The use of antiviral drugs for influenza

Question 1

What are 3 unique concerns about influenza in children?

Answer 1

* high influenza rates in school-aged children

* atypical, non-specific nature of influenza illness

* high risk for adverse outcomes in children < 5yrs

Question 2

What age group has highest hospitalization rate for influenza?

Answer 2

<6mo

Question 3

When do you initiate antivirals >48 hours post illness onset in influenza patients?

Answer 3

initiate >48h from onset if illness:

• requires hospitalization
• illness is progressive, severe or complicated, regardless of previous health status
• individual belongs to group at high risk for severe disease (other than young age)
• Treat healthy people <48 h after symptom onset

* if starting tx, initiate as rapidly as possible b/c benefits are greater with earlier initiation (within 12h of onset) than later (at 48h or later)

Question 4

Which groups are at risk for severe influenza?

Answer 4

* < 59 months age

* >= 6 months; adolescents and adults with chronic health conditions (severe enough to require regular medical follow-up or hospital care):

* cardiac of pulmonary (BPD, CF, asthma, risk of aspiration)

* DM and other metabolic diseases

* renal disease

* anemia or hemoglobinopathy

* cancer or other immune-compromising conditions (due to disease or therapy)

* obesity (BMI >= 40kg/m2 OR BMI z-score >=3 SD above mean for age and gender)

* neurological or neurodevelopmental conditions

* <18 yr with prolonged tx with ASA for chronic condition

* all indigenous persons

* all residents of chronic care facilities

* all pregnant women in all trimesters

* adults >= 65 yrs of age

Question 5

When would you use zanamavir instead of oseltamavir?

Answer 5

Cases not responding to oseltamivir

Cases with illness despite oseltamivir prophylaxis