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Influenza (Antivirals: NA inhibitors (Oseltamivir (Tx & ppx: >14…
Influenza
Antivirals: NA inhibitors
Oseltamivir
Tx & ppx: >14 days old (per CDC)
75mg BID x5 days (adults tx); 75mg daily x5d is ppx
Admin within 48hr, ideally within 12hr
In clinical practice you will give to high-risk patients in a 'no harm, no foul' attitude
PO, IM routes
AEs: delirium, hallucinations
Preferred in pregnancy tx, hospitalized, or severe progressive illness
Zanamivir
Tx: >7yo
Inhalation
2 puffs BID x 5d
Ppx: >5yo
Inhalation
2 puffs daily x5d
Admin within 48hr
May be preferred in pregnancy ppx w/o respiratory conditions due to limited systemic exposure
Peramivir
Tx: >18 yo
No ppx
IV
600mg IV x1 dose
Kids will have weight-based dosing
Who will get ppx?
High risk for infection & could not get vaccinated
OR if you are vaccinated but exposed within the 2w immunity period
OR immuncompromised who can't develop immune response & exposed to infection
OR long-term care residents when outbreak occurs
Risk factors
Age
Older than 65 yo
<2yo
Pregnancy
Immunocompromised
Cardiopulmonary disease
Asthma, DM
Clinical Presentation
Rapid onset of sore throat, fever, myalgia, fatigue, headache, nonproductive cough, rhinitis
Sore-throat generally self-limited
Complications
Exacerbation of underlying conditions, secondary bacterial pneumonia, pneumonia, Reye's syndrome, pericarditis, myocarditis, encephalopathy, transverse myelitis
Labs
CBC, RIDTs, RT-PCR (gold standard)
Vaccines
Inactivated (IIV)
Trivalent (IIV3)
HD for those >65yo
Egg allergy --> Flublok (RIV3)
Quadrivalent (IIV4)
Intradermal formulation available (Fluzone, age 18-64yo)
Extra influenza B coverage
Indicated for anyone >6mo
For those under 9yo, 2 vaccines needed
More IgG response
Takes 2w for vaccine to be effective
Live-attenuated (LAIV)
Intranasal formulation (Flumist) 2-49yo
Avoid in pregnant women & immunocompromised
Lower IgG response, but higher IgA (mucosal, will stay around longer)
Special populations
Pregnancy
Vaccinate any semester, IIV
Avoid antivirals while breastfeeding
Immunocompromised
Annual vaccination with IIV
Consider HD
If a pt develops a GBS episode within 6w of flu shot, AVOID vaccine in those who are at low-risk of infection complications
If at high-risk of infection complications, benefits may outweigh the risks
Travel
Think about when & where you are traveling. What is their predicted flu? When is their flu vaccine?
Generally get about 2w before traveling
Flu vaccine is efficacious for ~6mo- 1yr
Southern hemisphere has different flu season
Reyes Syndrome
Avoid LAIV if child (2-17yo) is using aspirin
Can give IIV
The only people who should not receive vaccine: <6mo old or severe hypersensitivity
Nonpharm
Treatment
Rest
Fluids
Prevention
Hand washing
Cover cough
Contact avoidance