Streptococcus pneumoniae is the most common bacterial coinfection associated with influenza and pneumonia [310314], but S. aureus, including methicillin-resistant strains [48, 315317], and S. pyogenes coinfections have also been reported in patients with pneumonia and influenza [167, 318, 319]. One randomized clinical trial (RCT), performed at medical wards of 2 teaching hospitals in the United Kingdom, found no evidence that RT-PCR testing for influenza influenced antibiotic prescribing or clinical outcome in adult patients; however, few study patients with RT-PCRconfirmed influenza were prescribed antiviral treatment [135]. A combined analysis of data from one phase 2 RCT and one phase 3 RCT of peramivir treatment reported that the frequency of adverse events was similar to placebo [260]. In a retrospective study of clinical predictors of influenza in hospitalized patients, fever with cough or sore throat had a sensitivity of 43% for patients without asthma, and only 21% for asthmatic patients [32]. Jan. 13, 2021. Exploring high-efficient technologies for swine wastewater treatment is urgent and becoming a hot topic in the recent years. Two antiviral drugs are recommended for treating swine flu: the oral drugs oseltamivir. This content does not have an English version. 2011; doi:10.1542/peds.2010-3852. Most of the available clinical data from patients with resistant virus infections that emerged during treatment are derived from case reports and case series in which patients on oseltamivir treatment were switched to other antivirals often late in the clinical course of their illness [285, 286, 340, 349353]. Each of these subgroups was addressed by its dedicated subcommittee. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of a patients individual circumstances. These include: Respiratory droplets and aerosols. Labeling of drug preparations containing salicylates. Influenza season refers to the surveillance period when influenza activity typically occurs, such as during October through May, in the United States. The composting treatment period was for 8 days from 15:00 h, 28 October, to 11:00 h, 4 November. Swine Flu cases along with H3N2 virus on the rise in India; Central . However, other studies of infants born to women who had laboratory-confirmed influenza during pregnancy have not shown higher rates of prematurity, preterm labor, low birth weight, or lower Apgar scores compared with infants born to uninfected women [230, 241, 242]. There are limited data to define the optimal duration of therapy for influenza in immunocompromised patients, but retrospectively collected data suggest that treatment can safely extend to 10 days or longer. There is no evidence that NAIs have benefit for ill patients without influenza virus infection. Accessed Jan. 6, 2021. Thus, antiviral treatment of influenza has the potential to decrease medical care costs and antibiotic-attributable adverse events, and potentially decrease bacterial resistance to antibiotics. Use caution when giving aspirin to children or teenagers. The diagnostic value for PCT to exclude bacterial coinfection among influenza patients was reasonably high in this study [326]. For molecular assays, NP or mid-turbinate nasal swab specimens are the preferred upper respiratory tract specimens. It is important to realize that guidelines cannot always account for individual variation among patients. Accessed Oct. 13, 2020. https://www.cdc.gov/flu/treatment/takingcare.htm. Invasive bacterial coinfection may occur (with Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes [group A streptococci], and others) [4245]. Acetaminophen oral. Panelists were required to disclose to the IDSA and the chairs any new activities that had the potential to be viewed as a COI prior to engaging in the activity. If postexposure antiviral chemoprophylaxis is administered, it should be given within 48 hours of exposure to a person with influenza. Two meta-analyses of methodologically weaker observational studies (including concurrent antiviral treatment for most patients) reported that despite the limitations of the included studies, corticosteroid treatment of hospitalized influenza patients appeared to be associated with increased mortality, but firm conclusions were not possible due to lack of information on dosing, or indication for corticosteroid treatment [364, 365]. Based upon available evidence, recommendations are provided below for specific antiviral agents, route, dosing, and duration of therapy. XVII. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. XXI. Frequently asked influenza (flu) questions: 2020-2021 season. All showed statistically significant protection; the pooled estimate of efficacy against laboratory-confirmed symptomatic influenza for the 3 trials was 79% (95% CI, 67%87%) [398]. How long should postexposure antiviral chemoprophylaxis be given? 4th ed. Guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza Ref: UKHSA publication gateway number: GOV-10342 PDF, 608 KB, 42 pages This file may not be suitable. Between January 2 to March 5, 451 cases of H3N2 have been reported in India, according to reports. INTRODUCTION. A large autopsy series of 100 fatal cases found no evidence of extrapulmonary influenza A(H1N1) pdm09 virus infection [167]. Multiple influenza diagnostics and therapeutics are in advanced development, and new influenza tests, antiviral medications, and other therapeutics might be approved by the FDA after publication of these guidelines. Some investigators have attributed the majority of deaths during the 1918 H1N1 pandemic to bacterial coinfection [307]. Nebulization of the commercial formulation of zanamivir containing lactose should be avoided in intubated patients, given documented severe and fatal complications reported with this mode of administration [296, 297]. Influenza activity is defined as the circulation of seasonal influenza A and B viruses among persons in the local community. If you have a chronic respiratory disease, your doctor may prescribe additional medications to help relieve your symptoms. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Turnaround times to results range from 1 to 8 hours. Several respiratory syndromes can be associated with either bacterial or viral pathogen infections or coinfections, including community-acquired pneumonia, sinusitis, pharyngitis, and acute otitis media. Clinicians should maintain familiarity with local patterns of influenza activity in their communities throughout influenza season. XVIII. The authors suggested this was in part due to the length of illness prior to admission (>48 hours) or unfamiliarity by physicians with RT-PCR. Decisions about antiviral chemoprophylaxis should consider the anticipated severity of illness, risk of complications, and mortality associated with influenza in the population at risk, and on the ability to implement control measures, including isolation and spatial separation of susceptible individuals from each other. Pada akhir Mac dan awal April tahun 2009, wabak jangkitan virus novel Influenza A H1N1 dikesan di Mexico. Influenza viral replication in the respiratory tract, including asymptomatic shedding, can be prolonged, and emergence of resistant variants during or after antiviral treatment can occur more frequently in immunocompromised patients than in immunocompetent patients [134, 287289]. Respiratory viral infection, including influenza virus infection, can be difficult to distinguish from bacterial infection. AskMayoExpert. This content does not have an Arabic version. In contrast, several observational studies have reported benefits of influenza testing. Use of antiviral chemoprophylaxis limited to an individual affected ward is reasonable if the number of influenza cases is small when the outbreak is declared, and if the affected wards residents and staff had limited contact with those of other wards before the outbreak was declared. If there is clinical suspicion of antiviral resistance as the cause of failure to improve or clinical deterioration, it is critical to consider a change in NAI treatment and to perform testing to confirm the presence of continued viral replication and to document resistance. Renaud DL (expert opinion). The panel followed a process used in the development of previous IDSA guidelines that included a systematic weighting of the strength of recommendations and quality of evidence based upon the US Public Health Service Grading System for ranking recommendations in clinical guidelines as utilized in the previous 2009 guidelines (Table 1) [17]. In a report of an influenza outbreak in an ambulatory stem cell transplant center, only 7% had signs and symptoms that met the CDC ILI definition; only a minority had fever [79]. There are no data available that provide an estimate of how often a single identified laboratory-confirmed influenza case represents the start of an influenza outbreak. Multiplex respiratory pathogen panels range from narrow, targeting influenza A and B viral and RSV RNA, to broad, targeting more than a dozen respiratory viruses and other pathogens in respiratory specimens. In contrast, NAI resistance has been reported among severely immunocompromised patients more frequently than immunocompetent patients during prolonged influenza viral replication and antiviral treatment, and after postexposure antiviral chemoprophylaxis [289, 335342]. Finding influenza virus transmission on a second ward should prompt consideration of facility-wide antiviral chemoprophylaxis, as considerable experience by subject matter experts in this scenario has demonstrated eventual emergence of further influenza virus transmission to multiple units within the facility when implementation of facility-wide antiviral chemoprophylaxis is not implemented. In ambulatory adults with uncomplicated influenza, peramivir administered as a single IV dose is an alternative, but is costlier. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza. Types of influenza viruses. Recommendations for prevention and control of influenza in children, 2017-2018. Dosing and duration of uncomplicated influenza is the same for all pediatric age groups (2 inhalations twice daily for 5 days). 'In India, viral illnesses caused by H3N2, COVID-19, and swine flu are on the rise. An open-label multicenter RCT of convalescent or postimmunization plasma (containing variable concentrations of hemagglutinin inhibition antibodies) treatment plus standard care vs standard care alone in hospitalized children and adults with laboratory-confirmed influenza did not find significant clinical benefit or antiviral effects, but convalescent plasma was well-tolerated, and a phase 3 trial is under way [380]. XV. When should testing be done for infection with an antiviral-resistant influenza virus? The decision to use antiviral chemoprophylaxis must balance the knowledge of the prevalence of antiviral resistance among circulating influenza viruses (see http://www.cdc.gov/flu/professionals/index.htm), risk of emergence of resistance, risk of severe complications of influenza, the potential for side effects, and the ability to initiate early therapy for influenza. Clinicians should test respiratory specimens for influenza if influenza-associated neurologic complications are suspected. XX. Early antiviral treatment of influenza can reduce the risk of otitis media in young children and the need for antibiotic therapy for lower respiratory tract complications [189, 191, 194]. One comparative study reported variability in the analytical sensitivity of different rapid influenza antigen tests to detect dilutions of influenza viruses [116]. 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