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CDC: Give Immediate Antivirals to High Risk Patients with Flu Symptoms

ATLANTA – When high-risk patients present to your emergency department with flu-like symptoms, the CDC says there’s no need to hesitate on the course of treatment.

“While doctors may prescribe antiviral drugs for non-high risk patients with flu, all high risk patients with suspected influenza should be receiving antiviral drugs,” the CDC emphasizes.

Patients considered to be at high risk of serious flu complications include those 65 and older, children younger than 5 years (and especially those younger than 2 years), pregnant women and any person with a variety of health conditions such as asthma, neurological and neurodevelopment conditions, chronic lung disease, heart disease, blood disorders, diabetes and other endocrine disorders, kidney disorders, liver disorders, metabolic disorders, weakened immune systems, morbid obesity as well as patients younger than 19 on long-term aspirin therapy.

In addition to oseltamivir (Tamiflu) and zanamivir (Relenza), a new intravenous formulation, peramivir (Rapivab) has been approved by the FDA for use this season in patients 18 and older.

While the drugs work best when started within two days of symptom onset, patients with high-risk conditions can benefit even when antiviral treatment is initiated later, the CDC points out.

EDs have been inundated with flu patients for the last six weeks, especially in the South but increasingly in the Midwest, according to public health officials. The Northeast and West have yet to feel the full force of the flu season, however, and the CDC suggests the nation may just be reaching the midpoint.

Currently, medical visits for influenza-like illness (ILI) have been elevated for six consecutive weeks. Over the past 13 flu seasons, ILI visits remain up for an average of 13 weeks. In fact, those visits now are even with the peak of the 2012-13 season, the last time H3N2 viruses predominated.

The most recent weekly flu report notes that more than 40 states are experiencing either high or widespread flu activity, mostly resulting from circulation of drifted H3N2 viruses. Similar to past H3N2-predominant seasons, the nation also is experiencing relatively higher flu hospitalization rates. For week 52, overall flu-related hospitalizations were 12.6 per 100,000 people, comparable to the 13.3 per 100,000 overall hospitalization rate seen during the same week of the 2012-13 season, but higher than the 8.9 per 100,000 rate observed during week 52 last season, which was H1N1-predominant.

Most of the H3N2 viruses circulating this year are drifted from the H3N2 virus in the annual vaccine, according to the CDC. While recent studies indicate that flu vaccine reduces the risk of medical visits due to flu by approximately 60% among the overall population when the vaccine is a good match, effectiveness is lowered by drifting. For example, during the 2007-08 flu season, when drifted H3N2 viruses circulated, vaccine effectiveness estimates against H3N2 were 43%.

Vaccine effectiveness estimates are expected to be available in mid-January for the current season.

Despite the lower effectiveness, the CDC continues to recommend flu vaccination for everyone older than 6 months old who has not received one. The recommendation includes patients who have already gotten the flu this season because flu vaccines protect against three or four different viruses, and the possibly remains of a second wave of flu activity, which often is caused by an influenza B virus.