VI. The panel followed a process used in the development of previous IDSA guidelines that included a systematic weighting of the strength of recommendations and quality of evidence based upon the US Public Health Service Grading System for ranking recommendations in clinical guidelines as utilized in the previous 2009 guidelines (Table 1) [17]. In addition, influenza during pregnancy can precipitate spontaneous abortion [244, 245]. Most RCTs of NAI treatment of outpatients with seasonal influenza were conducted before 2009, whereas most observational studies of NAI treatment were done during or after the 2009 H1N1 pandemic. Severe influenza treatment guidelines for Korea also indicate that systemic corticosteroid administration should not be performed for the treatment of severe influenza patients unless the therapeutic effect has already been proven . Additional information is also available about the emergence of antiviral resistance. XVI. However, only a small proportion of the new data arises from randomized controlled clinical trials. VII. The H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide. The composting treatment period was for 8 days from 15:00 h, 28 October, to 11:00 h, 4 November. Many facilities cannot afford to have several ill staff absent from work, and increased staff demands at the time of outbreak declaration may make it challenging for referral to a primary care provider to prescribe antiviral chemoprophylaxis. A study from 2 hospitals in Belgium during the 2015 influenza season reported that use of a rapid molecular assay in emergency departments helped avoid 10.7% of hospitalizations, 46.4% of antibiotic prescriptions, and 42.9% of additional investigations for influenza-positive patients, and helped facilitate prescription of oseltamivir and patient isolation [138]. Centers for Disease Control and Prevention. For serological diagnosis of seasonal influenza virus infection, paired acute and convalescent serum specimens must be collected and tested together, and cannot inform clinical management. A recent modeling study estimated that 291243645832 seasonal influenzaassociated respiratory deaths occur annually worldwide [10]. Influenza illness can present in a range of symptomatology: from a mild upper respiratory infection to an acute, life-threatening illness. Seasonal influenza is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose. Treatment of hospitalized patients and patients at higher risk for influenza. However, because results are not available in a timely manner, viral culture cannot inform clinical management of influenza patients, but can confirm negative test results from RIDTs and immunofluorescence assays, such as during an institutional outbreak, and to provide influenza virus isolates for further characterization. XIV. Zanamivir is administered as an orally inhaled powder, concentrated in the respiratory tract with limited systemic absorption that is excreted unchanged by the kidneys. An additional meta-analysis of published observational studies suggested that not only was mortality increased, but also nosocomial bacterial infection, duration of mechanical ventilation, and ICU stay were greater in corticosteroid-treated patients (patient ages not reported) with suspected or confirmed influenza [366]. Two meta-analyses of methodologically weaker observational studies (including concurrent antiviral treatment for most patients) reported that despite the limitations of the included studies, corticosteroid treatment of hospitalized influenza patients appeared to be associated with increased mortality, but firm conclusions were not possible due to lack of information on dosing, or indication for corticosteroid treatment [364, 365]. The virus leads to a lung (respiratory) disease in pigs. It's called swine flu because it's similar to a flu virus that affects pigs (swine). antiviral agents for H1N1 influenza 09, drawing on studies of seasonal and H5N1 (avian) influenza, emerging data on H1N1 Recommendations for use of antiviral treatment for influenza: The Medical influenza . Of note, IV peramivir given once daily to hospitalized adults and children aged 7 years, in addition to standard of care, failed to show superiority vs placebo [298], although enrollment criteria did not exclude patients based on duration of illness. Following infection, influenza virus strain-specific antiviral activity is present in convalescent plasma of immunocompetent persons. These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. Some of the newer cartridge-based RT-PCR assays can yield results in 6080 minutes. Accessed Oct. 13, 2020. When the results of influenza molecular testing will not be available until the next day, outbreak control measures should be instituted when a single laboratory-confirmed case of influenza is accompanied by influenza activity in the community and by 2 or more other residents with symptoms compatible with influenza. During the 2009 H1N1 pandemic, of 30 maternal deaths in the United States, 7.1% occurred in the first trimester; 26.8% in the second trimester, and 64.3% in the third trimester [3]. Influenza is associated with a variety of signs and symptoms that may vary by age, underlying chronic disease, complications, host immune status, and influenza virus type or influenza A virus subtype. Clinicians should consult the CDC webpages for the latest information on approved influenza tests (https://www.cdc.gov/flu/professionals/diagnosis/index.htm) and approved antivirals (https://www.cdc.gov/flu/professionals/antivirals/index.htm). Swine Flu cases along with H3N2 virus on the rise in India; Central . XV. This may also be appropriate if >48 hours has elapsed since exposure, as the patient may already have infection established, warranting full-dose therapy. https://www.cdc.gov/flu/treatment/takingcare.htm. A prospective study found that fever >38C, chills, headache, malaise, and sore eyes were significantly associated with a positive RT-PCR test result for influenza virus in children younger than 15 years [29]. Interim Guidance for Correctional and Detention Facilities on Novel Influenza A (H1N1) Virus May 24 Interim Biosafety Guidance for All Individuals handling Clinical Specimens or Isolates containing 2009-H1N1 Influenza A Virus (Novel H1N1), including Vaccine Strains Aug 15 Infection Control in Outpatient Hemodialysis Centers May 8 Laboratory Testing Certain factors made an influenza diagnosis more likely, including having a high-risk condition, being in an inpatient setting, and not having a bacterial infection diagnosis. Invasive bacterial coinfection may occur (with Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes [group A streptococci], and others) [4245]. In contrast, when mortality was analyzed as the endpoint for children aged <16 years hospitalized with influenza, the meta-analysis reported that early vs later initiation of NAI treatment, and early initiation vs no treatment, did not have significant survival benefit, although the low number of deaths limited statistical power [16, 195]. Decisions on whether to administer postexposure antiviral chemoprophylaxis should consider the nature of the exposure, the exposed persons risk of developing complications from influenza, the ability to promptly administer antiviral therapy if symptoms develop, advice from public health authorities, and clinical judgment. To reduce the risk of subtherapeutic dosing if influenza virus infection has occurred following exposure, antiviral treatment (twice-daily dosing) rather than once-daily chemoprophylaxis dosing has been recommended by some experts, particularly in immunocompromised patients, when postexposure antiviral chemoprophylaxis is indicated. AskMayoExpert. Antiviral drugs are sometimes prescribed within the first day or two of symptoms. Health care and research efforts should focus on defining treatment guidelines in patients with cancer and attempt to improve on current vaccination strategies. Secondary bacterial pneumonia due to methicillin-resistant S. aureus (MRSA) is becoming more prevalent and has been a more common finding in recent pediatric influenza-associated deaths [42, 4648]. Dosing is based upon age and weight; however, the FDA has not reviewed data on safety and efficacy of oseltamivir in neonates <2 weeks of age. Therefore, early antiviral treatment of persons with uncomplicated influenza who have household members that are immunocompromised is recommended to provide potential benefit in reducing the risk of influenza in the household contacts. Use of convalescent plasma or intravenous immunoglobulin (IVIg) that contains neutralizing antibodies [356, 357], as well as other antiviral agents (eg, polymerase inhibitors baloxavir marboxil, pimodivir, favipiravir), are under investigation. The guidelines also address diagnostic testing and use of antivirals for management of institutional influenza outbreaks. Seasonal A (H1N1) refers to the human influenza A (H1N1) viruses that were circulating prior to the introduction of pandemic influenza A(H1N1) 2009 virus and which continued to circulate during 2009. During an influenza outbreak at a long-term care facility, should antiviral chemoprophylaxis be administered to residents only on affected units or to all residents in the facility? Lower respiratory tract specimens have much higher sensitivity for detection of influenza viruses in critically ill patients because influenza virus shedding may be lower or have stopped in the upper respiratory tract, whereas influenza viral replication in the lower respiratory tract may be higher and prolonged [121, 122, 161163]. Testing combined specimens from 3 sites (combined nasal and throat swabs plus a nasal aspirate) was more sensitive for detecting influenza A(H1N1)pdm09 virus than any single sample [157]. "Influenza has been detected in Mumbai, Pune, Nagpur, Aurangabad, Thane . Especially during seasons in which influenza vaccine effectiveness is low, consideration can be given to administration of antiviral chemoprophylaxis to vaccinated staff for the duration of an outbreak. Fever (38C), headache, cough, and absence of abnormal breathing sounds in pediatric patients had a positive predictive value of 57.1% [29]. Staff at facilities with low influenza vaccination coverage among staff and/or residents, lack of surveillance for acute respiratory illness in residents, <6 air changes per hour, many multibed shared rooms, crowded dining and activity rooms, and multiple frequent visitors who are not adequately screened for illness symptoms should consider early and rapid implementation of outbreak control measures after a single laboratory-confirmed influenza case. He or she may use various tests to diagnose influenza. Although critically ill patients may have a variety of complications that alter drug absorption and excretion (ie, altered gastrointestinal motility, renal dysfunction), most studies suggest that oral oseltamivir, when administered by nasogastric tube, results in adequate drug exposures [293]. The doctor may also offer symptomatic treatment for a fever, sore throat, runny nose and cough to alleviate your child's discomfort. A prospective study of >500 influenza patients in North Carolina reported that emergency department patients commonly reported cough, nasal congestion, fever, fatigue/malaise, headache, poor appetite, sore throat, and myalgias/muscle aches, whereas hospitalized patients reported shortness of breath and wheezing [33]. In another prospective study among pediatric outpatients aged 13 years with respiratory infections, fever was the only reliable predictor of culture-confirmed influenza virus infection [40]. Centers for Disease Control and Prevention. Abrupt onset of fever with cough is most predictive of uncomplicated influenza in adult outpatients, with a sensitivity of >70% during the influenza season [2629]. In another, inhaled zanamivir given for 28 days was 84% effective (95% CI, 55%94%; attack rate, 3.4% vs 0.5%) for symptomatic laboratory-confirmed influenza and 67% effective (95% CI, 39%83%) against laboratory-confirmed influenza meeting a strict case definition [385]. One placebo-controlled RCT of inhaled zanamivir in influenza patients with mild to moderate asthma or COPD found adequate tolerance and symptom benefit [303]. Active daily surveillance for new influenza cases, with influenza testing for suspected cases, should be enhanced throughout the entire facility as soon as an outbreak is declared on any one ward. The 2009 flu pandemic was confirmed to have spread to the Philippines on May 21, 2009. Guidelines and . As per the govt, H3N2 accounts for nearly 79% of all the influenza viruses found in samples taken from persons . One observational study reported that outbreak duration was the shortest when oseltamivir chemoprophylaxis was administered to all residents of one nursing home vs only for exposed residents at another nursing home or not used at a third nursing home [410]. RIDTs are primarily point-of-care immunoassays; one test is an immunofluorescent assay. The purpose of this guidelines recommendations is to provide clinicians with evidence-based recommendations for the diagnosis and treatment of seasonal influenza, including use of commercially available influenza diagnostic tests, use of approved antiviral agents for treatment and chemoprophylaxis of influenza, and use of antibiotics or other adjunctive measures for treatment of complications associated with influenza. There are limited data to define the optimal duration of therapy for influenza in immunocompromised patients, but retrospectively collected data suggest that treatment can safely extend to 10 days or longer. However, some immunofluorescence assays may be part of a respiratory panel and thus useful for the identification of other respiratory viruses. Timely diagnosis may decrease unnecessary laboratory testing for other etiologies and use of antibiotics, improve the effectiveness of infection prevention and control measures, and increase appropriate use of antiviral medications [11, 12]. antiviral agents for H1N1 influenza 09, drawing on studies of seasonal and H5N1 (avian) influenza, emerging data on H1N1 Recommendations for use of antiviral treatment for influenza: Neuraminidase inhibitors Currently there are no guidelines for home isolation or area wide testing for H3N2, he added. Have a body mass index above 40, which is defined as morbid obesity. Pregnant women: Metabolism of oseltamivir is increased in pregnancy, reducing exposure to oseltamivir carboxylate by 30% compared to nonpregnant women [269, 270]. The ability to rapidly identify other casesthe combination of a sensitive surveillance case definition and use of RT-PCR testing of upper respiratory tract specimens for laboratory diagnosiscan reduce the risk that additional, undetected influenza cases are present at the time the first case is diagnosed and help to ensure early detection of influenza virus transmission if an outbreak has started [431]. 2011; doi:10.1542/peds.2010-3852. https://www.cdc.gov/flu/prevent/index.html. Although the benefits of therapy are greatest if therapy is started within 48 hours of illness onset, there is evidence of clinical benefit with later initiation of therapy in critically ill adults [16]. Medscape. There are no published data to quantify the risk of influenza virus transmission among different wards of a long-term care facility. Turnaround times to results range from 1 to 8 hours. 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