This is a message from the Louisiana Department of Health Emergency Operations Center (LDH EOC) to share a CDC Resource List for Clinicians regarding early vaccination and treatment of patients with influenza with antiviral medications.
Summary: Influenza activity is occurring earlier than expected this year nationwide and is increasing in Louisiana.
Goal of Update:
This health update is being issued:
• to recommend that influenza vaccination campaigns should begin immediately, rather than wait until October,
• to remind clinicians that influenza should be high on their list of possible diagnoses for ill patients, because influenza viruses are circulating in Louisiana, 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.
• Influenza vaccination campaigns should begin as soon as your institution has vaccine, rather than wait until October.
Antiviral Recommendations for the 2017-2018 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:
1) Is hospitalized – treatment is recommended for all hospitalized patients,
2) Has severe, complicated, or progressive illness – this may include outpatients with severe or prolonged progressive symptoms or who develop complications such as pneumonia, and
3) 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.
If you have questions or concerns about an influenza case, please call the Louisiana Office of Public Health at 504-568-8313 or after hours at 1-800-256-2748.