The pediatrician's role in influenza control.

Influenza is the most important of acute respiratory illnesses that cause persons to seek medical care. For infants some other viruses such as respiratory syncytial and parainfluenza viruses share in the assault but influenza is the only respiratory virus for which we have tools for prevention. We need to use these tools effectively to build a wall of protection around vulnerable patients. The fact that influenza vaccine does not have the same efficacy as other pediatric vaccines should not discourage its use but should challenge us to implement fully the current recommendations. Not only is influenza a slippery, changeable virus but also the pathogenesis of the infection and the host response are different. Influenza virus invades and destroys the respiratory epithelium and a viremic phase is not essential to this destruction. Therefore the virus is sheltered from many of the host immune and protective mechanisms that can be stimulated by natural infection or vaccines. Furthermore immunity to influenza tends to wane even after natural infection. Thus the challenge is to extend the utilization of the available vaccine and the antiviral to decrease the unrelenting serious morbidity associated with influenza. The hope is that better vaccines and antivirals will soon be available to aid in the battle. The cold recombinant vaccine, a live attenuated virus developed by Massaab, has potential for use in children. Rimantadine, an analogue of amantadine, has fewer side reactions and has been shown to be effective in children. Ribavirin, recently licensed for treatment of respiratory syncytial virus disease, is also effective for treatment of both influenza A and B viruses.