RISK FACTORS
. For contracting disease:
. Patients in semi-closed environments such as nursing homes
. Students, prisoners
. Crowded, close environments during times of epidemics
. For complications
. Chronic pulmonary diseases
. Cardiovascular diseases including valvular problems and congestive heart failure
. Metabolic diseases
. Hemoglobinopathies
. Malignancies
. Pregnancy, especially in the 3rd trimester
. Neonates, infants, elderly
. Immunosuppression
GENERAL MEASURES
• Symptomatic treatment (saline nasal spray, analgesic gargle)
• Cool-mist, ultrasonic humidifi er to increase moisture of inspired air
• Modified respiratory isolation techniques
• Hospitalized patients may require oxygen or ventilatory support
• Avoid smoking
ACTIVITY As tolerated. Strict hand washing procedures.
DIET Increase fluid intake
DRUG (S) OF CHOICE
Antivirals effective if administered within the fi rst 48 hours
. Rimantadine and amantadine are effective only for influenza A
. Rimantadine is now preferred over amantadine by some experts due to fewer side effects
. 100 mg twice per day orally for 3-5 days. It shortens duration of fever, systemic and respiratory symptoms
by about one day. Effective if taken within the fi rst 48 hours.
. The rimantadine dose should be decreased to 100 mg/d for elderly nursing home residents and those
with either liver or severe renal impairment.
. See manufacturerfs guidelines for childrens dosages
. Zanamivir and oseltamivir are effective for influenza types A and B; shortens duration by 1 day
. Oseltamivir also reduces complications of infl uenza
. Zanamivir dose is 2 inhalations twice per day for 5 days (persons 7 years and older)
. Oseltamivir dose is 75 mg po twice per day for 5 days (persons 13 years and older). If severe renal
impairment, 75 mg po once per day. 2 mg/kg/day in two divided doses for children (up to 150 mg).
. Antipyretics
. Acetaminophen - fever control in children.
. Aspirin should not be used in children under 16 years due to risk of Reye syndrome
PATIENT MONITORING In mild cases, usually no follow-up required. Follow moderate or severe cases until symptoms resolved and any complications are treated effectively.
PREVENTION/AVOIDANCE
. Incubation - 1 to 4 days; infected persons most contagious during peak symptoms
. Trivalent influenza vaccine
. Recommended for all adults age 50 and older
. Recommended for high risk individuals: chronic pulmonary disease, cardiovascular disease, immunosuppression, hemoglobinopathies, renal diseases, metabolic disease, diabetes, HIV, long term aspirin
therapy, asplenia, alcoholism
. Recommended for health care providers, home care providers, staff and residents of nursing homes and
other chronic care facilities, homeless, public safety workers and close contacts of high risk individuals
. In 2004, vaccination of healthy 6-23 month-olds is recommended
. Should be administered in the Fall prior to influenza season
. Some side effects possible, e.g., fever and mild, local reaction at vaccination site.
. Dose is 0.5 IM except for children < 3 years old. Children 6 through 35 months old should receive 0.25 mL.
. Single dose/year except for children < 9 years old who should receive 2 doses the fi rst year that they
receive influenza vaccine (1 month apart)
- Vaccine contraindications: Anaphylaxis to eggs (do skin testing first)
- 1-2 weeks after immunization before protection occurs
. Live attenuated infl uenza vaccine (LAIV)
. For healthy persons 5-49 years old
. Persons who should not be vaccinated: anaphylaxis to eggs, immunocompromising conditions, pregnant
women, persons with high-risk conditions, persons with a history of Guillain-Barre syndrome
. Amantadine, rimantadine and oseltamivir:
. May be used prophylactically in high risk groups (that have not been vaccinated or need additional control
measures) during epidemics of infl uenza. It should not be considered as a substitute for vaccination unless vaccine contraindicated.
. Take for duration of outbreak, if no vaccine given. Discontinue after 14 days if used in addition to vaccine.
. Prophylactically during infl uenza season for those with contraindications to vaccine
. Prophylactically for staff and residents in nursing home outbreaks of influenza
. Prophylactically for immune defi cient persons who are expected not to respond to vaccination
. Oseltamivir at 75 mg qd can be used for influenza types A and B, whereas rimantadine is effective for only type A
POSSIBLE COMPLICATIONS
. Otitis media
. Pneumonia
. Reye syndrome
. Rhabdomyolysis
. Post-infl uenza asthenia
. Acute sinusitis
. Croup
. Apnea in neonates
. Bronchitis
. Death
. Exacerbation of CHF
EXPECTED COURSE/PROGNOSIS Favorable