Title: Influenza 2014-What you need to know<br/>Author: Feras Khan<br/><a href='http://umem.org/profiles/faculty/1145/'>[Click to email author]</a><hr/><p>
<strong>How does it present?</strong></p>
<ul>
<li>
Fever, cough, sore throat, runny nose, muscle aches, headaches, fatigue, diarrhea (in children especially)</li>
</ul>
<p>
<strong>Who cares…I got my vaccine! Does the vaccine work this year?</strong></p>
<ul>
<li>
There has been some antigenic drift this year in the influenza A (H3N2) type virus.</li>
<li>
52% are anti-genically different than the H3N2 vaccine virus.</li>
<li>
So the vaccine is less effective this year <em>but</em> it can give some cross-protection (in addition to protection against the other strains used in the vaccine)</li>
<li>
CDC recommends still getting the vaccine (<a href="http://www.cdc.gov/flu/protect/vaccine/vaccines.htm">http://www.cdc.gov/flu/protect/vaccine/vaccines.htm</a>)</li>
<li>
91% of samples reported to the CDC have been influenza A this year</li>
</ul>
<p>
<strong>Can I test for this?</strong></p>
<ul>
<li>
Rapid influenza diagnostic tests check for antigen detection</li>
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Pooled sensitivity of 62%; specificity of 98%</li>
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False negatives are common</li>
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Good technique during sample collection is important</li>
</ul>
<p>
<strong>The CDC is recommending treatment...wait I thought we were done with Tamiflu?</strong></p>
<ul>
<li>
Benefits: shortens the duration of symptoms (day or less), reduces the risk of complications, reduces the risk of death among hospitalized patients</li>
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Risks: side effects (see below)</li>
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A recent Cochrane review revealed that treatment did not really help reduce complications and most of the data on anti-viral agents is biased (Roche funded) and hotly debated</li>
</ul>
<p>
<strong>Who is at risk/who deserves <span style="background-color:#ffff00;">consideration</span> for treatment?</strong></p>
<ul>
<li>
Hospitalized patients with influenza </li>
<li>
Old people (>65)</li>
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Children</li>
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Pregnant women</li>
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Chronic medical conditions (asthma, COPD, diabetes, or heart disease)</li>
<li>
American Indians and Alaskan natives</li>
<li>
Chronic immunosuppression</li>
<li>
Institutional outbreaks (nursing homes, correctional facilities)</li>
</ul>
<p>
<strong>Pearls of treatment</strong></p>
<ul>
<li>
Treat as early as possible (<48hours from symptom onset)</li>
<li>
5 days of treatment; twice daily dosing. Wt based for children. Renally dosed.</li>
<li>
Oseltamivir: used for more severe influenza cases</li>
<li>
Zanamivir: 7 years or older; IV Zanamivir is currently in Phase III clinical trials</li>
</ul>
<p>
<strong>What are the side effects of anti-viral agents?</strong></p>
<ul>
<li>
Don’t use zanamivir in patients w/ pulmonary disease</li>
<li>
Transient neuropsychiatric events for oseltamivir</li>
<li>
Nausea, vomiting, diarrhea are common both both</li>
</ul>
<p>
</p>
<fieldset><legend>References</legend>
<p>
http://www.cdc.gov/flu/index.htm</p>
<div class="cit" style="font-size: 0.8465em; line-height: 1.45em; font-family: arial, helvetica, clean, sans-serif;">
<span role="menubar"><a abstractlink="yes" alsec="jour" alterm="Cochrane Database Syst Rev." aria-expanded="false" aria-haspopup="true" href="http://www.ncbi.nlm.nih.gov/pubmed/24718923#" role="menuitem" style="color: rgb(102, 0, 102); border-bottom-width: 0px;" title="The Cochrane database of systematic reviews.">Cochrane Database Syst Rev.</a></span> 2014 Apr 10;4:CD008965. doi: 10.1002/14651858.CD008965.pub4.</div>
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif;">
<span class="highlight">Neuraminidase</span> <span class="highlight">inhibitors</span> for <span class="highlight">preventing</span> and <span class="highlight">treating</span> <span class="highlight">influenza</span> in healthy adults and children.</h1>
<div class="auths" style="font-size: 0.923em; font-family: arial, helvetica, clean, sans-serif;">
<a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Jefferson%20T%5BAuthor%5D&cauthor=true&cauthor_uid=24718923" style="color: rgb(102, 0, 102); border-bottom-width: 0px;">Jefferson T</a><span style="font-size: 0.8461em; line-height: 1.6363em; position: relative; vertical-align: baseline; top: -0.5em;">1</span>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Jones%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=24718923" style="color: rgb(102, 0, 102); border-bottom-width: 0px;">Jones MA</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Doshi%20P%5BAuthor%5D&cauthor=true&cauthor_uid=24718923" style="color: rgb(102, 0, 102); border-bottom-width: 0px;">Doshi P</a>, et al. </div>
</fieldset>