of my predecessor, Mike Chaney, in improving immunization coverage rates not only among infants and children, but also adolescents and adults.
Second, with the assistance of a dedicated staff, I have also been working to ensure and secure ongoing funding for the underinsured children in Georgia. These children are not covered by either the federal VFC program or an insurance plan. Georgia has always been fortunate enough to be able to purchase vaccines for these children. Expansion of the Child and Adolescent Immunization Schedule has created a tremendous strain on the vaccine budget. However, it's something we can't afford NOT to do. We have to find a way to continue to provide vaccines for these "gap" children. By protecting them, we also protect our families and our communities. These goals are in alignment with the Georgia Division of Public Health's current emphasis on "prevention."
Lastly, enlisting providers to utilize all aspects of the Georgia Registry of Immunization Transactions and Services (GRITS) is a major goal. Providers who administer vaccines to children enrolled in the Georgia Healthy Families are required to submit shot data to GRITS in order to receive reimbursement. As a result, training for providers who have not begun using GRITS or "refreshers" for providers already using GRITS will be a huge priority.

Q: What are two primary issues Georgians are
currently faced with relative to immunizations?
A: As mentioned previously, funding for underinsured children
and their access to childhood immunizations are and will continue to be issues to address, especially as more vaccines are introduced. Ensuring high vaccination rates of Georgia's population is key in preventing diseases for Georgia's families.
Emphasis will always be on children, but we also have to think about our adults. A family perspective is the focus ensuring all members of the family, including grandparents, are protected. Georgia needs to improve its influenza and pneumococcal vaccine coverage rates for persons 65 years of age and older. The 2004 National Immunization Survey ranked Georgia fourth in the nation for coverage rates of the 2-year-old population for all of the routinely recommended vaccines. However, according to 2005 data from CDC's Behavioral Risk Factor Surveillance System (BRFSS), Georgia ranks 39th for pneumococcal vaccination and 44th for influenza vaccine coverage rates (out of 51 states) for adults aged 65 years and older. Therefore, Georgia will continue to keep the emphasis on both our children and adults 65 years of age and older to improve the low pneumococcal rates. (See cover article for more information.)
Q: What is the status of GRITS? A: GRITS is a birth-to-death registry and should be used as a
tool to increase immunization coverage in all ages and populations. The reminder-recall function in GRITS is a readily available tool that healthcare providers, public and private, can use to increase rates and to manage many functions of providing vaccines. The challenge is to get all healthcare providers thinking in terms of promoting immunizations and protecting those patients they regularly see not only in their practices and clinics, but also in their communities.
Q: What were the results of the 2005 Georgia
Population-Based Study?
A: The Georgia Immunization Study results for 2005 show
that 77 percent of children in Georgia have received all of the recommended vaccinations. This is a slight decrease from 81 percent in 2004. This dip in coverage rates coupled with the recent resurgence of vaccine-preventable diseases, such as mumps and pertussis, indicates that we cannot afford to become complacent with the work we are doing in immunization. We must continue to do everything we can to reduce missed opportunities to vaccinate and ensure that vaccines are available for all children in Georgia. Results can be viewed on the Web at http://health.state.ga.us/pdfs/ publications/reports/gaimmunizationstudy.05.pdf. n
Immunize Georgia / 2006 / VOL. 2 3

Influenza Season 2006-2007: Have You Been Vaccinated Against the Flu?

New recommendations for healthcare personnel (HCP) to receive influenza vaccinations will help decrease the transmission of influenza from caregivers to persons at high risk, thereby reducing influenza-related deaths. Even the Joint Commission on Accreditation of Healthcare Organizations has approved a requirement for hospitals and nursing homes to offer influenza vaccinations to all employees who work with patients starting in 2007. According to the Centers for Disease Control and Prevention, less than half the nation's health workers are vaccinated against influenza.1 The Healthy People 2010 objective is to achieve healthcare professional vaccination coverage levels of 60 percent by 2010.2
A study of adults under 65 years of age indicates that vaccination against influenza can reduce both direct medical costs and indirect costs from work absenteeism, including fewer healthcare provider visits, fewer lost workdays, fewer days working with reduced effectiveness and a decrease in antibiotic use.2
Factors which influence reluctance to receive the influenza vaccine include fear and misunderstanding of vaccine side effects, insufficient time or inconvenience, perceived ineffectiveness of the vaccine, medical contraindication, perceived low likelihood of contracting influenza, reliance on treatment with homeopathic medications, avoidance of medications and fear of needles.

Basic knowledge about influenza and participation in structured in-service education or conferences have been associated with improved vaccination rates. Removing administrative barriers and providing vaccine in locations at times easily accessible by HCP will also play a critical role in improving influenza vaccination rates in your practice.
Make plans now to ensure your staff is vaccinated against influenza this season. It may be beneficial to review the February 2006 MMWR Recommendations and Report, "Influenza Vaccination of Health-Care Personnel." Some of the key points include: Use strategies that will increase influenza vaccine acceptance. Obtain a signed declination from the HCP who declines
influenza vaccination for reasons other than medical contraindications. Monitor HCP influenza vaccination coverage and declination at regular intervals during influenza season and provide feedback to staff and administration.
1. "Flu Shots Favored for Hospital Staff." www.washingtonpost.com. Accessed on June 16, 2006.
2.Centers for Disease Control and Prevention. Influenza Vaccination of Health-Care Personnel. MMWR. February 24, 2006 / 55(RR02): 1-16. n

Pneumococcal Vaccination continued from page 1
increased risk for pneumococcal disease. Ideally, the fourth dose in the series would be given between 12 and 15 months of age, a goal that requires timely immunizations. There are benefits to ensuring children get all four doses and that the fourth dose is given as early as possible (i.e., on or after the first birthday). Prescribing information for PCV7 indicates a significant increase in serum antibody concentrations after the fourth dose. Since the period of greatest risk for IPD is under age 2 years, providing the fourth dose as early as possible optimizes protection at the time of highest risk. Other reasons to target "vaccines at a first birthday visit" include the decline in well-baby visits after age 12 months and other vaccines that children need at age 12 months.4 Following the recommended immunization schedule and providing vaccines in a timely manner will ensure children are fully protected.
Some children (e.g., children who are immunocompromised or asplenic or who have sickle cell disease, renal failure, nephrotic syndrome or chronic cardiopulmonary conditions) are at higher risk for IPD. In addition to PCV7, these children should also receive

one dose of the pneumococcal polysaccharide vaccine (PPV23) when they reach 2 years of age. This vaccine protects against 23 pneumococcal serotypes, some of which are not covered by PCV7.
Like high-risk children, high-risk adults need one dose of the PPV23. Unimmunized adults should receive a dose of PPV 23 when they reach age 65. High risk adults who were vaccinated prior to age 65 should receive a second dose on or after age 65 if five years have passed since the first dose. Pneumococcal vaccine can be given any time of the year. Because some risk groups overlap, patients who receive a flu shot should be assessed for their need for pneumococcal vaccination.
PPV23 is another vaccine with significant health benefits that is underutilized in Georgia. A recently published study showed that adults hospitalized for pneumonia who had received the pneumococcal vaccine were "40 to 70 percent less likely to die during hospitalization than either unvaccinated patients or patients
continued on back page
Immunize Georgia / 2006 / VOL. 2 4

GRITS Champion

Kids First Champions Immunization Registry

Kids First is a physician-directed organization focused exclusively on general pediatrics. The Kids First membership includes over 180 primary care pediatric physicians from 37 practices at 50 geographically-dispersed locations in metro Atlanta. The Kids First consortium represents pediatric care for more than 400,000 children in metro Atlanta. The organization formed in 1997, strives to promote excellent pediatric care and benefits from the collaboration of its member physician groups.

GRITS has over 5.7 million clients and 54 million immunizations records. Approximately
3,000 partners use GRITS.

Kids First Pediatric Alliance recently organized local private physicians in metro Atlanta to enter legacy loads into the Georgia Registry of Immunization Transactions and Services (GRITS). The legacy loads consisted of previous immunization records.
"Kids First is helping GRITS to gain a stronger presence in the metro Atlanta area, "said Thomas Moss, GRITS Manager. "When we began to focus our efforts in metro Atlanta, we knew from prior lessons learned that a key barrier to physician participation was the need to load historical immunization records into the registry. "Kids First identified the vital immunization information (i.e., DOB, first and last names, date of immunization) in the consortium's practice management systems that could be extracted to meet the required CDC standards."

According to Tom Finnerty, Kids First's Chief Operating Officer, Kids First guided its members in creating BATCH Flat Files

containing patient immunization history which they loaded into GRITS. Kids First identified the vital immunization information (i.e., DOB, first and last names, date of immunization) in the consortium's practice management systems that could be extracted to meet the required CDC standards."
"GRITS has been trying for almost five years to get private physicians to take a look at GRITS and use it in their practices" said Michelle Conner, Director of the Georgia Immunization Program. "With Kids First on board, we have a greater chance of maintaining their attention as the GRITS database grows."
A great example is Kids First consortium member, Children's Medical Group, PC (CMG). Since loading 150,000 historical records, the practice is entering immunization records into GRITS at a weekly average of over 3,000 records. Most recently, Children's Medical Group's total number of immunization records in the registry had reached over 300,000 records. "At first we thought it would be a nightmare to upload records from a practice of our size, especially uploading records as far back as 1996," said Connie Knight, Practice Administrator. "But the interface between GRITS and our system worked extremely well, and we strongly encourage other practices to go this route."
"Their numbers are very impressive, and we see the immediate impact of Children's Medical Group, PC, on the growth of GRITS," Moss said. "As a private physician, they have entered over 11,000 manual records, and this is an extraordinary accomplishment for most private physician practices."
For questions on how to become a GRITS partner, call GRITS at 404-463-0810 or visit http://health.state.ga.us/programs/immunization/ grits/.
This article was written by Connie F. Smith, Program Information and Marketing Coordinator, Georgia Immunization Program. n
The Kids First Pediatric Alliance is assisting GRITS in reaching the National Healthy People 2010 Goal, which is to enroll 95 percent of children under age 6 in an immunization registry by 2010. The goal of GRITS is to assure that all persons in Georgia receive appropriate, timely immunizations to lead healthy, disease-free lives.

Immunize Georgia / 2006 / VOL. 2 5

Pneumococcal Vaccination continued from page 4

with unknown status. Vaccinated patients also had a lower risk of developing respiratory failure, kidney failure, heart attack or other ailments."5 According to 2005 data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS), Georgia ranked 39th for pneumococcal vaccination (out of 51 states) for adults aged 65 years and older.6
With suboptimal vaccination rates and so much to be gained from vaccine use, we should work toward improving Georgia's pneumococcal vaccination rates.
1. Invasive Pneumonia and Antibiotic Resistance Decreased After Childhood Vaccine. David S. Stephens, MD. Posted on April 7, 2005. Accessed on June 20, 2006. http://www.sciencedaily.com/releases/2005/03/050325225905.htm.
2. Centers for Disease Control and Prevention. Direct and Indirect Effects of Routine Vaccination of Children with 7-Valent Pneumococcal Conjugate Vaccine on Incidence of Invasive Pneumococcal Disease United States, 1998-2003. MMWR. 2005; 54 (No. 36).
3. Estimated Vaccination Coverage with Individual Vaccines and Selected Vaccination Series Among Children 19-35 Months of Age by State and Immunization Action Plan Area U.S., National Immunization Survey, 2004. Children in the Q1/2004-Q4 2004 National Immunization Survey were born between February 2001 and May 2003.
4. Recommended Childhood and Adolescent Immunization Schedule United States, 2006. 5. Vaccinated Adults Less Likely to Die from Pneumonia. Posted on March 16, 2006.
Accessed on June 20, 2006. http://www.sciencedaily.com/releases/2006/03/060316002244.htm. 6. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. 2005 Data. http://www.cdc.gov/BRFSS/.
This article was contributed by Kathryn Arnold, MD, Medical Epidemiologist with the Georgia
Division of Public Health. n
Visit www.choa.org/immunization to access previous volumes of the Immunize Georgia newsletter and the Take 5 for Teens brochure.
2006 Children's Healthcare of Atlanta/CHDA919037 jt08.06 DPH06/120HW

ImmunGizeeorgia
Published by Children's Healthcare of Atlanta 1655 Tullie Circle NE, Atlanta, Georgia 30329-2321
Children's Healthcare of Atlanta 404-250-kids, www.choa.org
Immunize Georgia Angie Matthiessen, M.S.W. 404-785-7225, fax 404-785-7258 angie.matthiessen@choa.org
Georgia Immunization Program Ruth Gilmore, B.S.N. 404-657-3158, fax 404-657-1463 http://health.state.ga.us/programs/immunization/
Vaccines For Children Program 404-657-5013, fax 404-657-5736 800-848-3868, fax 800-372-3627
American Academy of Family Physicians Georgia Chapter 404-321-7445, www.gafp.org
American Academy of Pediatrics Georgia Chapter 404-876-7535, www.gaaap.org
CDC-INFO Contact Center 800-232-4636, www.cdc.gov/nip
CDC Spanish-Language Hotline 800-232-4636, www.cdc.gov/spanish/

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Parent Pages / Immunize Georgia / 2006 / VOL. 2
ParentPages ShotSmarts From Immunize Georgia

Mumps Outbreaks Confirm the Need to be on the Lookout for Diseases
Two mumps outbreaks have occurred in the United States within the past year. In December 2005, an outbreak of mumps was identified in Iowa and spread to several states during the spring of this year. In summer 2005, an outbreak of mumps occurred among campers and staff at a camp in New York.

Even though measles, mumps, rubella and other vaccine-preventable diseases (VPDs) are uncommon in the United States, outbreaks of VPDs can and do occur, and parents should be on the alert. Vaccinepreventable diseases are spread from person to person in close contact; therefore, schools or college campuses are ideal settings for disease outbreaks. Outbreaks can even occur among people who have been vaccinated, as no vaccine is 100 percent effective.

one of your family members becomes ill, you should contact your physician. Your physician will decide if you or your family member should have an examination. When a person is found to have an infectious disease, staff at the Georgia Division of Public Health may work with your physician to provide recommendations to prevent disease spread. You should always be sure that you and your family members are up to date on immunizations.

Iowa outbreak As of May 2006, over 2,500 mumps cases, largely from the Midwest, have been reported to the Centers for Disease Control and Prevention (CDC) as part of the outbreak that began in Iowa. A key factor that contributed to the spread of mumps in the Midwest was that it occurred among college students. Because many college students live in dormitories, where frequent and extended close contact with other students is common, mumps spread more easily.1 Meningitis is another VPD that can spread easily on college campuses.
Outbreak at a Summer Camp in New York The first mumps case in the camp outbreak was a 20-year-old British man who came to New York on June 19, 2005, to work as a camp counselor. There was an ongoing outbreak of mumps in the United Kingdom (UK) during 2004 2005, and it is likely that this young man was exposed to mumps at home before departing for the United States. The British counselor had not been vaccinated against mumps, and on June 30, he became ill with mumps-like symptoms. Because mumps is an uncommon disease in the United States, it was not considered as a cause for the counselor's illness. Therefore, the counselor continued to work among the camp population. As a result, 31 persons (campers and staff) became ill with mumps.2
In both of these outbreaks, mumps was not suspected in the initial cases, which led to spread of the disease. Early detection of vaccinepreventable disease is important to prevent outbreaks. When you or

Take Action: Make sure you and your family members are up to date on
immunizations. Keep a current record of the immunization histories for each of
your family members. Good hand washing is important to prevent disease. Hands
should be washed with soap and warm water and should be lathered for at least 15 seconds. When soap and water are not available, alcohol-based hand cleansers are appropriate. Send kids to school with pocket-sized alcohol cleansers. Teach and encourage proper respiratory etiquette. Coughs and sneezes should be covered with elbows or tissues whenever possible, and hands should be washed after coughing, sneezing or nose-blowing. Tissues should be thrown in the trash after use. When you or one of your family members becomes ill, be sure to call your doctor.
1.Centers for Disease Control and Prevention. Update: Multistate Outbreak of Mumps--United States, January 1--May 2, 2006. MMWR Dispatch. 2006; 55: 1-5.
2.Centers for Disease Control and Prevention.Mumps Outbreak at a Summer Camp--New York, 2005. MMWR. 2006; 55 (No. 7): 175-177. n

2006 Children's Healthcare of Atlanta/CHDA919037 jt08.06 DPH06/120HW Parent Pages are intended to be copied and distributed to parents.

www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/

Parent Pages / Immunize Georgia / 2006 / Vol.2

This Flu Season Protect Your Child, Protect Your Family

The following account is from Antonio's mother as she describes her baby's experience of suffering from influenza.

The first 10 months of Antonio's life progressed smoothly. He was a happy baby, always laughing. As fall arrived, Antonio began catching numerous colds and did not seem to recover as quickly as other babies his age. Since he was not in day care, I wondered why he contracted so many illnesses. His breathing would become labored, and he would vomit incessantly from the mucous build-up in his nose and lungs.
Just prior to Antonio's first birthday in October, he became very ill--he was unable to be consoled, had a very high fever, was listless and vomiting. When we arrived at the emergency room, his breathing was extremely labored, and he was excessively dehydrated from the fever and vomiting. He was admitted to the hospital and placed in a large, industrial-type crib with metal bars. Antonio's arm had to be tied down so that the intravenous fluids he was being given could be placed in his little arm. He was surrounded by an oxygen tent to aid with his breathing. Seeing a small baby in this condition is enough to break anyone's heart, but for a parent, it was heart-wrenching. He responded well to the treatments and was able to go home for close follow-up with his pediatrician.

shot. The staff person informed me there was a shortage and the vaccine was available only for high risk children. I told the nurse that he had been hospitalized twice last year and that he might be high risk. It wasn't until this time that the staff informed me that, in fact, he had been hospitalized due to complications from the flu and that since he also has asthma, he should receive the flu vaccine. Antonio had recently been diagnosed with asthma, which is a condition that is only diagnosed after a child exhibits ongoing symptoms. Since asthma may not be diagnosed until the second year of life, the realization that your child is high risk may come too late.
Each year, 36,000 people die from complications related to influenza. Antonio's parents experienced the heartbreak of watching their helpless infant suffer from flu complications and are now the first in line each year to vaccinate Antonio, his baby brother and themselves. They want to avoid the ultimate devastation that 150 families endure each year when their child dies from the flu. For more information about how some families have taken action since losing their children to the flu, please go to www.familiesfightingflu.org.

On October 22, he became irritable once again and started having high fevers. Three days later, he was prescribed Albuterol to help with his breathing, and the pediatrician kept a close watch on him to ensure he did not develop pneumonia. On November 17, I became very concerned about his condition--throughout the day he continued to vomit and had a very high fever. As the night wore on, he seemed to become more listless, but as day broke, Antonio's fever finally broke. I called the pediatrician to say he felt cold and clammy, but still so very listless.
The pediatrician directed me to rush Antonio to the hospital. Once in the emergency room, he again was given oxygen and intravenous fluids. While in the hospital, my husband and I learned that being cold and clammy was not a sign the fever had broken, but rather a dangerous sign that his blood pressure was too low. Three days later he was discharged to a very nervous set of parents. Fortunately Antonio made it through the rest of the flu season without any major illnesses.

Take action ALL children between 6 and 59 months of age and the
family members or caregivers of children age 0-59 months should be vaccinated against influenza each year. Ask your doctors, other healthcare providers and your child's teachers if they have received their flu shot. Seek immediate medical attention if your child shows any of the following symptoms, as they may be a sign of complications from the flu*: oHigh and prolonged fever (102F or above for more
than 72 hours) o Bluish or gray skin color o Drop in body temperature (hypothermia) o Difficulty with breathing o Not able to take in usual amount of fluids o Flu-like symptoms improve but then return with fever
and worse cough o Worsening of underlying medical conditions (for
example, heart or lung disease, diabetes)

Flash forward one year to the impending influenza season. I called the pediatrician to inquire about his need for a flu

* Taken from the www.familiesfightingflu.org http://www. familiesfightingflu.org . Accessed on June 20, 2006. n

2006 Children's Healthcare of Atlanta/CHDA919037 jt08.06 DPH06/120HW Parent Pages are intended to be copied and distributed to parents. www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/