Modifying clinical practices to manage influenza in children effectively.

Children less than 5 years of age are at increased risk of morbidity from influenza infection compared with older children and adults aged 18-54 years. Although much of the disease burden can be prevented by annual vaccination, the misperception that influenza does not result in serious illness in children, including schoolchildren, contributes to ongoing low vaccination rates. In conjunction with community surveillance of influenza activity, rapid diagnostic tests can help identify influenza patients who may benefit from initiation of antiviral therapy. Antiviral therapy is most effective when started within at least 48 hours of the onset of symptoms, the earlier the better. The neuraminidase inhibitors oseltamivir and zanamivir are safe and effective as first-line treatments and prophylaxis for influenza in children. These agents have been shown to decrease symptoms and shorten the duration of illness, as well as to curb the spread of influenza infection. The neuraminidase inhibitors also have shown efficacy against influenza B infection and exhibit less viral resistance than the older adamantane antiviral class.