The
Infectious Diseases Society of America (IDSA) has released updated
recommendations for the diagnosis, treatment, chemoprophylaxis and
institutional outbreak management of seasonal influenza.
Some key
recommendations from the guidelines published online Dec. 19, 2018 in the
journal Clinical Infectious Diseases are:
· Individuals who present with influenza-like illness, pneumonia, or
nonspecific respiratory illness (e.g., cough without fever) especially
those at high-risk for flu complications such as
hospitalization and death should be tested and promptly treated with antiviral
treatment promptly if they are sick enough to be hospitalized with flu
symptoms. Pregnant women and the extremely obese (BMI ≥40) are among those at
high risk for complications from the flu.
Others in the high-risk category include:
o
Young children (especially those younger than 2 years
old)
o
Immunocompromised individuals (such as people with HIV or
AIDS, cancer, who have had an organ transplant or who are on chronic steroids)
o
People younger than 19 years old who are receiving
long-term aspirin therapy
o
Persons with chronic medical conditions including asthma,
neurological or neurodevelopmental disorders (such as cerebral palsy, epilepsy
and stroke), heart or lung disease, kidney, liver or metabolic disorders; and
nursing home residents
· Outpatients
who have been diagnosed with the flu and are at high risk for complications
should also be provided antiviral treatment as soon as possible.
· Newer and
highly accurate molecular tests that deliver results in 15-60 minutes should be
used to aid diagnosis instead of rapid-influenza diagnostic tests (RIDTs),
which produce quick results but can be falsely negative in at least 30% of
outpatients with influenza.
· Antiviral
treatment is recommended within 2 days after the start of flu symptoms in
people who are not at high risk for complications; the guidelines recommend
that they should also be prescribed to those at high risk even if they have
been sick for >2 days.
· Antiviral
treatment should be started immediately in people at high risk of flu
complications who are being admitted to the hospital with suspected influenza,
without waiting for the results of molecular influenza testing. According to
the guideline, influenza testing is important because physicians are more
likely to treat patients with antiviral medications if they have a definitive
diagnosis, further reducing the likelihood of prescribing antibiotics
inappropriately, especially in outpatients.
· Infectious
diseases (ID) experts should be consulted if people at high risk become
seriously ill with influenza.
· Antiviral
drugs should not be used for routine or widespread chemoprophylaxis outside of
institutional outbreaks.
· Antiviral chemoprophylaxis for the duration of the influenza season can be
considered for adults and children aged ≥3 months who have the highest risk of
influenza-associated complications.
Additionally, inactivated influenza vaccine is recommended for unvaccinated
adults and children aged ≥3 months who are at high risk of developing
complications from influenza in whom influenza vaccination is expected to be
effective (but not yet administered).
(Source:
IDSA News release, Dec. 19, 2018)
Dr KK
Aggarwal
Padma
Shri Awardee
President
Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Immediate
Past National President IMA
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