Flu Guidelines From IDSA Update Testing, Treatment Recommendations

Troy Brown, RN

December 19, 2018

Updated clinical practice guidelines on seasonal influenza from the Infectious Diseases Society of America (IDSA) urge prompt diagnostic testing with newer, more accurate molecular tests, and treatment and chemoprophylaxis with antiviral medications for pregnant women and others at high risk for influenza complications.

"Influenza can be serious, especially for the sizable group of people at high risk," Timothy M. Uyeki, MD, MPH, MPP, co-chair of the guidelines committee and chief medical officer of the Influenza Division of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said in a news release. "Annual influenza vaccination is the best way to prevent influenza, but it is not 100% effective. Those at high risk need to be encouraged to seek medical care right away if they develop influenza symptoms during influenza season."

The guidelines by Uyeki and colleagues were published online today in Clinical Infectious Diseases.

The new recommendations update guidelines previously published by IDSA in 2009, before the 2009 H1N1 influenza pandemic.

Since then, rapid molecular diagnostic assays have become available, new risk factors for severe illness have been identified, and peramivir, a parenteral neuraminidase inhibitor, has been approved by the US Food and Drug Administration for use in the United States.

Patients at high risk for influenza complications who are ill enough to require hospitalization for flu symptoms should undergo prompt testing and receive antiviral treatment quickly — without waiting for results of molecular testing. High-risk individuals diagnosed with influenza as outpatients should also receive antiviral treatment as quickly as possible, according to the guidelines.

Those not at high risk for complications should receive antiviral treatment within 2 days of symptom onset; however, those at high risk should receive antiviral medications even if they have been ill for longer than 2 days.

For diagnostic testing, the guideline authors favor "newer and highly accurate molecular tests that deliver results in 15 to 60 minutes instead of rapid-influenza diagnostic tests, which produce quick results but can be falsely negative in at least 30% of outpatients with influenza."

Patients at high risk for complications from influenza include pregnant women and those who have given birth within the previous 2 weeks; patients with extreme obesity (body mass index > 40 kg/m2); children younger than 5 years, particularly those younger than 2 years; those aged 65 years or older; individuals with a weakened immune system as a result of disease or medication; patients younger than 19 years who are receiving long-term aspirin therapy; patients with chronic medical conditions such as asthma, neurological or neurodevelopmental disorders (including cerebral palsy, epilepsy, and stroke), heart or lung disease, kidney, liver or metabolic disorders; residents of nursing homes and other chronic care facilities; native Americans; and native Alaskans.  

Immunocompromised patients, such as those who have received a lung transplant or hematopoietic stem cell transplantation, may be more likely to develop influenza viral pneumonia and bacterial or fungal coinfections; therefore, their clinical team should include an infectious disease specialist with experience in treating infectious diseases in transplant recipients, if possible.

"High-risk individuals who are hospitalized with flu complications are at an increased risk for serious bacterial infections and infectious diseases physicians' expertise is critical to ensuring they receive the best care," said senior author Andrew T. Pavia, MD, FIDSA, co-chair of the guidelines committee and chief of the Division of Pediatric Infectious Diseases at the University of Utah, Salt Lake City, in the news release. "Infectious disease doctors also can provide guidance when a patient who has the flu is not responding to antiviral treatment or is getting worse."

"We are always concerned about preparing for the next pandemic, but we also are focused on preventing and controlling seasonal influenza," Uyeki concluded in the news release. "While pandemics aren't predictable, we know that every year we're going to have seasonal influenza and we need to improve how we prevent and control it through influenza vaccination, better diagnosis, and early antiviral treatment of patients."

The guideline authors have disclosed a variety of financial relationships including those with the pharmaceutical industry and medical associations. A complete list is available at the journal's website.

Clin Inf Dis. Published online December 19, 2018. Full text

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