Influenza Prevention and Treatment for the 2012-2013 Season

Influenza Prevention and Treatment for the 2012-2013 Season Faculty

Stefan Gravenstein, MD, MPHProfessor of MedicineThe Center for Geriatric Medicine Case Western Reserve UniversityCleveland, OhioAdjunct Professor of MedicineWarren Alpert Medical School of Brown UniversityClinical Director, Healthcentric Advisors Providence, RI

Why Don’t People Get Vaccinated?Why Don’t People Get Vaccinated?• I'm healthy, I don't need it.• There is a vaccine shortage, others may need it.• The vaccine may have side effects.• A doctor hasn't told me I need it.• The vaccine might not be available.• I don't visit a doctor regularly.• The vaccine may not work well.• I might get influenza.• I don't know when to get vaccinated.• The vaccine could worsen current conditions.• I dislike needles or shots.• The vaccine costs too much.• Insurance doesn't cover the vaccine.

Johnson DR, et al. Am J Med. 2008;121:S28-S35.

Vaccines Are Effective Only If AdministeredVaccines Are Effective Only If Administered

• Prevent missed opportunities to vaccination.• Vaccinate as soon as possible once vaccines

become available. • Vaccinate before influenza is active as patients

can not be expected to return for the vaccine when influenza is likely to be circulating in the community.

• Vaccination does not cause influenza or influenza-like illness, but a healthy immune response can produce cold-like symptoms following vaccination.

Universal VaccinationUniversal VaccinationRoutine influenza vaccine is recommended for all persons aged 6 months and older who do not have contraindications to vaccination. Contraindications include: • History of severe allergic reaction to influenza vaccine

• Patients with a history of severe allergic reaction to eggs should be referred to a person with expertise in risk assessment

• History of Guillain-Barré syndrome after receiving influenza vaccine

• Age younger than 6 months

CDC. MMWR. 2010;61:613-618.

Flu Season ActivityFlu Season ActivityPercentage of Visits for Influenza-like Illness Reported by the US

Outpatient Influenza-like Illness Surveillance Network, Weekly National Summary, 2012-2013 and Selected Previous Seasons

CDC. FluView. http://www.cdc.gov/flu/weekly/

Who Is at Higher Risk for Complications of Influenza?Who Is at Higher Risk for Complications of Influenza?

• Children younger than 2 years• Adults aged 65 years or older• People with chronic disorders (ie, pulmonary, cardiovascular,

renal, hepatic, hematologic, metabolic, neurologic, or neurodevelopmental conditions)

• People with immunosuppression caused by medications or the human immunodeficiency virus

• Women who are pregnant or postpartum (within 2 weeks of delivery)

• People younger than 19 years receiving long-term aspirin therapy• American Indians/Alaska Natives• People who are very severely obese (body mass index > 40

kg/m2)• Residents of nursing homes and chronic-care facilities

CDC. Available at: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. Accessed January 5, 2013.

Rapid Influenza Diagnostic Tests (RIDTs)Rapid Influenza Diagnostic Tests (RIDTs)

• Sensitivities of RIDTs are generally 40-70%, but a range of 10-80% has been reported compared with viral culture or reverse transcription polymerase chain reaction.

• Specificities of RIDTs are approximately 90-95% (range 85-100%).

• A negative RIDT result does NOT exclude a diagnosis of influenza in a patient with suspected influenza.

• When clinical suspicion of influenza and antiviral treatment is indicated, antiviral treatment should be started without waiting for results of additional influenza testing.

CDC. Available at: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. Accessed January 9, 2013.

Antiviral Agents for Treatment and Chemoprophylaxis of Seasonal Influenza

Antiviral Agents for Treatment and Chemoprophylaxis of Seasonal Influenza

Antiviral Agent Use

FDA Approved for (age) Adverse Events

Oseltamivir

Treatment ≥ 2 week

Adverse effects: Nausea, vomitingSporadic, transient neuropsychiatric events (self injury or delirium) mainly reported among Japanese adolescents and adults

Chemoprophylaxis ≥ 1 year

Zanamivir

Treatment ≥ 7 years

Allergic reactions: Oropharyngeal or facial edemaAdverse effects: Diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections

Chemoprophylaxis ≥ 5 years

CDC. Available at http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. Accessed January 9, 2013.

Antiviral Agent Dosages in AdultsAntiviral Agent Dosages in Adults

Antiviral Agent Use Dosage

Oseltamivir

Treatment 75 mg twice daily

Chemoprophylaxis 75 mg once daily

Zanamivir[a]Treatment

10 mg (2 inhalations) twice daily

Chemoprophylaxis10 mg (2 inhalations)

once daily

a. Not recommended for use in people with underlying respiratory disease (eg, asthma, COPD)

CDC. Available at http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. Accessed January 9, 2013.

Strategies for a Successful Vaccination ProgramStrategies for a Successful Vaccination Program

• Postcard reminder when vaccine supply arrives at the clinic• Reminder telephone call• Standing order that vaccination is offered to every patient• Active declination

• Inform those who decline vaccination that the health care provider would like to discuss their concerns

• Have office professionals get vaccinated and wear pins or equivalent to endorse vaccination

• Time the effort with public health messaging• Use the influenza vaccination opportunity to get other

vaccinations up to date