Sex: U
Vaccine: FLU3
Symptoms: Breath sounds abnormal, Chest X-ray abnormal, Cough, Incorrect storage of drug, Increased upper airway secretion
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 B in the literature article. Concurrent medical conditions included cerebral palsy, inability to move, inability to speak and intellectual disability. In October or 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 24 February 2011, within months of vaccination with FLULAVAL, the subject experienced tachypnea, fever (39 deg. C), non-productive cough, rhonchi and tachypnea secretions increased. The oxygen saturation was 84%. On day 2, the subject developed wheezing and had diminished left lower lung breath sounds. The subject was hospitalised for 8 days with temperature of 37.1 deg.C, elevated white blood cell count, tachycardia and respiratory failure requiring mechanical ventilation. Chest radiography showed hazy opacities with low lung volume. He was tested positive for influenza A. The subject was treated with OSELTAMIVIR. At the time of reporting, the events were resolved. This case has been linked to case B0774395A; related by publication. Summary of the literature article: Children with neurologic and neurodevelopmental conditions are at increased risk for severe outcomes from influenza, including death. In April 2011, the 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 summarized 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 seen 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 vaccinate all eligible residents and staff members against influenza.