January 2, 2018
Please share this advisory with all pertinent colleagues and staff within your practice or institution.
Dear Colleagues,
Please see the attached notice (click here CDC HAN_Flu_Dec 2017) from The U.S. Centers for Disease Control and prevention (CDC) which describes 1) increased influenza A(H3N2) activity and its clinical implications; 2) a summary of influenza antiviral drug treatment recommendations; 3) an update about approved treatment drugs and supply this season; and 4) background information for patients about influenza treatment.
CDC and Massachusetts Department of Public Health (MDPH) wish to remind clinicians that:
· Influenza should be high on their list of possible diagnoses for ill patients because influenza activity is increasing nationwide, and
· Early presumptive antiviral treatment is indicated for all hospitalized patients and all high-risk patients (either hospitalized or outpatient) with suspected influenza. It should not be delayed, even for a few hours, to await the results of testing. While antiviral drugs work best when treatment is started within 2 days of illness onset, clinical benefit has been observed even when treatment is initiated later.
Background
In the United States (U.S.), influenza activity has increased significantly over recent weeks with influenza A(H3N2) viruses predominating so far this season. In the past, A(H3N2) virus-predominant influenza seasons have been associated with more hospitalizations and deaths in persons aged 65 years and older and young children compared to other age groups. In addition, influenza vaccine effectiveness (VE) in general has been lower against A(H3N2) viruses than against influenza A(H1N1)pdm09 or influenza B viruses. Last season, VE against circulating influenza A(H3N2) viruses was estimated to be 32% in the U.S.
CDC expects that VE could be similar this season, should the same A(H3N2) viruses continue to predominate. For this reason, in addition to influenza vaccination for prevention of influenza, the use of antiviral medications for treatment of influenza becomes even more important than usual. The neuraminidase inhibitor (NAI)antiviral medications are most effective in treating influenza and reducing complications when treatment is started early. Evidence from previous influenza seasons suggests that NAI antivirals are underutilized in outpatients and hospitalized patients with influenza who are recommended for treatment.
Resources
CDC guidance about antiviral treatment and prophylaxis for influenza can be found at https://www.cdc.gov/flu/professionals/antivirals/index.htm.
CDC guidance about flu diagnosis can be found here: https://www.cdc.gov/flu/professionals/diagnosis/index.htm.
The recently redesigned MDPH Flu website at www.mass.gov/flu has information for providers and the general public. Click on ‘Information for Healthcare and Public Health Professionals’ for such provider resources as influenza control guidance, model standing orders, screening forms and planning clinics and campaigns. We hope you find these resources helpful.
Please continue to vaccinate patients throughout the flu season. For questions about state supplied flu vaccine availability and ordering, please contact the Vaccine Management Unit at 617-983-6828. For questions about flu vaccine recommendations and treatment, please call the Immunization Program at 617-983-6800 and ask to speak to an immunization epidemiologist.
Thanks for all your efforts to protect children and adults against influenza this season.
Susan
Susan M. Lett, MD, MPH
Medical Director, Immunization Program
Division of Epidemiology and Immunization
Massachusetts Department of Public Health
617-983-6823
susan.lett@state.ma.us
MDPH Website: www.mass.gov/dph