Distributed via the CDC Health Alert NetworkJanuary 15, 2013, 16:00 ETCDCHAN-00339
CDC continues to recommend antiviral medications for treatment of seasonal influenza and annual vaccination as the best tools for prevention[i].
Evidence from past influenza seasons and the 2009 H1N1 pandemic has shown that treatment with antiviral medications can have clinical and public health benefit in reducing severe outcomes of influenza when initiated as soon as possible after illness onset.
Clinical trials and observational data show that early antiviral treatment may do the following:
Below is a summary of CDC's influenza antiviral recommendations.
Summary of CDC recommendations for influenza antiviral medications for the 2012-2013 season:
Clinical benefit is greatest when antiviral treatment is administered early. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness and in hospitalized patients when started after 48 hours of illness onset, as indicated by observational studies. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who:
Clinical judgment, on the basis of the patient's disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients.
Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza.
While influenza vaccination is the first and best way to prevent influenza, a history of influenza vaccination does not rule out the possibility of influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza.
Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.
For more information:A full summary of clinical recommendations that includes the sections listed below is available at www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm:
CDC communication to health care providers:
FDA Announcement Addressing Intermittent Shortages of Oseltamivir Phosphate (Tamiflu ®) for Oral Suspension (6mg/mL 60 mL):
On January 10, 2013, the U.S. Food and Drug Administration (FDA) released information indicating there may currently be intermittent shortages of Oseltamivir Phosphate (Tamiflu ®) for Oral Suspension (6mg/mL 60 mL) - used to treat influenza in children - due to increased demand for the drug. This is the pediatric suspension (liquid). Instructions for pharmacists on how to compound an oral suspension from Tamiflu® 75 mg (adult) capsules are available at www.tamiflu.com/hcp/resources/hcp_resources_pharmacists.jsp. These instructions provide for an alternative oral suspension when commercially manufactured oral suspension formulation is not readily available.
In some cases, clinicians may consider substituting a 30 or 45 mg capsule for children (if dose is appropriate) rather than suspension, particularly if there are spot shortages of suspension. These capsules may be opened and mixed with a sweet liquid, such as regular or sugar-free chocolate syrup, if oral suspension is not available. Instructions to share with caregivers are available here: www.cdc.gov/flu/antivirals/mixing_tamiflu_qa.htm.
[i] Findings from early data indicate the overall effectiveness of the 2012-2013 seasonal influenza vaccine is 62%. The data are published in "Early Estimates of Seasonal Influenza Vaccine Effectiveness - United States, January 2013," in the January 11, 2013, Morbidity and Mortality Weekly Report. This estimate is within the range of what is expected during seasons when most circulating influenza viruses characterized by CDC are like the viruses included in the vaccine.
At this time, people seeking vaccination may need to call more than one provider to locate vaccine. The flu vaccine locator (flushot.healthmap.org) may be helpful.
[ii] On December 21, 2012, the U.S. Food and Drug Administration (FDA) approved the antiviral medication oseltamivir (trade name Tamiflu®) for the treatment of influenza in people aged 2 weeks and older. An FDA press release related to this announcement is available at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm333205.htm.
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