摘要：Children represent one quarter of the US population. Because of its enormous size and special needs, it is critically important to address this population group in pandemic influenza planning. Here we describe the ways in which children are vulnerable in a pandemic, provide an overview of existing plans, summarize the resources available, and, given our experience with influenza A(H1N1), outline the evolving lessons we have learned with respect to planning for a severe influenza pandemic. We focus on a number of issues affecting children—vaccinations, medication availability, hospital capacity, and mental health concerns—and emphasize strategies that will protect children from exposure to the influenza virus, including infection control practices and activities in schools and child care programs. APPROXIMATELY 74 MILLION residents of the United States (25% of the population) are younger than 18 years, and 20 million are younger than 5 years. 1 More than 55 million children are enrolled in schools, 2 and 11 million children younger than 5 years are in out-of-home child care. 3 Children are a vulnerable segment of the population, dependent on others for providing their food, shelter, transportation, and medical care. Ensuring that the needs of children are met is essential to planning for a severe influenza pandemic. Although planners, program managers, and communities are beginning to recognize these needs and to address them as part of the ongoing influenza A(H1N1) outbreak, there are still gaps in plans designed to protect children in an influenza pandemic. Here we discuss strategies for strengthening pandemic influenza planning. Our discussion is based on a pair of assumptions. First, lessons from the ongoing H1N1 pandemic in 2009 underscore the need for community-based plans that address children. Second, communities will suspend routine activities (e.g., school-based health screenings) in a severe pandemic and focus on priority needs. Given the large number of planning needs related to children, we touch on priority issues and build on a pandemic influenza report developed by the American Academy of Pediatrics and the Trust for America's Health. 4 In doing so, we focus on the following critical prevention and treatment topics: infectious disease (including influenza) prevention practices, vaccinations, medication availability, hospital capacity, and mental health concerns. Community leaders should address children and adults separately because influenza affects children differently than adults, with children being more vulnerable in terms of infection, complication, and mortality rates. Seasonal influenza rates are higher among young children than among members of other age groups, 5 , 6 and these children (as are the elderly) are at greater risk for complications than are older children, adolescents, and nonelderly adults. 5 , 7 , 8 Typically, the influenza mortality curve follows a U shape, with high mortality among very young children and the elderly. However, the 1918 pandemic strain killed a disproportionate number of healthy young adults, leading to a W-shaped age mortality curve in the United States, with high rates of mortality among very young children, those aged 15 to 45 years, and the elderly. 9 – 11 During the 1957 pandemic, children appeared to have less residual immunity than adults, and infection rates were higher among children. 12 The current outbreak of H1N1, which began outside of the typical influenza season, has thus far resulted in only a limited numbers of deaths overall; however, the impact of subsequent waves of this virus on children is yet to be determined. Children routinely spend time in crowded settings, such as schools, after-school care, and childcare, increasing their risk of contracting influenza. Because of the amount of time they spend in these settings, children disproportionately contribute to disease transmission and amplification of an epidemic or pandemic. Children are more frequently responsible than adults for secondary transmission within households, and they usually shed more virus and do so for longer periods of time than adults. 13 The Institute of Medicine 14 and the American Academy of Pediatrics, 4 as well as the Pandemic and All Hazards Preparedness Act (the aim of which is to improve public health and medical preparedness and response capabilities for emergencies), 15 consider children a vulnerable population. According to these organizations and this legislation, the emergency care system is not prepared for disasters involving children, and the needs of this “at-risk” population in disasters are frequently overlooked. (Other determinants of vulnerability among children, including poverty, race/ethnicity, and special health care needs, are addressed in other articles in this supplement.)
