Atlanta—Even if they don’t require immediate hospitalization, people at high risk for complications from the flu—including death—should be provided antiviral treatment as soon as possible, according to updated influenza guidelines form the Infectious Diseases Society of America.

The article in Clinical Infectious Diseases points out that while antiviral treatment is recommended within 2 days after the start of flu symptoms in patients who are not at high risk for complications, the guidelines urge prescriptions for the drugs to those at high risk even if they have been sick for more than 2 days.

The following are categorized as high-risk, according to authors from the CDC and their colleagues:
• Pregnant women
• People who are extremely obese, defined as a body mass index of 40 or more
• Young children (especially those younger than age 2 years)
• Women who have recently given birth
• Those with a weakened immune system due to disease or medication (such as people with HIV or AIDS, cancer, who have had an organ transplant, or who are on chronic steroids)
• People younger than age 19 years who are receiving long-term aspirin therapy
• Those with chronic medical conditions, including asthma, neurological or neurodevelopmental disorders (such as cerebral palsy, epilepsy, and stroke), heart or lung disease; kidney, liver or metabolic disorders; and nursing home residents
• American Indians and native Alaskans.

“Influenza can be serious, especially for the sizable group of people at high risk,” explained Timothy M. Uyeki, MD, MPH, MPP, cochair of the guidelines committee and chief medical officer of the Influenza Division of the National Center for Immunization and Respiratory Diseases at the CDC. “Annual influenza vaccination is the best way to prevent influenza, but it is not 100 percent effective. Those at high risk need to be encouraged to seek medical care right away if they develop influenza symptoms during influenza season.”

The previous guidelines were published just before the 2009 H1N1 influenza pandemic, the fourth pandemic in the past 100 years. One change was a recommendation to use newer, highly accurate molecular tests that deliver results in 15 to 60 minutes instead of rapid-influenza diagnostic tests, which produce quick results but can be falsely negative in at least 30% of outpatients with influenza.

Guideline authors also urge that antiviral treatment should be started immediately in hospitalized patients at high risk of flu complications who are admitted with suspected influenza, and that clinicians should not wait for results of molecular influenza testing.

Still, the panel emphasizes that influenza testing is important because physicians are more likely to treat patients with antiviral medications if they have a definitive diagnosis. That means less likelihood of prescribing unnecessary antibiotics, especially in outpatients.

Last season, the flu was responsible for an estimated 49 million illnesses in the United States, including 960,000 hospitalizations and 79,000 deaths.

“We are always concerned about preparing for the next pandemic, but we also are focused on preventing and controlling seasonal influenza,” Uyeki said. “While pandemics aren’t predictable, we know that every year we’re going to have seasonal influenza and we need to improve how we prevent and control it through influenza vaccination, better diagnosis and early antiviral treatment of patients.

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