Nosocomial acquisition of influenza is a consideration in persons who experience an onset of fever 48 hours or more after hospital admission during the influenza season [8084]. Empiric antiviral treatment should be considered for confirmed, probable, or suspected cases of H1N1 influenza. Although older studies demonstrated efficacy of adamantanes (amantadine and rimantadine) for chemoprophylaxis, the use of adamantanes is not recommended because of widespread adamantane resistance among circulating influenza A viruses [249, 399, 400], the inherent resistance of influenza B viruses to adamantanes, and the rapid emergence and transmission of adamantane-resistant influenza A viruses during adamantane treatment. During 20162017, some IDSA panelists worked with international experts on reviewing advances in the field and updating this research agenda. Types of influenza viruses. However, other studies of infants born to women who had laboratory-confirmed influenza during pregnancy have not shown higher rates of prematurity, preterm labor, low birth weight, or lower Apgar scores compared with infants born to uninfected women [230, 241, 242]. A large autopsy series of 100 fatal cases found no evidence of extrapulmonary influenza A(H1N1) pdm09 virus infection [167]. One large retrospective observational study not included in any meta-analyses reported data for 607 adults hospitalized with influenza A(H1N1)pdm09 in 51 Canadian ICUs [370]. Treatment recommendations for H1N1 pandemic swine influenza as per World Health Organization guidelines Patients who report with uncomplicated clinical presentation due to confirmed or strongly suspected virus infection and are in a group known to be at higher risk of developing severe or complicated illness, should be treated with oseltamivir . Educating patients and arranging for early empiric initiation of antiviral therapy if influenza symptoms develop may be an effective alternative to postexposure antiviral chemoprophylaxis, but studies comparing these 2 approaches have not been conducted. Zanamivir is detectable at low concentrations in breastmilk of lactating women who received inhaled zanamivir [276]. The CDC and WHO perform ongoing assessment of the antiviral susceptibility of circulating influenza viruses [349]; updated summaries of US data are available at https://www.cdc.gov/flu/weekly/summary.htm. These clinical practice guidelines are an update to the guidelines published by the IDSA in 2009, prior to the 2009 H1N1 influenza pandemic. Similar findings were reported in a systematic review of oseltamivir RCTs in children and adults [254]. Infants and young children may present with fever and suspected sepsis [35, 36]. Key facts about human infections with variant viruses. For the detection of influenza viruses by nonmolecular assays, combined specimens or NP aspirates should be considered. 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]). CLINICAL MANIFESTATIONS. Where necessary, screening of retrieved articles was conducted in duplicate and independently. Performance of these assays depends heavily on laboratory expertise and the quality of the specimen collected (ie, specimens must include respiratory epithelium cells; requires a florescent microscope and an experienced laboratory technician). Drug dosing is standardized for oral oseltamivir and inhaled zanamivir (Table 8). Each of these subgroups was addressed by its dedicated subcommittee. 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]. Early antiviral therapy must be considered among hospitalized children diagnosed with or suspected to have influenza, especially if they have risk factors such as asthma, cardiac problems, or other. In a retrospective study of clinical predictors of influenza in hospitalized patients, fever with cough or sore throat had a sensitivity of 43% for patients without asthma, and only 21% for asthmatic patients [32]. NAI resistance can vary among influenza viruses and the specific NAI being used. Higher sensitivity to detect influenza viruses in respiratory specimens has been reported for one rapid molecular assay (isothermal nucleic acid amplification) than for rapid antigen detection tests [117119], and a meta-analysis of rapid molecular assays reported pooled sensitivities of 92% and 95% for detection of influenza A and B viruses, respectively, and pooled specificities of 99% [111]. Oseltamivir (tablets or oral suspension formulation) may be administered to all pediatric age groups with influenza, including premature infants [216]. Sullivan JE, et al. For molecular assays, NP or mid-turbinate nasal swab specimens are the preferred upper respiratory tract specimens. H1N1 Swine flu is a subtype of influenza A virus (a communicable viral disease), which causes upper, and potentially, lower respiratory tract infections in the host it infects, resulting in symptoms such as nasal secretions, chills, fever, decreased appetite, and possibly lower respiratory tract dis Feeding your Baby: What Parents Should Know, Info for Pregnant Women in Education, Child Care, and Health Care, CDC Guidance for Businesses and Employers To Plan and Respond to the 20092010 Influenza Season, Planning for 2009 H1N1 Influenza: A Preparedness Guide for Small Business, Managing Calls and Call Centers during a Large-Scale Influenza Outbreak: Implementation Tool, EMS and 9-1-1 Personnel: Managing Confirmed or Suspected Infections, Guidance from Pediatric Stakeholders: A Coordinated Approach to Communicating Pediatric-related Information on Pandemic Influenza at the Community Level, CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others, Interim CDC Guidance on Day and Residential Camps, Guidance on Helping Child Care & Early Childhood Programs Respond to Flu during 20092010 Flu Season, Guidance for State & Local Health Officials & School Administrators for 2009-2010 School Year, Guidance for Institutions of Higher Education for 2009-2010 Academic Year, Flight Crews Arriving from Affected Areas, Centers for Disease Control and Prevention. Hospital units with longer length-of-stay patients (eg, rehabilitation units, transplant units) and skilled nursing facilities are relatively closed environments with high-risk patient populations and are similar to long-term care facilities for the elderly [417, 432, 433]. pathogens such as Influenza A (H1N1, . Myocarditis and encephalitis were the most frequently described extrapulmonary complications associated with influenza in adults in a recent comprehensive review [63]. RIDTs can identify influenza A and B viral nucleoprotein antigens in respiratory specimens and rapidly (<15 minutes) provide results. The lower systemic exposure might also compromise the effectiveness of once-daily oseltamivir chemoprophylaxis. Several studies have evaluated the efficacy of postexposure antiviral chemoprophylaxis for household members after influenza diagnosis in a household member [386390]. For . However, 10% of the baloxavir recipients with paired sequenced samples had emergence of viral escape mutants with reduced drug susceptibility, and most of these patients had infectious virus detected 5 days after treatment and longer duration of symptoms than in baloxavir recipients without these mutations [459]. Therefore, in studies of NAI treatment of patients with nonspecific ILI without documentation of influenza virus infection (intention-to-treat), clinical outcomes are biased toward lower efficacy or effectiveness [14] than in studies of treatment of laboratory-confirmed influenza. A prospective study of adults aged 2850 years across 2 influenza seasons in Taiwan reported that fever and cough had the best sensitivity (86%), while fever, cough, and sneezing had the best specificity (77%) for influenza [31]. Which antiviral drugs should be used for postexposure chemoprophylaxis? Cohen J, et al. In a patient with suspected or confirmed influenza, when should bacterial coinfectoin of the upper or lower respiratory tract be considered, investigated, and treated? At annual intervals, the SPGC will determine the need for revisions to the guideline based on an examination of current literature evidence and the likelihood that any new data will have an impact on the recommendations. 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]. Novel H1N1 Influenza Practice Assessment School Nurses: On the Frontline in the Battle Against Influenza Ethical Dilemmas for Healthcare Professionals: Can We Avoid Influenza? One RCT reported that combination oral therapy with oseltamivir, amantadine, and ribavirin resulted in a significant but modest reduction in influenza viral shedding at treatment day 3, but was not associated with significant reduction in multiple clinical endpoints compared with oseltamivir monotherapy in adult outpatients with laboratory-confirmed influenza [253]. Decisions on extended duration of antiviral chemoprophylaxis for severely immunocompromised patients such as HSCT recipients should consider issues such as the potential for emergence of antiviral-resistant influenza viruses as well as tolerability and absorption issues for those with gastrointestinal graft-vs-host disease. A study of hospitalized pediatric influenza patients reported that the proportion that received antiviral treatment increased from 20% to 69% overall during 20072015, but varied from 42% to 90% among 46 hospitals during 20142015 [23]. There are no published data to quantify the risk of influenza virus transmission among different wards of a long-term care facility. Both oseltamivir phosphate and the metabolite oseltamivir carboxylate have been demonstrated to cross the placenta [271276]. One meta-analysis of observational studies of rapid influenza antigen testing of respiratory tract specimens (mostly upper respiratory tract specimens) compared to molecular assays or viral culture reported that rapid influenza antigen tests had moderate sensitivity (62%) and high specificity (98%) among all ages [110]. Secondary bacterial pneumonia due to methicillin-resistant S. aureus (MRSA) is becoming more prevalent and has been a more common finding in recent pediatric influenza-associated deaths [42, 4648]. See recommendations 4042 and Evidence summary for discussion of the role of postexposure prophylaxis in high-risk patients who are close contacts of influenza patients. Results are available within 24 hours after specimen submission. Seasonal epidemics of influenza A and B viruses occur each fall, winter, and spring in the United States, while influenza C virus infections occur sporadically. Dosing and duration of uncomplicated influenza is the same for all pediatric age groups (2 inhalations twice daily for 5 days). Residents of long-term care facilities and hospitalized patients are at high risk for complications of influenza, even if vaccinated, because influenza vaccine effectiveness may be low, particularly in elderly persons. Content on this page was developed during the 2009-2010 H1N1 pandemic and has not been updated. Supportive care such as drinking liquids, taking pain relievers for fever and headache, and resting may be helpful. There are no fully enrolled prospective, randomized, placebo-controlled trials of oral oseltamivir or inhaled zanamivir in hospitalized influenza patients. Previously, the Food and Drug Administration did not suggest anyone below the age of 12 get their self . . The Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, and the American College of Obstetricians and Gynecologists reviewed and endorsed the guideline. Most observational studies of corticosteroid treatment of hospitalized patients have been reported in adults [199, 367, 368]. 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. Signs and symptoms. Bacterial coinfection contributed to critical and fatal illness during the 2009 H1N1 pandemic [122, 167, 308310]. Antiviral chemoprophylaxis can also be offered to unvaccinated staff with vaccine contraindications and to immunocompromised staff (who are expected to have poor immune response to vaccination) for the duration of an institutional outbreak. Inactivation of H1N1 was kinetically determined by the treatment of disinfectants to virus solution. Effective isolation and control of outbreaks can be challenging and may require different strategies. Baloxavir was well tolerated, with no difference in adverse events compared with oseltamivir or placebo. 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. Centers for Disease Control and Prevention. For additional guidance, see IDSA guidelines on the management of community-acquired pneumonia, S. aureus infections, and rhinosinusitis. If postexposure antiviral chemoprophylaxis is administered, it should be given within 48 hours of exposure to a person with influenza. A pooled meta-analysis of observational studies with individual-level data from >29000 hospitalized patients (86% with laboratory-confirmed influenza, 14% clinically diagnosed with influenza) reported survival benefit of NAI treatment (primarily oseltamivir) in adults compared with no treatment, with significantly greater survival benefit with early (within 2 days of illness onset) compared with later initiation (>2 days after onset) of NAI treatment [16]. Comprehensive testing for molecular markers associated with NAI resistance requires specialized assays that may be available at some public health and academic laboratories. Your doctor may diagnose you with influenza based on your signs and symptoms. XII. Similar sensitivity in detecting respiratory viruses has been demonstrated for mid-turbinate nasal swab specimens compared with NP swabs [151]. Data on the ability of postexposure antiviral chemoprophylaxis to prevent serious complications of influenza are not available, although reductions in symptomatic influenza cases would be expected to also reduce the risk of complications. 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 . None of the guidelines above recommend systematic corticosteroid use regularly with H1N1 infection. What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu)? To receive weekly email updates about this site, enter your email address: How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? Seasonal influenza is an acute respiratory infection caused by influenza viruses which circulate in all parts of the world. 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