CDC urges rapid antiviral treatment of very ill and high-risk patients suspected of having influenza

Cases of both influenza A and influenza B have been reported since October 2015.
Cases of both influenza A and influenza B have been reported since October 2015.

The CDC urges all clinicians to use rapid antiviral treatment of very ill and high-risk patients suspected of having influenza without waiting for testing.

“Since October 2015, CDC has detected co-circulation of influenza A (H3N2), A(H1N1)pdm09, and influenza B viruses. However, H1N1pdm09 viruses have predominated in recent weeks,” stated the CDC in a Health Advisory distributed by the Health Alert Network. “The spectrum of illness observed thus far … has ranged from mild to severe and is consistent with that of other influenza seasons.”

So far, both severe respiratory illnesses and fatalities have been reported, and the CDC expects additional increases in disease frequency in the upcoming weeks. Although existing laboratory data confirm that the majority of circulating strains are covered via the 2015-2016 influenza vaccine, the CDC has offered the following recommendations to all clinicians:

  • Clinicians should encourage all patients 6 months of age and older to be vaccinated against influenza.
  • Clinicians should encourage all persons with influenza-like illness, especially those at high risk for influenza complications, to seek prompt care.
  • Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza, and clinicians using RIDTs should use caution when interpreting negative RIDT results. Antiviral treatments should not be withheld from patients testing negative by RIDT.
  • Influenza antiviral use guidelines for the 2015-2016 flu season are the same as guidelines used in prior flu seasons.
  • Antiviral treatment should be initiated within 48 hours of symptom onset. Patients with severe, complicated, or progressive illness may still benefit from antiviral treatment outside of the 48-hour window.
  • Treatment with an appropriate neuraminidase inhibitor antiviral drug – including oral oseltamivir, inhaled zanamivir, or intravenous peramivir – is recommended as soon as possible for any patient who meets the following criteria:
    • the patient is hospitalized
    • the patient has severe, complicated, or progressive illness
    • the patient is at a higher risk for influenza complications. This list includes:
      • children younger than 2 years
      • adults older than 65 years
      • patients with chronic pulmonary (including asthma), cardiovascular, renal, hepatic, hematological (including sickle cell disease) metabolic disorders (including diabetes mellitus) or neurologic and neurodevelopmental conditions (including disorders of the brain or spinal cord)
      • patients with immunosuppression
      • women who are pregnant or 2 weeks postpartum
      • patients younger than 19 years who are receiving long-term aspirin therapy
      • patients who are American Indians or Alaska Natives
      • patients who are morbidly obese, and
      • patients who are residents of nursing homes or other chronic-care facilities
  • Antiviral treatment may also be administered to suspected or confirmed influenza patients who were previously healthy, symptomatic outpatients not at high-risk.
  • Clinical judgment is  important when making antiviral treatment decisions for outpatients
  • A history of influenza vaccination does not rule out possible influenza virus infection in a patient with clinical signs and symptoms of influenza.

“Clinicians are reminded to treat suspected influenza high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results,” stated the CDC. “Early antiviral treatment can reduce influenza morbidity and mortality.”

Reference

  1. Flu Season Begins: Severe Influenza Illness Reported (CDCHAN-00387) [CDC Health Advisory]. Atlanta, GA: Centers for Disease Control and Prevention. Posted February 1, 2016. Accessed February 12, 2016. 
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