Thank you for the hard work and long hours you have experienced over the past several weeks coming out of check-up season! We truly appreciate your efforts in helping to keep up with these extraordinary volumes and are here to support you. Despite these challenging times, your contributions have resulted in marked improvement in performance in measures related to antibiotic stewardship.

 

An ongoing review of utilization patterns show the majority of visits to the emergency department (ED) are children under 5 years of age with symptoms of fever or upper respiratory infection. Current volumes in the ED and in outpatient offices are exacerbated by COVID-19 and monkeypox-related concerns along with documentation requirements by childcare and school entities.

 

We are pleased to provide you with the following resources that you may pair with your outstanding medical judgment and adherence to infection control methods refined during the pandemic.


Patient information sheet

 

The following fever patient information sheet, developed at Children’s, may be provided to parents during well child visits. This information sheet can also aid in staff interactions by providing uniform messaging across the network.

  • Guidance on how to treat low acuity symptoms at home
  • Progression of symptoms indicating need to seek care or medical advice
  • Indications to proceed to ED

Return to childcare/school note content

 

The messaging below may be incorporated into your documentation which includes a brief summary of community guidance regarding indications for safe return to school or daycare and the role of testing.

 

Suggested Return to School/Childcare Messaging:

Due to the community-wide circulation of many respiratory viruses, a symptom-based approach is recommended to optimize return to school/childcare (select)

_______________ (NAME) had symptoms starting on _____________ (DATE). They may return to school/childcare (SELECT) on ________________ (DATE + 5 full days after symptom onset), provided that their symptoms are improving, and they are fever-free for 24 hours without the use of fever-reducing medication. ______________ (NAME) should continue to wear a well-fitting mask until _____________ (DATE + 10 full days after symptom onset). If _______________ (NAME) is unable to wear a well-fitting mask, they should continue to isolate at home until ________________ (DATE + 10 full days after symptom onset).


Monkeypox guidance

 

Although infections associated with monkeypox are continuing to decline in the adult community, concerns remain about monkeypox diagnoses in children with skin lesions. To date, monkeypox infections in children in the United States are extremely rare (17 U.S. cases in children < 15 years of age as of Aug. 31, 2022; 4 are Georgia residents). Almost all cases in children < 15 years of age had a close contact to an adult (usually a household member) with a known monkeypox infection. A child < 15 years of age without a close contact to a person with monkeypox is more likely to have another infectious or non-infectious etiology for their skin lesions.

 

Clinicians may perform outpatient testing in their offices with kits available from commercial laboratories such as LabCorp and Quest Diagnostics (listed for information – does not imply endorsement).

  • Any child > 2 years of age with skin lesions should be masked. All children should have their skin lesions covered and should be evaluated in a private room.
  • Clinicians should wear a fitted N-95 respirator, gloves, gown and eye protection when performing swabbing of lesions and patients. Monkeypox lesions are usually painful and do not need to be unroofed to collect an adequate specimen.
  • Lesions should be kept covered before and after swabbing.
  • Patients should isolate until all lesions have healed and a fresh layer of skin covers the former lesion, often up to 28 days, or until another etiology has been determined for the lesions. 

Vaccination guidance

 

In preparation for cold and flu season, we know you will prioritize continued attention to vaccination for COVID-19 and influenza.

 

Influenza vaccinations should be dispensed as soon as available, with the goal of having all children influenza immunized by Oct. 31, 2022. Vaccination should be initiated as soon as feasible given children who have not previously received two lifetime doses of a seasonal influenza vaccine will require two doses of influenza—separated by four weeks—in order to be completely immunized.

 

Influenza vaccines can be given simultaneously (in different sites) with all other vaccinations, including COVID-19 vaccinations. If not given simultaneously, there is no time period by which influenza vaccines and non-influenza vaccines (including COVID-19 vaccines and any other childhood vaccines) should be separated.

 

Together, we can effectively care for kids by encouraging the best care at the right time and in the right place.

 

 

Thank you for your partnership.


Brad Weselman, MD

Executive Director
The Children’s Care Network

 

 

Andi Shane, MD

Division Chief, Infectious Disease

Children’s Healthcare of Atlanta

 

Srikant Iyer, MD

Chief Quality Officer

Division Chief, Emergency Services
Children’s Healthcare of Atlanta

 

Dan Salinas, MD

Chief, Community Clinical Integration Officer

Children’s Healthcare of Atlanta