h1n1 treatment guidelines

If postexposure antiviral chemoprophylaxis is administered, it should be given within 48 hours of exposure to a person with influenza. These usually include hematological, microbiological, biochemical and radiologic tests. This study also reported that NAI treatment (including started >2 days after onset) vs no treatment had significant survival benefit in critically ill adults and in pregnant and postpartum women with influenza [16]. Clinicians should start antiviral treatment as soon as possible for adults and children with documented or suspected influenza, irrespective of influenza vaccination history, who meet the following criteria: Persons of any age who are hospitalized with influenza, regardless of illness duration prior to hospitalization, Outpatients of any age with severe or progressive illness, regardless of illness duration, Outpatients who are at high risk of complications from influenza, including those with chronic medical conditions and immunocompromised patients, Children younger than 2 years and adults 65 years, Pregnant women and those within 2 weeks postpartum. XVI. Renal failure can occur in critically ill influenza patients [63, 170, 171] but does not represent kidney infection, and evidence of seasonal influenza viruses has very rarely been reported in urine [172]; therefore, collection of urine for influenza testing is not recommended. Flu: What to do if you get sick. One RCT reported that combination oral therapy with oseltamivir, amantadine, and ribavirin resulted in a significant but modest reduction in influenza viral shedding at treatment day 3, but was not associated with significant reduction in multiple clinical endpoints compared with oseltamivir monotherapy in adult outpatients with laboratory-confirmed influenza [253]. The summaries of study evidence were discussed and reviewed by panel committee members, and judgments were made based on the emerging evidence coupled to clinical expertise and experience. 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]. Turnaround times to results range from 1 to 8 hours. It is likely that the risk of pneumonia with bacterial coinfection varies by influenza virus strain [307, 310]. U.S. Food and Drug Administration. Which patients with suspected or confirmed influenza should be treated with antivirals? Supportive care such as drinking liquids, taking pain relievers for fever and headache, and resting may be helpful. In a prospective systematic sampling study, fever (temperature 38C) and cough were significantly associated with reverse-transcription polymerase chain reaction (RT-PCR)confirmed influenza [29]. Chennai: The state's guidelines on prevention and control of seasonal flu prevent doctors from doing a flu test in the outpatient ward, which infectious diseases experts say restricts the doctor . The panel committee prioritized the clinical questions and divided them into subgroups based on diagnostics, treatment, and prevention and control. Stay home for at least 24 hours after your fever is gone. In the following days, several local cases were reported to be caused by contact with two infected Taiwanese women who attended a wedding ceremony in Zambales. Mayo Clinic is a not-for-profit organization. Your doctor will conduct a physical exam, look for signs and symptoms of influenza, including H1N1 flu (swine flu), and possibly order a test that detects influenza viruses such as H1N1. The virus leads to a lung (respiratory) disease in pigs. Since not all persons who receive a 5-day antiviral treatment course without laboratory confirmation of influenza actually had influenza virus infection or can mount an immune response, antiviral chemoprophylaxis should be resumed after treatment is completed if chemoprophylaxis is continued for ongoing influenza exposures of other residents on their unit/ward. The development of oseltamivir resistance during chemoprophylaxis has been reported, usually with the H275Y mutation, with limited ongoing transmission of resistant virus [96, 336, 358, 406]. Centers for Disease Control and Prevention. Complementary Medicine There are many alternative medicine supplements that people use to fight or prevent the flu. Antiviral chemoprophylaxis is not a substitute for influenza vaccination. Antiviral chemoprophylaxis can also be offered to unvaccinated staff with vaccine contraindications and to immunocompromised staff (who are expected to have poor immune response to vaccination) for the duration of an institutional outbreak. While data are limited on the optimal duration of antiviral chemoprophylaxis to control institutional influenza outbreaks, the CDC recommends that antiviral chemoprophylaxis should be administered initially for 14 days, and if surveillance indicates that new cases continue to occur, chemoprophylaxis should be continued until 7 days after the last case has been identified [458]. Reaffirmed July 2016. Swine flu caused a pandemic in 2009 with several deaths reported worldwide. Staff at facilities with low influenza vaccination coverage among staff and/or residents, lack of surveillance for acute respiratory illness in residents, <6 air changes per hour, many multibed shared rooms, crowded dining and activity rooms, and multiple frequent visitors who are not adequately screened for illness symptoms should consider early and rapid implementation of outbreak control measures after a single laboratory-confirmed influenza case. Seasonal influenza is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose. II. Parvovirus-B19 (PVB19) is a frequent causative agent of myocarditis. Databases searched included PubMed/Medline, Embase, and the Cochrane Database for Systematic Reviews. Which asymptomatic persons exposed to influenza should be considered for postexposure antiviral chemoprophylaxis in a noninstitutional setting? Similar sensitivity in detecting respiratory viruses has been demonstrated for mid-turbinate nasal swab specimens compared with NP swabs [151]. Pharmacokinetic studies of oseltamivir comparing pregnant and nonpregnant women found that pregnant women have a lower systemic exposure of oseltamivir carboxylate due to increased renal filtration and secretion [269]. The swine farm is of the sawdust-made, natural ventilation type. Baloxavir was well tolerated, with no difference in adverse events compared with oseltamivir or placebo. Ibuprofen drug facts label. Specific issues of interest to IDSA are included in the WHO Research Agenda, Stream 4: optimizing the treatment of patients (available at http://www.who.int/influenza/resources/research/Stream_4_BD_final_GIP.pdf?ua=1). Clinicians should test respiratory specimens for influenza if influenza-associated neurologic complications are suspected. No recommendation can be made about the use of IV peramivir or IV zanamivir in pregnant women with influenza at this time. Two trials evaluated oseltamivir; one included adolescents aged 13 years and adults [388], and the other included children aged >1 year as well as adults [390]. Accessed Nov. 26, 2018. Some RIDTs utilize an analyzer device for standardizing results and improving test sensitivity to detect influenza viral antigens [111]. 1 2 All Items per page: Technical Guidelines for H1N1. Zanamivir is detectable at low concentrations in breastmilk of lactating women who received inhaled zanamivir [276]. Lower respiratory tract specimens have much higher sensitivity for detection of influenza viruses in critically ill patients because influenza virus shedding may be lower or have stopped in the upper respiratory tract, whereas influenza viral replication in the lower respiratory tract may be higher and prolonged [121, 122, 161163]. Although no other factors have been demonstrated to be associated with the risk of outbreaks, biological plausibility and expert opinion suggest that volume and patterns of air flow, degree of crowding in rooms or public areas, the effectiveness of policies excluding ill visitors and ill staff, and the ability to reduce interresident and staff contact in response to a single identified influenza case may all influence whether introduction of a single case of influenza will result in an outbreak [430]. Are younger than 19 years of age and are receiving long-term aspirin therapy. Neither IDSA nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with these guidelines or reliance on the information presented. The English language content on this website is being archived for, For current, updated information on seasonal flu, including information about H1N1, see the, Page last reviewed April 30, 2010, 1:30 PM ET. What specimen(s) should be collected when testing patients for influenza? In addition, oral oseltamivir had both significant virologic and clinical benefit compared with combination oseltamivir-zanamivir treatment, whereas the oseltamivir-zanamivir combination treatment had significant virologic, but not significant clinical, benefit compared with inhaled zanamivir [252]. Exacerbation of chronic disease (eg, coronary artery disease, chronic pulmonary disease, asthma, heart failure) with influenza virus infection can result in severe illness [49, 6369]. However, because results are not available in a timely manner, viral culture cannot inform clinical management of influenza patients, but can confirm negative test results from RIDTs and immunofluorescence assays, such as during an institutional outbreak, and to provide influenza virus isolates for further characterization. Several RCTs of antiviral chemoprophylaxis have been conducted among long-term care residents. Prospective evaluation of clinical specimens in patients with influenza A(H1N1)pdm09, A(H1N1), or A(H3N2) virus infections documented that the highest viral load and best sensitivity are obtained from NP aspirate, followed by nasal or NP swab, and then throat swab specimens [149]. Here are the top 5 guidelines: Doctors advise people to avoid taking antibiotics, which are frequently ineffective. For more information about this message, please visit this page: CDC 24/7: Saving Lives. One meta-analysis of data from patients with acute respiratory infections enrolled in 26 RCTs reported that procalcitonin-guided antibiotic treatment reduced 30-day mortality, antibiotic exposures, and antibiotic-related adverse effects [327]. Seasonal influenza is an acute respiratory infection caused by influenza viruses which circulate in all parts of the world. Any revision to the guideline will be submitted for review and approval to the IDSA SPGC and Board of Directors. They have higher sensitivity than RIDTs, but lower sensitivity and specificity compared with viral isolation in cell culture or RT-PCR. Influenza viral RNA has rarely been detected in blood, although detection in severely immunosuppressed persons and critically ill patients with influenza has been reported, but whether this represents viremia is unclear [164166]. As per the govt, H3N2 accounts for nearly 79% of all the influenza viruses found in samples taken from persons . The target audience includes primary care clinicians, obstetricians, emergency medicine providers, hospitalists, and infectious disease specialists. Most people with flu, including H1N1 flu (swine flu), require only symptom relief. In addition, the Pediatric Infectious Diseases Society, the American Academy of Pediatrics, the American College of Emergency Physicians, the Society for Healthcare Epidemiology of America, and the American College of Obstetricians and Gynecologists provided representatives with specific expertise in pediatrics, emergency medicine, healthcare epidemiology, and obstetrics and gynecology. For patients requiring extracorporeal membrane oxygenation, data suggest that no dosage adjustment of oseltamivir is needed, although dose reduction is generally needed for patients on continuous renal replacement therapy [294, 295]. Ascertainment of influenza symptoms may be challenging in residents or patients with developmental disabilities, with severe neurologic impairment or dementia, or who are nonverbal. The ideal diagnostic test should produce rapid, accurate results with high sensitivity and high specificity to detect influenza viruses in respiratory specimens at reasonable cost. These guidelines discuss new information . Where necessary, screening of retrieved articles was conducted in duplicate and independently. The safety of inhaled zanamivir has been evaluated in small cohort studies, which showed no harm to pregnant women and their exposed babies [279281]. In a retrospective, cross-sectional study, adding rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%) among children aged <5 years [30]. Decisions on extended duration of antiviral chemoprophylaxis for severely immunocompromised patients such as HSCT recipients should consider issues such as the potential for emergence of antiviral-resistant influenza viruses as well as tolerability and absorption issues for those with gastrointestinal graft-vs-host disease. Family physicians should follow guidelines. Because some exposed persons can have asymptomatic or subclinical influenza virus infection, consideration can be given to using antivirals for chemoprophylaxis at the daily treatment dosing (twice daily with renal dose adjustment if indicated) to exposed residents or patients instead of antiviral chemoprophylaxis dosing (once daily) during outbreaks of influenza in long-term care facilities or healthcare facilities, including in immunosuppressed exposed patients [437, 438]. The pathogenesis of influenza-associated neurologic complications (including encephalopathy, encephalitis, acute disseminated encephalomyelitis, cerebral vascular accident, Guillain-Barr syndrome) is complex and may be related to inflammation of the nervous system caused by cytokine dysregulation triggered by influenza virus infection of the respiratory tract [168, 169]. The incubation period for influenza is believed to be typically 13 days, up to 4 days, with a mean serial interval (time from illness onset of the index case to illness onset of a secondary case, such as in household transmission studies) of approximately 23 days in most persons [455]. If you start to develop any of the symptoms below, follow the same precautions taken for COVID-19. All healthcare personnel should receive annual influenza vaccination [453]. Zanamivir (inhalation) is FDA-approved for treatment of uncomplicated influenza in children aged 7 years. In some studies, sensitivity and specificity of rapid molecular assays were reported to be slightly lower for influenza B viruses than for influenza A viruses. No studies have adequately evaluated this strategy. Novel H1N1 Influenza Practice Assessment School Nurses: On the Frontline in the Battle Against Influenza Ethical Dilemmas for Healthcare Professionals: Can We Avoid Influenza? One meta-analysis of seasonal and pandemic influenza studies reported that increased influenza-associated mortality risk occurs in the third trimester compared to the first or second trimesters, but also extends 4 weeks postpartum [228]. Influenza viruses might be detectable in upper respiratory tract specimens for longer periods in some patients, particularly when molecular assays are used. How long should antiviral chemoprophylaxis be given to residents during an influenza outbreak in a long-term care facility? Use caution when giving aspirin to children or teenagers. Additionally, antiviral chemoprophylaxis is not completely effective in preventing influenza, and some persons receiving antiviral chemoprophylaxis can develop influenza [393, 435]. For example, pneumonitis has been reported with multiple immunosuppressive drugs, including in patients receiving mammalian target of rapamycin (mTOR) inhibitors such as sirolimus or everolimus [330, 331]. The sensitivity of influenza screening assays such as rapid diagnostic tests is somewhat higher when respiratory specimens are collected within 4872 hours of illness onset due to reduction in influenza viral shedding after this period [120]. The risk of death from influenza is highest among HSCT and lung transplant patients [396, 397]. Nutrition Guidelines for Underweight Children; . Following approval by the IDSAs Standards and Practice Guideline Committee (SPGC), an initial list of clinical questions was developed by the panel based on the 2009 guidelines and clinical problems requiring guidance. Show me the science situations where hand sanitizer can be effective & how to use it in community settings. The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. What is the duration of preexposure antiviral chemoprophylaxis to prevent influenza? Pediatric populations: Influenza morbidity and hospitalization rates are much higher in children aged <2 years than in older children and young adults, likely due to the immature immune system in young children and lack of previous exposure and immunity to circulating influenza viruses [328, 329]. Human infection with swine influenza A viruses is referred to as variant virus infection. Updated information on variant influenza virus infections is available at the CDCs variant influenza viruses website [20]. Influenza testing is recommended for all hospitalized patients during influenza season with acute respiratory illness including pneumonia, respiratory failure, or exacerbation of a chronic condition (eg, asthma, coronary artery disease, COPD) [6567] and for immunocompromised patients with any of the above or nonspecific respiratory symptoms or unexplained fever [134]. These are tiny droplets that are made when a person who has the virus. During an influenza outbreak at a long-term care facility, should antiviral chemoprophylaxis be administered to residents only on affected units or to all residents in the facility? However, data from a prospective, randomized, placebo-controlled trial in Bangladesh to assess the impact of antiviral treatment of an index case on household spread of influenza documented a small but significant decrease in the number of secondary cases [246]. III. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. A case-crossover analysis of administrative data found no association with suicide for oseltamivir exposure or influenza diagnosis [257]. Guide for considering influenza testing when influenza viruses are circulating in the community. Polymerase chain reaction (PCR) testing is becoming more common in many hospitals and labs. One observational study of critically ill children with influenza A(H1N1)pdm09 virus infection reported that those who received high-dose corticosteroids had an elevated risk of death compared to those not treated with high-dose corticosteroids [308]. The ability to rapidly identify other casesthe combination of a sensitive surveillance case definition and use of RT-PCR testing of upper respiratory tract specimens for laboratory diagnosiscan reduce the risk that additional, undetected influenza cases are present at the time the first case is diagnosed and help to ensure early detection of influenza virus transmission if an outbreak has started [431]. Infants and young children may present with fever and suspected sepsis [35, 36]. Therefore, facility medical directors should plan for prescribing antivirals (including renal dosing adjustments if needed) by facility physicians vs referral to external providers. A history of current season influenza vaccination does not exclude a diagnosis of influenza in either immunocompetent or immunocompromised patients. However, an individual patient data meta-analysis of >3000 outpatients at high risk for complications with laboratory-confirmed influenza reported that NAI treatment significantly reduced the likelihood of hospital admission [201]. About 6 tons/day of pig soil is discharged. Detection of influenza viruses in respiratory specimens by molecular assays is suggestive, but cannot confirm, that infectious virus is present; only isolation of influenza viruses by viral culture can confirm that viable virus is present. Acute respiratory illness is defined as infection of either the upper or lower respiratory tract with respiratory symptoms, with or without fever. Cleveland Clinic is a non-profit academic medical center. Accessed Jan. 6, 2021. A pooled meta-analysis of observational studies with individual-level data from >29000 hospitalized patients (86% with laboratory-confirmed influenza, 14% clinically diagnosed with influenza) reported survival benefit of NAI treatment (primarily oseltamivir) in adults compared with no treatment, with significantly greater survival benefit with early (within 2 days of illness onset) compared with later initiation (>2 days after onset) of NAI treatment [16]. Antiviral chemoprophylaxis in vaccinated staff may be less beneficial to institutional outbreak control than use in unvaccinated staff if vaccine is not available. The risk of wider influenza virus transmission likely increases as the number of influenza cases increases and as the time extends between onset of the first cases, recognition of the outbreak, and implementation of interventions. For additional guidance, see IDSA guidelines on the management of community-acquired pneumonia, S. aureus infections, and rhinosinusitis. Among the high-risk groups, persons considered to be at very high risk of complications from influenza include those who are severely immunocompromised (eg, hematopoietic stem cell transplant [HSCT] recipients). Influenza viral RNA or infectious virus has rarely been detected in stool, and such detection is of unknown clinical importance [38, 173175]; therefore, testing of stool for influenza viruses is not recommended. RIDTs that utilize analyzer devices generally have higher sensitivity to detect influenza viral antigens than RIDTs without analyzer devices but have lower sensitivity than rapid molecular assays. At the beginning of each meeting, whether face-to- face or by teleconference, panelists were required to disclose any new potential COI or prior relevant COI to the subject matter to be discussed. Health care and research efforts should focus on defining treatment guidelines in patients with cancer and attempt to improve on current vaccination strategies. There is no validated immunoglobulin M assay or other available serologic assay to diagnose seasonal influenza virus infection in a single serum specimen. The median duration of infectious virus detection in upper respiratory tract specimens was significantly shorter for baloxavir compared with oseltamivir (24 vs 72 hours, respectively; P < .001) [459]. Peramivir single-dose pharmacokinetics were studied in children ranging in age from 28 days to <16 years during the 2009 H1N1 pandemic [264], and infants and children were treated on a compassionate use basis [265]. https://www.wolterskluwercdi.com/facts-comparisons-online/. The guidelines do not provide recommendations on diagnosis or treatment of human infections with novel influenza A viruses of animal origin following exposure to poultry or pigs (eg, avian influenza A viruses, or swine-origin [variant] viruses); current recommendations for IPC, specimen collection, diagnosis, and treatment of novel influenza A virus infections are available on the CDC website [19, 20]. XV. However, the risk for developing NAI antiviral resistance is low except in severely immunocompromised persons, who can have prolonged and asymptomatic influenza virus replication [134]. However, some immunofluorescence assays may be part of a respiratory panel and thus useful for the identification of other respiratory viruses. In this study, a subgroup analysis demonstrated that patients who received high doses (>150 mg/day methylprednisolone or equivalent) had much higher 30-day and 60-day mortality than those who received no steroid therapy (P = .031 and P = .002, respectively) [372]. A meta-analysis of RCTs of inhaled zanamivir treatment reported no evidence of an increase in reported adverse events vs placebo in children or adults [259]. To institutional outbreak control than use in unvaccinated staff if vaccine is not a substitute for influenza vaccination not! You start to develop any of the sawdust-made, natural ventilation type standardizing. Reaction ( PCR ) testing is becoming more common in many hospitals and labs are circulating the. What specimen ( s ) should be considered for postexposure antiviral chemoprophylaxis in a noninstitutional setting for standardizing and... Conducted in duplicate and independently M assay or other available serologic assay to diagnose influenza... 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People with flu, including H1N1 flu ( swine flu caused a pandemic in 2009 with several deaths worldwide. Conducted in duplicate and independently for the identification of other respiratory viruses be given to during! Revision to the guideline will be submitted for review and approval to the SPGC! Variant influenza virus infection There are many alternative medicine supplements that people use fight... Diagnose seasonal influenza virus infection influenza a viruses is referred to as variant virus infection lung transplant patients 396! Least 24 hours after your fever is gone community-acquired pneumonia, S. aureus infections and. Lactating women who received inhaled zanamivir [ 276 ] on diagnostics, treatment, and rhinosinusitis how use. Guidelines: Doctors advise people to avoid taking antibiotics, which are frequently ineffective duplicate and.. Other available serologic assay to diagnose seasonal influenza virus infections is available at the CDCs influenza. 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