It is no secret that we are in the midst of a challenging influenza season, with a `drifted’ H3N2 virus – one that is not well matched to this year’s vaccine - accounting for roughly 70% of all of the influenza cases so far this winter. While the weekly FluView reports haven’t painted a picture of an extreme flu season as yet, there are easily a couple of months to go for this year’s epidemic.
Today, in a follow up HAN Health Update, the CDC revisits this year’s problematic flu season and the very strong advice to physicians to prescribe antiviral medications early for patients with flu symptoms and a heightened risk of complications.
The CDC has scheduled a 12pm Press briefing for today, during which time I’m sure this HAN will be a major focus. For now, some excerpts from today’s release. Clinicians, in particular, will want to follow the link below and read this release in its entirety.
For everyone else, the take home advice is to call your physician if you suspect you have the flu, particularly if you fall into any of the high risk groups. Despite some of the negative press they have received, antivirals can reduce the severity and duration of flu symptoms (see CID Journal: Under Utilization Of Antivirals For At Risk Flu Patients).
This is an official
CDC HEALTH UPDATE
Distributed via the CDC Health Alert Network
January 9, 2015, 11:00 ET
As a follow-up to HAN 00374 (Dec. 3, 2014), CDC is providing 1) a summary of influenza antiviral drug treatment recommendations, 2) an update about approved treatment drugs and supply this season, and 3) background information for patients regarding anti-influenza treatment.
Widespread influenza activity is being reported in most U.S. states, with influenza A (H3N2) viruses most common. H3N2-predominant flu seasons have been associated with more hospitalizations and deaths in older people and young children in the past. In addition, approximately two-thirds of H3N2 viruses that have been tested at CDC are antigenically or genetically different from the H3N2 vaccine virus. This difference suggests that vaccine effectiveness may be reduced this season. High hospitalization rates are being observed, similar to what was seen during the 2012-2013 influenza season. Hospitalization rates are especially high among people 65 years and older. In this context, the use of influenza antiviral drugs as an adjunct to vaccination becomes even more important than usual in protecting people from influenza. Antiviral medications are effective in treating influenza and reducing complications. Antivirals are available and recommended, but evidence from the current and previous influenza seasons suggests that they are severely underutilized.
This CDC Health Update is being issued
- to remind clinicians that influenza should be high on their list of possible diagnoses for ill patients, because influenza activity is elevated nationwide, and
- to advise clinicians that all hospitalized patients and all high-risk patients (either hospitalized or outpatient) with suspected influenza should be treated as soon as possible with one of three available influenza antiviral medications. This should be done without waiting for confirmatory influenza testing. While antiviral drugs work best when given early, therapeutic benefit has been observed even when treatment is initiated later.
CDC Antiviral Recommendations for the 2014-2015 Season
CDC recommends antiviral medications for treatment of influenza as an important adjunct to annual influenza vaccination. Treatment with neuraminidase inhibitors has been shown to have clinical and public health benefit in reducing illness and severe outcomes of influenza, as evidenced from randomized controlled trials, meta-analyses of randomized controlled trials, and observational studies of oral oseltamivir, inhaled zanamivir, or parenteral peramivir treatment during past influenza seasons and during the 2009 H1N1 pandemic.
All Hospitalized, Severely Ill, and High Risk Patients with Suspected Influenza Should Be Treated with Antivirals
Any patient with suspected or confirmed influenza in the following categories should be treated with a neuraminidase inhibitor:
- Is hospitalized – treatment is recommended for all hospitalized patients
- Has severe, complicated, or progressive illness – this may include outpatients with severe or prolonged progressive symptoms or who develop complications such as pneumonia
- Is at higher risk for influenza complications (hospitalized or outpatient) – patients in this group include:
- children younger than 2 years (although all children younger than 5 years are considered at higher risk for complications from influenza, the highest risk is for those younger than 2 years);
- adults aged 65 years and older;
- persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
- persons with immunosuppression, including that caused by medications or by HIV infection;
- women who are pregnant or postpartum (within 2 weeks after delivery);
- persons aged younger than 19 years who are receiving long-term aspirin therapy;
- American Indians/Alaska Natives;
- persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
- residents of nursing homes and other chronic-care facilities.