Effective isolation and control of outbreaks can be challenging and may require different strategies. Each of these subgroups was addressed by its dedicated subcommittee. It adds new information on diagnostic testing, use of antivirals, and considerations of when to use antibiotics and when to test for antiviral resistance, and presents evidence on harm associated with routine use of corticosteroids. In this study, a subgroup analysis demonstrated that patients who received high doses (>150 mg/day methylprednisolone or equivalent) had much higher 30-day and 60-day mortality than those who received no steroid therapy (P = .031 and P = .002, respectively) [372]. People at higher risk of flu complications include people who: If you develop any type of flu, these measures may help ease your symptoms: Consider pain relievers. INTRODUCTION. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza Published CID, 12/19/2018 Clinical Infectious Diseases, Volume 68, Issue 6, 15 March 2019, Pages e1-e47, https://doi.org/10.1093/cid/ciy866 An algorithmic approach may help optimize the use of influenza testing (Figure 1). Furthermore, all panelists were precluded from participating in any marketing-related activities (eg, lectures or advisory boards directly funded by a pharmaceutical or device company with interests related to the guideline subject[s]). One RCT of oseltamivir chemoprophylaxis for 10 days vs placebo in frail elderly patients in long-term care facility units after a single laboratory-confirmed case of influenza over 4 seasons in the Netherlands did not find a significant benefit; however, this study was underpowered due to fewer influenza outbreaks than expected [440]. Antiviral drugs are the mainstay of clinical treatment of swine influenza and can make the illness milder and enable the patient to feel better faster. There are multiple options for influenza diagnostic and confirmatory testing [108]. However, any hospitalized patient may be in the incubation period for influenza virus infection when admitted and become symptomatic during the first few days of hospitalization for other illnesses or injuries. NEW DELHI: The Union Territory of Puducherry on Wednesday announced holidays in schools for Classes 1 to 8 from March 17 to March 26, 2023, in view of rising cases of H1N1 and H3N2 influenza. During influenza outbreaks, influenza vaccine should be offered to unvaccinated staff throughout the facility, and antiviral chemoprophylaxis can be offered for 14 days postvaccination (until protective antibodies have developed). Reye syndrome. Combination antiviral therapy with 2 or more active agents with different mechanisms of action is an investigational approach that may reduce the development of additional de novo resistance in immunocompromised patients and other patients at higher risk for the emergence of resistant viruses during or after therapy [354, 355]. Both oseltamivir phosphate and the metabolite oseltamivir carboxylate have been demonstrated to cross the placenta [271276]. The guidelines do not provide recommendations on infection prevention and control (IPC) measures for seasonal influenza in all healthcare settings; these are available on the Centers for Disease Control and Prevention (CDC) website [18]. Retrospective observational studies have suggested benefit of antiviral treatment in reducing transmission to household contacts [247, 248]. Protecting People., Guidelines - Noncommercial Settings With Pigs, Guidelines - Commercial Settings With Pigs, National Influenza Vaccination Week (NIVW), Vaccination Guidance for State, Local, Tribal & Territorial Health Officials, Clinician Guidance for Specific Audiences, Guidance for Pregnant and Breastfeeding Women, Guidance for Schools, Colleges and Universities, Template Letter for Healthcare Providers about the Vaccine Adverse Event Reporting System (VAERS), Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season, Interim Guidance for Influenza Surveillance: Prioritizing RT-PCR Testing in Laboratories, Interim Guidance for Reporting Influenza-Associated Hospitalizations and Deaths, Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season, Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests, 10 Actions Steps for Medical Offices and Outpatient Facilities, 2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness, 2009-2010 Influenza Season Triage Algorithm for Children (18 years) With Influenza-Like Illness, Emergency Use Authorization (EUA): Medical Products, Clinical Data Collection Forms and Templates, Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak, 2009 H1N1 Flu and Seasonal Flu Information for Rheumatology Health Professionals, Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices: Guidance from Stakeholders, Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season, Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings, Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel, Questions and Answers about Updating Guidance on Infection Control Measures for Influenza in Healthcare Settings, Interim Infection Control Guidance on 2009 H1N1 Influenza for Personnel at Blood and Plasma Collection Facilities, Q&A: Respiratory Protection For Preventing 2009 H1N1 Influenza Among Healthcare Personnel, CDC Guidance for Emergency Shelters for the 2009-2010 Flu Season, Post-mortem Care and Safe Autopsy Procedures for Novel H1N1 Influenza, Interim Guidance for Correctional and Detention Facilities on Novel Influenza A (H1N1) Virus, Interim Biosafety Guidance for All Individuals handling Clinical Specimens or Isolates containing 2009-H1N1 Influenza A Virus (Novel H1N1), including Vaccine Strains, Infection Control in Outpatient Hemodialysis Centers, Specimen Collection, Processing, and Testing for Suspected Infection, Submission of Tissue Specimens for Pathologic Evaluation, Protocol for Antiviral Susceptibility Testing by Pyrosequencing, CDC Protocol of Realtime RTPCR for Swine Influenza A(H1N1), DSAT Guidance on CDC Import Permits for Swine-Originated Flu, Home Care Guidance: Physician Directions to Patient/Parent. There are some patient populationspecific issues to consider: Influenza virus resistance to NAI drugs is detected infrequently in clinically significant situations [246]. The virus leads to a lung (respiratory) disease in pigs. Clinicians should consider novel influenza A virus infection in the differential diagnosis in travelers who have recently returned from countries affected by poultry outbreaks of avian influenza and who have febrile respiratory symptoms and a recent history of direct or close exposure to poultry (well-appearing, sick or dead birds, or visiting a live poultry market [103, 104]). Accessed Feb. 22, 2018. The virus is contagious and can spread from human to human. One meta-analysis of seasonal and pandemic influenza studies reported that increased influenza-associated mortality risk occurs in the third trimester compared to the first or second trimesters, but also extends 4 weeks postpartum [228]. Following global consultations with multiple stakeholders, the WHO posted a comprehensive influenza research agenda in 2009 that addressed research gaps including surveillance, the animalhuman interface, novel influenza A virus infections, transmission, vaccines and other prevention strategies, diagnostics, disease pathogenesis, antivirals, and clinical management. Facility medical directors should consider consultation from public health experts. The 18-year-old arrived at the country on May 18 and was hospitalized the day after at the Research . A meta-analysis of RCTs of inhaled zanamivir treatment reported no evidence of an increase in reported adverse events vs placebo in children or adults [259]. Cough and fever provide the most predictive signs and symptoms when influenza viruses are circulating in the community [126]. Survival benefit of NAI treatment of hospitalized adult patients with laboratory-confirmed influenza was reported by one systematic review of the published systematic reviews of observational studies [202] and 2 meta-analyses of observational studies [13, 16], but not in another meta-analysis [203]. This guideline provides recommendations on: treatment with antivirals, specifically neuraminidase inhibitors; treatment with adjunctive therapies, specifically corticosteroids, macrolides and passive immune therapy; and use of diagnostic testing strategies to guide treatment. Patients who received subtherapeutic NAI dosing and who remain ill with laboratory-confirmed influenza might be at increased risk of emergence of NAI-resistant virus, although the risk is likely higher in severely immunocompromised patients. I. Thus, antiviral treatment of influenza has the potential to decrease medical care costs and antibiotic-attributable adverse events, and potentially decrease bacterial resistance to antibiotics. Oseltamivir chemoprophylaxis given once or twice daily vs placebo for 6 weeks reduced laboratory-confirmed influenza by 3.5% in an unvaccinated adult population (from 4.8% to 1.3%; NNT to prevent one case of laboratory-confirmed symptomatic influenza, 29) [384]. Between January 2 to March 5, 451 cases of H3N2 have been reported in India, according to reports. 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]. Accessed Nov. 29, 2018. However, influenza may be clinically indistinguishable from illness caused by other infectious etiologies (including bacterial and other viral infections such as respiratory syncytial virus, parainfluenza virus, human metapneumovirus, and adenovirus) [127]. In general, influenza patients who were treated with oseltamivir and are suspected of developing oseltamivir resistance should be switched to inhaled zanamivir, unless contraindicated. Once the analyses were completed, recommendations were reviewed and revised as appropriate by the panel. Chennai: The state's guidelines on prevention and control of seasonal flu prevent doctors from doing a flu test in the outpatient ward, which infectious diseases experts say restricts the doctor . In general, treatment with an antiviral agent, when indicated, should begin as soon as possible after the onset of typical influenza-like symptoms. 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. If necessary, the entire expert panel will be reconvened to discuss potential changes. Accessed Jan. 6, 2021. These usually include hematological, microbiological, biochemical and radiologic tests. RT-PCR is more likely to still be positive later in illness. A test confirming influenza may reduce the unnecessary use of antibiotics (especially if the procalcitonin level is low, suggesting that bacterial infection is unlikely) and improve antibiotic stewardship. RIDTs can identify influenza A and B viral nucleoprotein antigens in respiratory specimens and rapidly (<15 minutes) provide results. Meta-analyses of RCTs among outpatients with laboratory-confirmed influenza reported that oseltamivir treatment vs placebo was significantly associated with vomiting (relative risk [RR], 1.63) in children [200] and nausea (RR, 1.6; risk difference, 3.7%) and vomiting (RR, 2.43; risk difference, 4.7%) in adults [194]. The risk of death from influenza is highest among HSCT and lung transplant patients [396, 397]. We use cookies to ensure that we give you the best experience on our website. What is the duration of preexposure antiviral chemoprophylaxis to prevent influenza? Seasonal influenza A and B virus epidemics are associated with significant morbidity and mortality each year in the United States and worldwide. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza. https://www.cdc.gov/flu/swineflu/keyfacts-variant.htm. Among the high-risk groups, persons considered to be at very high risk of complications from influenza include those who are severely immunocompromised (eg, hematopoietic stem cell transplant [HSCT] recipients). Adequate studies have not been conducted to define which patients may benefit from therapy with an IV antiviral medication. One pertinent difference to note is the challenge associated with identifying whether cases of influenza with onset within 7296 hours of hospital admission are acquired in the hospital vs community acquired with onset after admission, because the incubation period for influenza ranges from 1 to 4 days. While the abrupt onset of fever with cough is a good indicator of influenza, signs and symptoms may vary for patients with different underlying conditions. even on the 5th day should continue treatment for 5 more days. Acetaminophen oral. Flu vaccine: Safe for people with egg allergy? There is no validated immunoglobulin M assay or other available serologic assay to diagnose seasonal influenza virus infection in a single serum specimen. Although laboratory testing of additional suspected cases is the most definitive means to confirm an outbreak, waiting for laboratory testing results may delay outbreak control measures. Testing sputum specimens by RT-PCR can increase the detection of influenza viral RNA over combined nasal and throat swabs [153155]. Where necessary, screening of retrieved articles was conducted in duplicate and independently. To control an influenza outbreak in a long-term care facility or hospital, should antiviral chemoprophylaxis be administered to exposed residents/patients? Use of available diagnostic modalities and proper interpretation of results can accurately identify patients presenting with influenza. When an institutional influenza outbreak is recognized, it is very likely that some exposed residents or patients are already incubating influenza virus infection coincident with the initiation of antiviral chemoprophylaxis. Keywords: seasonal influenza, diagnostic testing, treatment, chemoprophylaxis, institutional outbreaks, Topic: influenza, antimicrobial chemoprophylaxis, chemoprevention, antiviral agents, disease outbreaks. In addition, influenza during pregnancy can precipitate spontaneous abortion [244, 245]. Well-described risk factors for influenza complications allow clinicians to target patients who are most likely to benefit from prompt antiviral treatment of influenza (Table 4) [134, 170, 208, 216221]. Renaud DL (expert opinion). However, a small number of observational studies and one meta-analysis of observational studies of hospitalized influenza patients reported that NAI treatment did not have survival benefit [203, 211, 212]. Real-time surveillance by the Integrated Disease Surveillance Programme (IDSP . Multiplex RT-PCR assays target a panel of microorganisms using multiplex RT-PCR. Rapid influenza molecular assays that detect influenza viral RNA utilizing different nucleic acid amplification technologies have recently been approved by the FDA. Annual vaccination is the best method for preventing or mitigating the impact of influenza, but in certain situations, chemoprophylaxis with antiviral medications can be used for preexposure or postexposure prevention and can help control outbreaks in certain populations. Exploring high-efficient technologies for swine wastewater treatment is urgent and becoming a hot topic in the recent years. Additionally, antiviral chemoprophylaxis is not completely effective in preventing influenza, and some persons receiving antiviral chemoprophylaxis can develop influenza [393, 435]. Clinicians should maintain familiarity with local patterns of influenza activity in their communities throughout influenza season. 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]. Mayo Clinic; 2020. What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu)? Typical signs and symptoms of uncomplicated influenza are listed in Table 2. 1 Epidemiology of seasonal influenza [295 KB] 2 Guidelines for patient categorization [450 KB] 3 Guidelines for Providing Home Care [283 KB] 4 Guidelines on use of masks [277 KB] 5 Guidelines for clinical protocol [397 KB] 6 Guidelines for Sample Collection [606 KB] 7 Guidelines for . Electronic Code of Federal Regulations. Using aspirin during a viral illness increases the risk of developing Reye's syndrome, a rare but potentially life-threatening condition, in these individuals. In critically ill patients with respiratory failure who are receiving mechanical ventilation, a lower respiratory tract specimen (endotracheal aspirate or BAL fluid) should be obtained for influenza testing. Guidelines on the diagnosis and treatment of influenza were released on December 19, 2018, by the Infectious Diseases Society of America (IDSA). "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The recommendations also address the use of diagnostic tests and antiviral agents for the control of institutional influenza outbreaks. . XVIII. A majority of H1N1 cases are reported from Tamil . If there is clinical suspicion of antiviral resistance as the cause of failure to improve or clinical deterioration, it is critical to consider a change in NAI treatment and to perform testing to confirm the presence of continued viral replication and to document resistance. It's named for a virus that pigs can get. In the following days, several local cases were reported to be caused by contact with two infected Taiwanese women who attended a wedding ceremony in Zambales. Clinicians should also consider that a positive influenza test result does not exclude bacterial coinfection, and evaluation of the potential need for antibiotics, especially in patients with pneumonia, should be considered. One meta-analysis of data from patients with acute respiratory infections enrolled in 26 RCTs reported that procalcitonin-guided antibiotic treatment reduced 30-day mortality, antibiotic exposures, and antibiotic-related adverse effects [327]. One superiority-design RCT without a placebo arm did not demonstrate superiority of investigational IV zanamivir to oral oseltamivir in hospitalized patients with laboratory-confirmed influenza [251]. This suggests standard oseltamivir dosing irrespective of weight in adults [301, 302]. 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]. Most RIDTs and some rapid molecular assays are Clinical Laboratory Improvement Amendments (CLIA) waived tests that can be performed in clinical settings or by any clinical laboratory with a CLIA Certificate of Waiver. The 2009 flu pandemic was confirmed to have spread to the Philippines on May 21, 2009. They have higher sensitivity than RIDTs, but lower sensitivity and specificity compared with viral isolation in cell culture or RT-PCR. Similar sensitivity in detecting respiratory viruses has been demonstrated for mid-turbinate nasal swab specimens compared with NP swabs [151]. Accessed Nov. 27, 2018. 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. Oseltamivir treatment is associated with gastrointestinal symptoms. XIV. You should focus on relieving your symptoms and preventing the spread of the H1N1 to other people. For both the initial and the updated evidence search, the titles and abstracts of identified citations were screened, and potentially relevant citations were subjected to a full-text review, using predefined inclusion and exclusion criteria. 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. If influenza vaccine is not available, antiviral chemoprophylaxis can be offered to all unvaccinated staff. Some commercially available molecular assays can distinguish between influenza A virus subtypes. The only time you should leave home is to access medical care if needed. Real-time surveillance by the Integrated Disease Surveillance Programme (IDSP) shows that 955 cases of H1N1, also referred to as swine flu, have been reported by states till February 28. Nutrition Guidelines for Underweight Children; . Influenza can trigger acute myocardial infarction [70]. Because high-risk outpatients with suspected or confirmed influenza are recommended for prompt antiviral treatment, placebo-controlled studies are generally not possible in many countries, and the benefits of antiviral therapy in different high-risk groups to reduce complications have not been reported in completed prospective, randomized, placebo-controlled trials. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Zanamivir chemoprophylaxis for 6 weeks vs placebo in unvaccinated adults resulted in a 3% reduction in laboratory-confirmed influenza with fever (3.4% to 0.5%; NNT, 33) [385], and a 1.2% reduction when used for 28 days vs placebo in high-risk adolescents and adults (1.4% to 0.2%; NNT, 83] [391]. However, mid-turbinate swabs may not be approved for all assays or accepted by all laboratories. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Multiple studies have reported that rapid influenza diagnostic tests (antigen detection) have low to moderate sensitivity. In a multicenter, prospective, double-blind, randomized controlled trial of hyperimmune IVIg for severe illness with influenza A(H1N1)pdm09 virus infection (17 received hyperimmune IVIg from persons who recovered from laboratory-confirmed influenza A(H1N1)pdm09 virus infection, 18 received IVIg created from donors prior to the pandemic as a control group), hyperimmune IVIg treatment was associated with significant reduction in respiratory tract viral load and mortality [357]. Any potential benefit of higher oseltamivir dosing should be weighed against the severity of disease and the potential for unknown toxicities, and this is best done in the context of a study. Out these best-sellers and special offers on books and newsletters from Mayo Press... Only time you should leave home is to access medical care if needed the H1N1 to other.! Were reviewed and revised as appropriate by the panel been demonstrated for mid-turbinate nasal swab compared... 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