Sex: U
Vaccine: FLU3
Symptoms: Acute respiratory distress syndrome, Chest X-ray abnormal, Cough, Death, Hypotension
Clinical narrative: This case was reported in a literature article and described the occurrence of influenza A in a subject of unspecified age and gender who was vaccinated with FLULAVAL (GlaxoSmithKline). This case corresponds to patient A in the literature article. The subject's medical history included aspiration pneumonia and history of abnormalities noted on chest radiography. Concurrent medical conditions included inability to move, inability to speak, cerebral palsy, intellectual disability and neurological impairment. Between October and November 2010, the subject received an unspecified dose of FLULAVAL (administration site and route unknown) which was incorrectly stored: the vaccine refrigerator temperature was considerably below optimal temperature during the investigation. On 19 February 2011, within months of vaccination with FLULAVAL, the subject experienced fever (38.4 deg.C). His oxygen saturation was 88% on room air. On illness day 2, the subject developed mild cough and wheezing. On day 3, he became tachypneic and required increased respiratory suctioning. On day 5, the subject was hospitalised with fever (38.5 deg.C) and respiratory rate of 24 bpm. On day 6, he was tested positive for influenza A and developed both acute respiratory distress syndrome requiring mechanical ventilation and sepsis with hypotension requiring vasopressor support. On day 7, the chest radiography showed diffuse lung opacities that progressed to complete opacity of both lungs. The subject was treated with ciprofloxacin, Piperacillin, Tazobactam, vancomycin, Oseltamivir, oxygen, mechanical ventilation and vasopressor. The subject died in February 2011 on day 8, the cause of death was not reported. It was unknown whether an autopsy was performed. Summary of the literature article: Children with neurological and neurodevelopmental conditions are at increased risk for severe outcomes from influenza, including death. In April 2011, the state Department of Health and CDC investigated an influenza outbreak that began in February 2011 in a residential facility for 130 children and young adults with neurologic and neurodevelopmental conditions. This report summarizes the characteristics and clinical courses of 13 severely ill residents with suspected or confirmed influenza; 10 were hospitalized, and seven died. Diagnosis is challenging in this population, and clinicians should consider influenza in patients with neurologic and neurodevelopmental conditions who have respiratory illness or a decline in baseline medical status when influenza is circulating in the community. The findings in this report are subject to at least two limitations. First, a broad case definition was used to identify suspected cases, and not all ill residents underwent diagnostic testing; thus, respiratory pathogens other than influenza might have contributed to this outbreak. Second, residents of this facility are considerably more medically fragile than subjects with mild neurologic and neurodevelopmental conditions; therefore, this report is not generalizable to all patients with neurologic and neurodevelopmental conditions or all patients in residential-care centers. The authors' conclusion stated that prompt testing, early and aggressive antiviral treatment, and antiviral chemoprophylaxis are important for these subjects. When influenza is suspected, antiviral treatment should be given as soon as possible after symptom onset, ideally within 48 hours. Treatment should not wait for laboratory confirmation of influenza. During outbreaks, antiviral chemoprophylaxis should be provided to all residents of institutional facilities (e.g., nursing homes and long-term care facilities), regardless of vaccination status. Residential facilities for subjects with neurologic and neurodevelopmental conditions are encouraged to vaccinated all eligible residents and staff members against influenza.