Influenza

This year's influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

This year’s influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

A universal vaccine that protects against all strains of influenza virus may eventually replace yearly seasonal flu shots. This vaccine has been shown to be effective in animals, report investigators from the National Institute of Allergy and Infectious Diseases (NIAID).

This discussion reviews the currently available antivirals and recommendations for their use in influenza prophylaxis and treatment. Because our understanding of 2009 H1N1 influenza is still evolving, some off-label use of medications is discussed and noted. Information on 2009 H1N1 is updated frequently, andreaders are encouraged to monitor advisories from federal, state, and local health agencies for up-to-date information. (Drug Benefit Trends. 2010;22:10-14)

H1N1 influenza has paid an unwelcome visit to a number of nursing homes, reports the CDC.

MedImmune is recalling 13 lots of monovalent 2009 H1N1 influenza nasal spray vaccine whose potency has decreased or is expected to decrease shortly.

A single dose of 2009 influenza A (H1N1) vaccine induced protective antibody titers in more than 90% of children in an Australian study.

Sanofi Pasteur is recalling 4 lots of pediatric H1N1 vaccine in 0.25 mL pre-filled syringes because of concerns about potency.

Although the future clinical implications of mutations in the H1N1 influenza virus remain unclear, these changes do not pose an immediate threat.

Both seasonal and H1N1 influenza pose a greater risk of severe illness and complications in patients with diabetes-and these infections can also wreak havoc with blood glucose levels.

Children 9 years of age and younger have a much stronger immune response when they receive a second dose of 2009 H1N1 influenza vaccine, according to preliminary study results released by the NIH.

Tell patients who are clamoring for the H1N1 influenza vaccine that more doses will soon be available. At a recent press conference, Thomas Frieden, MD, Director of the CDC, had this message for health care providers: “Don’t reserve available vaccine; give it out as soon as it comes in, because more is on the way.”

Recently, President Obama declared that the 2009 H1N1 influenza pandemic is a national emergency.

Imaging experts are lining up to caution physicians not to read too much into study findings suggesting that chest CT is better than general radiography for examining A-H1N1 flu patients.

Caution patients to beware of buying H1N1 influenza remedies from Internet sites.

The CDC’s Advisory Committee on Immunization Practices recommends that children aged 6 months to 9 years receive 2 doses of influenza A (H1N1) 2009 monovalent vaccine; the doses should be given about 4 weeks apart.

Lung disease was the most common underlying condition in a British study of 192 patients who had been admitted to the hospital because of complications related to H1N1 influenza.

Confirming the presence of the H1N1 influenza virus in patients with suspected infection is critical to public health efforts to track, study, and contain the disease-and to the ability of clinicians to provide optimal management. Appropriate diagnostic testing is key to this process.

Not all patients in whom infection with the H1N1 influenza virus is suspected or confirmed need to be treated. Many patients with mild disease can forgo pharmacotherapy. In fact, in many cases, it may even be prudent to discourage such patients from coming into their health care provider's office, in the interest of infection control. However, all patients with severe disease and those considered at high risk for complications from seasonal influenza should be offered therapy with antiviral agents.

Before considering the infection control strategies recommended during the current H1N1 influenza pandemic, it is useful to review the transmission characteristics of influenza viruses-including H1N1-that form the basis for these strategies:

The ability to recognize cases of the new H1N1 flu and distinguish these from seasonal influenza and other respiratory illnesses is perhaps the overriding concern of primary care practitioners. Prompt and accurate identification of this entity is the key to both effective management of individual illness and effective public health measures.

The first 2009 H1N1 influenza vaccine to become available will be a nasal spray that contains live attenuated virus, said CDC health officials.

On Sept 15, 2009, the FDA approved 4 vaccines against the H1N1 influenza virus. Distribution of the vaccine to about 90,000 sites across the United States will begin in mid October.

Hold your ground when the worried well come into your office this fall demanding prescriptions for Tamiflu and Relenza

As a reflection of the disproportionate impact that the swine flu is having on young children, the CDC’s gift shop in Atlanta is now selling a swine flu toy-a soft 7 inch model of the virus that can be used by adults to explain H1N1 infection to youngsters.

When you encounter unexplained seizures or mental status changes in children who have influenza-like illness, send respiratory specimens for diagnostic testing and promptly start empirical antiviral therapy, especially in hospitalized patients.

Reserve antivirals for adults and children over age 1 who have severe novel H1N1 influenza or who are at high risk for complications.

Human infections with a novel influenza A (H1N1) virus were first identified in April 2009, with cases in the United States and Mexico. The epidemiology and clinical presentations of these infections are under investigation.

When you encounter unexplained seizures or mental status changes in children who have influenza-like illness, send respiratory specimens for diagnostic testing and promptly start empirical antiviral therapy, especially in hospitalized patients.

Federal health officials stressed the need to start planning now for the fall influenza season when they met with state delegates at the H1N1 Influenza Preparedness Summit. "Over the course of coming weeks and months, we will move aggressively to prepare the nation for the possibility of a more severe outbreak of the H1N1 virus," said Secretary of Health and Human Services Kathleen Sebelius.