pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Dealing With Influenza

URGENT WARNING
The 2017-2018 Influenza Season has been classified a pandemic – and has killed over 30 children this year in the U.S. alone with half the season left to go.
Flu Shots: It’s not too late to get them, if only because they also make any disease you DO GET less severe, in addition to providing protection against contracting the disease.
2017-2018 Influenza Season
You might have heard the rumor that the “flu shots” aren’t working this year (2017-2018)—that is NOT TRUE. The flu shots ARE working BUT this has turned out to be a “H3N2” year which is known to produce “breakthrough” cases with more severe illness, especially in young children and older adults.
 
U.S. Convalescent centers, care centers, hospitals—they’re all full of individuals suffering from influenza this winter. High risk groups are being especially hit and deaths are occurring. By January 2018 all states are considered heavily affected, only Maine, Alaska and Montana (and a little of northern Utah) are considered in the “low” category; although in Utah the disease is working its way up the state as of January.
 
“Flu shots” are still recommended for those who haven’t had them and physicians are advised to facilitate those of their patients in the high-risk category into obtaining antiviral treatments early in their course of illness.
 
A problem this year is that we’ve just learned that only 37% of high-risk patients with CONFIRMED influenza are actually prescribed antiviral medications. The same study also found that many of those high-risk patients not only didn’t obtain a vaccination but also delayed seeking care, thereby reducing the opportunity for optimal antiviral treatment.

Influenza Quick Facts

EVERYONE is encouraged to obtain vaccination against the influenza virus every fall. [I’ve written about this several times in the past]

Each year the CDC must use all its data to try and predict which type of the virus will become predominant the following year and advise manufacturers so as to have stocks of the most effective vaccine ready for the fall entry into the “flu season.” Mostly the guesses are spot on; however, we’ve discovered that even if they’re off a little the vaccine still conveys “skills” to the body which allows it an advantage in fending off an attack AND, if an infection does occur, to decrease it’s severity and length.

High Risk Groups

Deciding not to obtain a flu shot is just plain short-sighted and dangerous, especially if you are in a “high-risk” group. “High Risk” doesn’t necessarily mean that you are more likely to GET it – it means that you are MORE LIKLEY TO DIE if you get it!

High-risk patients are: pregnant women; adults aged 65 years or older; children younger than 2 years; and people with underlying health conditions, such as immunosuppression, asthma, diabetes, or heart disease. These are those who are at greater risk of developing flu complications.

If the virus does attack you (with or without the vaccination) IF antiviral medication is administered early, it can lessen illness severity; shorten the duration of illness; and reduce serious flu-related complications, such as pneumonia in outpatients and death in hospitalized patients.

I do have to say that included in the low figure are those patients whose doctor makes it so difficult to either get in to see them; obtain advice/treatment via telephone; or who basically completely turn their acutely ill patients over to the Emergency Room. In other words, who make obtaining timely treatment so onerous that only severe complications gain them treatment… too late.

These findings emphasize the importance of developing a deeper understanding of the barriers to prescribing antivirals and the need to create new methods to increase appropriate prescribing for high-risk patients.

Treatment With Anti-Viral Medication

Complicating this whole conversation is that the pharmacy companies have made anti-viral medications so expensive that money considerations nearly captivate every discussion.

There are three: oral oseltamivir, inhaled zanamivir, and intravenous peramivir. All are neuraminidase inhibitors, are chemically related and have activity against certain effects of both influenza A and B viruses.

Fortunately, in 2016 a generic brand of oseltamivir became available; but, having no competitors, there is not much benefit to U.S. consumers.

Clinical benefit is greatest when antiviral drugs are administered early; which is why the CDC encourages physicians NOT to delay decision about starting antivirals in all high-risk, hospitalized or severely ill patients. Ideally within 48 hours of symptom onset.

Physicians should also consider antiviral treatment on the basis of clinical judgment for previously healthy outpatients with confirmed or suspected influenza, even if they are not considered high risk, if treatment can be initiated within 48 hours of illness onset.

To treat influenza, oral oseltamivir and inhaled zanamivir are usually prescribed for 5 days, although hospitalized patients may receive longer treatment. Intravenous peramivir is administered in a single infusion over 15-30 minutes. Peramivir is approved for treatment in adults; zanamivir for the treatment of children aged 7 years or older; and oseltamivir for treatment in patients of all ages, including infants.

Updated Information

Citizens may obtain up-to-date information about each “influenza year” from several official organizations and their web sites.

The CDC publishes weekly surveillance data, including information on antiviral resistance, in their FluView US Influenza Surveillance Report. It’s a real interesting thing to look at.

Visit CDC’s Influenza page for the latest updates on flu activity and CDC’s information for healthcare professionals. In addition, for detailed guidance on nonpharmaceutical interventions (NPIs) and how to plan and prepare for a flu pandemic, see the 2017 Community Mitigation Guidelines, NPI Planning Guides, and Pandemic Flu Checklist.

 

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