Pregnant and extremely obese women are among those at high risk of influenza complications – including death – and should be tested and start antiviral treatment immediately if they are sick enough to be hospitalized with symptoms of influenza guidelines disclosed by the Infectious Diseases Society of America (IDSA). Outpatients who have been diagnosed with the flu and are at high risk of complications should also receive antiviral treatment as soon as possible, observe the seasonal influenza guidelines, which are published in Infectious Diseases Clinics.
The guidelines recommend the use of more recent and highly accurate molecular tests that provide results in 15 to 60 minutes instead of rapid influenza diagnostic tests (RIDTs), which produce rapid results but may be falsely negative in at least 30% of patients with influenza. Although antiviral treatment is recommended within two days of the onset of flu symptoms in people who are not at high risk of complications, the guidelines indicate that they should be prescribed for those at high risk, even if they have been ill for more than two days .
People who are extremely obese have a body mass index (BMI) of 40 or more. Others in the high-risk category include: young children (especially those younger than 2 years); women who gave birth recently; those with a weakened immune system due to illness or medication (such as people with HIV or AIDS, cancer, who have had an organ transplant, or who are on chronic steroids); people under the age of 19 who are receiving long-term aspirin therapy; those with chronic medical conditions, including asthma, neurological disorders or neurodevelopment (such as cerebral palsy, epilepsy and stroke), heart or lung disease, renal, hepatic or metabolic disorders; and residents of nursing homes; Native Americans and Alaska Native.
"The flu can be serious, especially for the large group of high-risk people," said Timothy M. Uyeki, MD, MPH, MPP, co-chair of the guidelines committee and medical director of the Influenza Division of the National Influenza Center . Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC). "Annual influenza vaccination is the best way to prevent influenza, but it is not 100% effective. High-risk people need to be encouraged to seek medical attention immediately if they develop flu-like symptoms during the flu season."
Typical signs and symptoms of influenza include fever, cough, muscle aches, chills, runny nose, and sore throat. Other symptoms may include headache and chest pain.
The guidelines point out that antiviral treatment should be started immediately in people at high risk of influenza complications being admitted to the hospital with suspected influenza, without waiting for the results of the molecular flu test. The influenza test is important because doctors are more likely to treat patients with antiviral drugs if they have a definitive diagnosis, further reducing the likelihood of inappropriate antibiotic prescribing, especially in outpatients.
If people at high risk become seriously ill with the flu, health professionals should turn to physicians with infectious diseases to provide expertise, observe the guidelines.
"High-risk individuals who are hospitalized with flu complications are at increased risk of serious bacterial infections and the specialty of physicians in infectious diseases is critical to ensuring they receive the best care," said Andrew T. Pavia, MD, co- president of FIDSA. the guidelines committee and chief of the Division of Pediatric Infectious Diseases at the University of Utah, Salt Lake City. "Identification physicians can also provide guidance when a patient with influenza is not responding to antiviral treatment or is getting worse."
The previous guidelines were published shortly before the 2009 H1N1 pandemic, the fourth pandemic in the last 100 years. Other pandemics occurred in 1918 (killing about 675,000 people in the United States), 1957 and 1968. A pandemic is a worldwide outbreak of a new influenza A virus that is very different from the seasonal influenza A virus circulating in people. Once it begins to circulate, the pandemic virus becomes a seasonal flu virus in subsequent years. Last season, influenza accounted for about 49 million illnesses in the United States, including 960,000 hospitalizations and 79,000 deaths.
"We are always concerned about preparing for the next pandemic, but we also focus on preventing and controlling seasonal influenza," Uyeki said. "Although pandemics are not predictable, we know that every year we will 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."
In addition to drs. Uyeki and Pavia, the panel of guidelines includes Henry H. Bernstein, DO, MHCM; John S. Bradley, MD, FIDSA; Janet A. Englund, MD, FIDSA; Thomas M. File Jr., MD, MSc, FIDSA; Alicia M. Fry, MD; Stefan Gravenstein, MD, MPH; Frederick G. Hayden, MD, FIDSA; Scott A. Harper, MD, MSc, MPH; Jon Mark Hirshon, MD, PhD; Michael G. Ison, MD, MS, FIDSA; B. Lynn Johnston, MD, FIDSA; Shandra L. Knight; Allison McGeer, MD, FIDSA; Laura E. Riley, MD; Cameron R. Wolfe, MBBS, MPH, FIDSA and Paul E. Alexander, MSc, MHSc, PhD.
IDSA has published more than 50 treatment guidelines in various conditions and infections, ranging from HIV / AIDS to skin and soft tissue infections. As with other IDSA guidelines, the flu guidelines will be available in smartphone format and quick reference pocket edition. Complete guidelines are available for free from the IDSA website at https: /
Note: For a copy of the Flu guidelines published on December 19, 2018, contact Samantha Guckenberger at (312) 558-1770 or [email protected]
The Society for Infectious Diseases of America (IDSA), based in Arlington, Va., Is a professional society representing more than 11,000 physicians and scientists specializing in infectious diseases. For more information, visit http: // www.
Infectious Diseases Clinics is a leading infectious disease journal with a broad international audience. The journal publishes articles on a variety of subjects of interest to practitioners and researchers. Topics range from clinical descriptions of infections, public health, microbiology and immunology to prevention of infections, evaluation of current and new treatments, and promotion of optimal practices for diagnosis and treatment. The journal publishes original research, editorial commentary, review articles and practical guidelines and is among the most frequently cited journals in the field of infectious diseases. Infectious Diseases Clinics is an official publication of the Society for Infectious Diseases of America (IDSA).