CDC Advisory: Flu Increasing, Be Ready With Antivirals

Marcia Frellick

December 28, 2017

Influenza activity, predominantly from A(H3N2), has increased significantly in recent weeks, according to the Centers for Disease Control and Prevention (CDC), which issued a health advisory Wednesday.

Given the characteristics of this season's flu, the CDC is recommending, in addition to the flu vaccine for prevention, increased use of neuraminidase inhibitor (NAI) antivirals for treatment.

Quick treatment is crucial and "should not be delayed even for a few hours to wait for the results of testing," according to the advisory. Treatment works best when started within 2 days of onset but has shown benefit for some patients even when initiated later.

Focus on treatment is important because in past seasons, A(H3N2) has been linked with more deaths and hospitalizations in people aged 65 years and older and young children than in other groups. Also, this year's vaccine effectiveness may be as low as last year's, at 32% for A(H3N2), the CDC says.

NAIs have been effective in randomized trials but have been underused with both outpatients and inpatients, the CDC notes.

The advisory reminds clinicians that all inpatients and all high-risk patients (whether inpatient or outpatient) who are suspected of having or confirmed to have influenza should be treated.

Those groups include the following:

  • Patients with severe, complicated, or progressive illness, including outpatients with severe or prolonged progressive symptoms or those who develop pneumonia;

  • Children under age 2 years or people 65 years and older, as well as people younger than 19 years who are receiving long-term aspirin therapy;

  • American Indians/Alaska natives;

  • Women who are pregnant or within 2 weeks postpartum;

  • People with suppressed immune systems;

  • Extremely obese people (body mass index of at least 40); and

  • Those living in long-term care facilities.

Treatment is also indicated when flu is suspected or confirmed for "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)," the CDC advises.

To more effectively treat patients quickly, the CDC says providers may want to consider setting up phone triage lines or write antiviral prescriptions without testing and before an office visit when treatment is deemed necessary over the phone.

Three NAIs are approved by the US Food and Drug Administration and recommended for the 2017-2018 season: oseltamivir; zanamivir; and peramivir.

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