The flu has arrived. The CDC reports an increasing incidence of severe influenza across the country. The link below will take you to an important CDC influenza alert about this. Below are excerpts from the alert and additional information about influenza.

CDC Influenza Alert

 

  1. Clinicians should rapidly treat suspected influenza in:
    • high-risk outpatients (see list in final item below);
    • patients with severe, complicated, or progressive symptoms;
    • all hospitalized patients.
  2. The CDC recommends treatment with either oral Tamiflu (oseltamivir), inhaled Relenza (zanamivir), or IV peramivir.  Note that inhaled Relenza probably should not be used in patients prone to bronchospasm.  Be sure to check dosages and precautions before prescribing or ordering any of these drugs.
  3. RIDTs (rapid influenza diagnostic tests) have a high potential for false negatives.  Therefore, decisions about starting antiviral treatment should not wait for laboratory confirmation.
  4. A history of influenza vaccination does not rule out influenza in an ill patient with clinical signs and symptoms compatible with influenza.  Therefore, vaccination status should not impede the initiation of prompt antiviral treatment.
  5. For previously healthy, symptomatic outpatients who are not at high risk, antiviral treatment can be considered, especially if treatment can be initiated within 48 hours of illness onset.  However, in these patients, antiviral treatment may afford only modest reductions in symptoms and length of illness.
  6. Patients with influenza should be advised not to work or go to school until afebrile to avoid infecting others.
  7. Early antiviral treatment is more effective at reducing morbidity and mortality.  However, delayed treatment may offer benefit when started up to 5 days after symptom onset, which is something to consider except in previously healthy, low-risk patients.
  8. Patients admitted to the hospital with suspected influenza should be placed in respiratory (droplet) isolation.
  9. High-risk outpatients for whom treatment should be considered include:
    • age < 2 or >64;
    • chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus);
    • neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, seizure disorders, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
    • immunosuppression, including that caused by medications or by HIV infection;
    • pregnancy through 2 weeks after delivery;
    • age <19 on long-term aspirin therapy;
    • American Indians and Alaska Natives;
    • morbid obesity;
    • patients in nursing homes or chronic-care facilities.

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