Avian Flu Diary: CDC: 2010-2011 Interim Influenza Antiviral Guidance

# 5060

Last night the CDC posted the details of their 2010-11 Interim Antiviral Guidance prior to their appearing in an upcoming edition of the MMWR.

First, a list of the major changes to this year’s guidance, then the summary (published Nov. 8th), and finally a look at the table of contents of the full guidance.

Interim Guidance on the Use of Influenza Antiviral Agents During the 2010-2011 Influenza Season

Primary Changes and Updates in the Recommendations

The 2010 recommendations include six principal changes or updates:

Antiviral treatment is recommended as soon as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness, or who are hospitalized.

Antiviral treatment is recommended as soon as possible for outpatients with confirmed or suspected influenza who are at higher risk for influenza complications; clinical judgment should be an important component of outpatient treatment decisions.

Antiviral medications currently recommended include oseltamivir and zanamivir, based upon recent viral surveillance and resistance data indicating that >99% of currently circulating influenza virus strains are sensitive to these medications.

Oseltamivir should be used to provide treatment or chemoprophylaxis for infants aged less than 1 year old when indicated.

Local influenza epidemiology and viral surveillance data, when available, and influenza testing of patients, when testing is done, should be used to help guide choice of antiviral medications when antiviral resistance profiles vary among circulating influenza A virus subtypes.

Antiviral treatment can be considered for any previously healthy non high risk symptomatic outpatient with confirmed or suspected influenza who is not in the recommended groups, based upon clinical judgment, if treatment can be initiated within 48 hours of illness onset.

This pre-publication summary was posted last week on the CDC website. Follow the link to read the copious footnotes.

Summary Influenza Antiviral Treatment Recommendations for 2010-2011

Studies indicate that early antiviral treatment can reduce the risk of complications from influenza, such as pneumonia, respiratory failure, and death. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who:

has severe, complicated, or progressive illness, or

is hospitalized, or

is at higher risk for influenza complications as follows:

Children younger than 2 years old;*

Although all children <2 years are at risk for severe complications from influenza, the risk is highest among young infants aged <6 months old. Because many children with mild febrile respiratory illness may have other viral infections (e.g. RSV, rhinovirus, parainfluenza, metapneumovirus virus), knowledge about other respiratory viruses as well as influenza virus strains circulating in the community is important for treatment decisions. **

Adults 65 years of age and older;

Persons with the following conditions: chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurological, neuromuscular, or metabolic disorders (including diabetes mellitus);

Immunosuppression, including that caused by medications or by HIV infection;

Women who are pregnant or post-partum (within 2 weeks after delivery);

Persons younger than 19 years of age who are receiving long-term aspirin therapy;

American Indians and Alaskan Natives;

Persons who are morbidly obese (body-mass index ≥40);

Residents of nursing homes and other chronic-care facilities.

Clinical judgment, based on the patient's disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important to consider when making antiviral treatment decisions for high-risk outpatients. When indicated, antiviral treatment should be started as soon as possible after illness onset.

The greatest benefit is when antiviral treatment is started within 48 hours of influenza illness onset.

Antiviral treatment may still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients when administered >48 hours from illness onset.

Antiviral treatment also can be considered for any previously healthy, non high risk, symptomatic outpatient with confirmed or suspected influenza based upon clinical judgment, if treatment can be initiated within 48 hours of illness onset.