Summary Influenza Antiviral Treatment Recommendations for 2010-2011

1. Studies indicate that early antiviral treatment can reduce the risk of complications from influenza, such as pneumonia, respiratory failure, and death. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who:
   • has severe, complicated, or progressive illness, or
   • is hospitalized, or
   • is at higher risk for influenza complications as follows:
     • Children younger than 2 years old;*
       • Although all children <2 years are at risk for severe complications from influenza, the risk is highest among young infants aged <6 months old. Because many children with mild febrile respiratory illness may have other viral infections (e.g. RSV, rhinovirus, parainfluenza, metapneumovirus virus), knowledge about other respiratory viruses as well as influenza virus strains circulating in the community is important for treatment decisions. **
     • Adults 65 years of age and older;
     • Persons with the following conditions: chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurological, neuromuscular, or metabolic disorders (including diabetes mellitus);
     • Immunosuppression, including that caused by medications or by HIV infection;
     • Women who are pregnant or post-partum (within 2 weeks after delivery);
     • Persons younger than 19 years of age who are receiving long-term aspirin therapy;
     • American Indians and Alaskan Natives;
     • Persons who are morbidly obese (body-mass index ≥40);
     • Residents of nursing homes and other chronic-care facilities.
   
   
2. Clinical judgment, based on the patient"e;s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important to consider when making antiviral treatment decisions for high-risk outpatients. When indicated, antiviral treatment should be started as soon as possible after illness onset.
   • The greatest benefit is when antiviral treatment is started within 48 hours of influenza illness onset.
   • Antiviral treatment may still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients when administered >48 hours from illness onset.


3. Antiviral treatment also can be considered for any previously healthy, non high risk, symptomatic outpatient with confirmed or suspected influenza based upon clinical judgment, if treatment can be initiated within 48 hours of illness onset.

Note: Recommended antiviral medications (neuraminidase inhibitors) are not licensed for treatment of children <1 year of age (oseltamivir) or aged <7 years (zanamivir). Oseltamivir was used for treatment of 2009 pandemic influenza A (H1N1) virus infection in children <1 year of age under an Emergency Use Authorization (EUA), but this EUA has expired. Limited information on use of oseltamivir for children from birth to 1 year is available (see Table 4).

*While children aged <5 years are considered to be at higher risk for influenza-related complications, the risk is highest among children aged <2 years old.

** The likelihood of influenza virus infection in a patient depends upon the prevalence of influenza activity in the local community, and the patient"e;s signs and symptoms. Information about influenza activity in the U.S. during the influenza season is available at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm. For information on local community influenza activity, clinicians should contact their local and state health departments.

Confirmation of influenza virus infection may be performed by different influenza testing methods. Information on influenza testing is available at: http://www.cdc.gov/flu/professionals/diagnosis/

In areas with limited antiviral medication availability, local public health authorities might provide additional guidance about prioritizing treatment within groups at higher risk for complications. Current CDC guidance on treatment of influenza should be consulted, and updated recommendations from CDC can be found at http://www.cdc.gov/flu/professionals/diagnosis/

Additional guidance on antiviral treatment of influenza

1. Committee on Infectious Diseases, American Academy of Pediatrics. Policy Statementa??Recommendations for Prevention and Control of Influenza in Children, 2010 a??2011. Available at: http://www.pediatrics.org/cgi/doi/10.1542/peds.2010-2216 doi:10.1542/peds.2010-2216
2. Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG et al. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2009 Apr 15;48(8):1003-32. Available at: http://www.journals.uchicago.edu/doi/pdf/10.1086/598513
3. World Health Organization. WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and other Influenza Viruses. Revised February 2010. Available at: http://www.who.int/csr/resources/publications/swineflu/h1n1_guidelines_pharmaceutical_mngt.pdf