Pandemic Influenza Plan - Questar III

Appendix 5-L
Prevention
Efforts to maximize vaccination coverage against Streptococcus pneumoniae is an
important component of post-influenza bacterial community-acquired pneumonia
prevention during the Interpandemic, Pandemic Alert, and Pandemic Periods. Current
guidelines on the use of the 23-valent pneumococcal polysaccharide vaccine among
adults and the 7-valent pneumococcal conjugate vaccine among children are
available. 13,14
Site of Care: Inpatient versus Outpatient
Adults
• IDSA-ATS draft guidelines recommend the use of severity scores, such as the
Pneumonia PORT Severity Index (PSI) and the CURB-65 system, 15,16 to
determine which patients can be safely treated as outpatients (Tables 2–5). The
use of these or other similar systems could be extremely important during the next
pandemic, as hospital beds will be in short supply. However, these systems should
be used to supplement rather than replace the judgment of the individual clinician.
Children
• Current guidelines provide indicators for hospitalization of children with CAP.
For infants, the indications include temperature >38.5 C, respiratory rate (RR)
>70 breaths per minute, chest retractions (indrawing), nasal flaring, hypoxia,
cyanosis, intermittent apnea, grunting, and poor feeding. Indications for
hospitalization among older children include temperature >38.5 C, RR >50, chest
retractions, nasal flaring, hypoxia, cyanosis, grunting, and signs of dehydration.
As with pandemic influenza, the decision to hospitalize for post-influenza bacterial
community-acquired pneumonia during the Pandemic Period will rely on the physician’s
clinical assessment of the patient as well as availability of personnel and hospital
resources. Although an unstable patient will be considered a high priority for admission,
patients with certain high-risk conditions (see Appendix J) might also warrant special
attention. Home management with follow-up might be appropriate for well-appearing
young children with fever alone.
Diagnostic Testing
Adults
Generally, the etiologies associated with CAP during the Interpandemic Periods will
continue to occur during a pandemic. Familiarity with the appropriate use of available
diagnostic tests is therefore a key feature of clinical preparedness.
• Draft IDSA-ATS guidelines recommend obtaining appropriate specimens for
etiologic diagnosis whenever such an etiology would alter clinical care. Given
that the most common etiologies of post-influenza bacterial community-acquired
pneumonia—S. pneumoniae and S. aureus, including community-acquired
methicillin-resistant S. aureus (CA-MRSA)—are treated differently, diagnostic
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