Influenza Prevention and Treatment for the Season Faculty Stefan Gravenstein, MD, MPH Professor of Medicine The Center for Geriatric Medicine Case Western Reserve University Cleveland, Ohio Adjunct Professor of Medicine Warren Alpert Medical School of Brown University Clinical Director, Healthcentric Advisors Providence, RI

Why Don’t People Get Vaccinated? I'm healthy, I don't need it. There is a vaccine shortage, others may need it. The vaccine may have side effects. A doctor hasn't told me I need it. The vaccine might not be available. I don't visit a doctor regularly. The vaccine may not work well. I might get influenza. I don't know when to get vaccinated. The vaccine could worsen current conditions. I dislike needles or shots. The vaccine costs too much. Insurance doesn't cover the vaccine. Johnson DR, et al. Am J Med. 2008;121:S28-S35.

Vaccines Are Effective Only If Administered Prevent missed opportunities to vaccination. Vaccinate as soon as possible once vaccines become available. Vaccinate before influenza is active as patients can not be expected to return for the vaccine when influenza is likely to be circulating in the community. Vaccination does not cause influenza or influenza-like illness, but a healthy immune response can produce cold-like symptoms following vaccination.

Universal Vaccination Routine influenza vaccine is recommended for all persons aged 6 months and older who do not have contraindications to vaccination. Contraindications include: History of severe allergic reaction to influenza vaccine Patients with a history of severe allergic reaction to eggs should be referred to a person with expertise in risk assessment History of Guillain-Barré syndrome after receiving influenza vaccine Age younger than 6 months CDC. MMWR. 2010;61:

Flu Season Activity Percentage of Visits for Influenza-like Illness Reported by the US Outpatient Influenza-like Illness Surveillance Network, Weekly National Summary, and Selected Previous Seasons CDC. FluView.

Who Is at Higher Risk for Complications of Influenza? Children younger than 2 years Adults aged 65 years or older People with chronic disorders (ie, pulmonary, cardiovascular, renal, hepatic, hematologic, metabolic, neurologic, or neurodevelopmental conditions) People with immunosuppression caused by medications or the human immunodeficiency virus Women who are pregnant or postpartum (within 2 weeks of delivery) People younger than 19 years receiving long-term aspirin therapy American Indians/Alaska Natives People who are very severely obese (body mass index > 40 kg/m 2 ) Residents of nursing homes and chronic-care facilities CDC. Available at: clinicians.htm. Accessed January 5, 2013.

Rapid Influenza Diagnostic Tests (RIDTs) Sensitivities of RIDTs are generally 40-70%, but a range of 10-80% has been reported compared with viral culture or reverse transcription polymerase chain reaction. Specificities of RIDTs are approximately 90-95% (range %). A negative RIDT result does NOT exclude a diagnosis of influenza in a patient with suspected influenza. When clinical suspicion of influenza and antiviral treatment is indicated, antiviral treatment should be started without waiting for results of additional influenza testing. CDC. Available at: Accessed January 9, 2013.

Antiviral Agents for Treatment and Chemoprophylaxis of Seasonal Influenza Antiviral AgentUse FDA Approved for (age)Adverse Events Oseltamivir Treatment≥ 2 week Adverse effects: Nausea, vomiting Sporadic, transient neuropsychiatric events (self injury or delirium) mainly reported among Japanese adolescents and adults Chemoprophylaxis≥ 1 year Zanamivir Treatment≥ 7 years Allergic reactions: Oropharyngeal or facial edema Adverse effects: Diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections Chemoprophylaxis≥ 5 years CDC. Available at Accessed January 9,

Antiviral Agent Dosages in Adults Antiviral AgentUseDosage Oseltamivir Treatment75 mg twice daily Chemoprophylaxis75 mg once daily Zanamivir [a] Treatment 10 mg (2 inhalations) twice daily Chemoprophylaxis 10 mg (2 inhalations) once daily a.Not recommended for use in people with underlying respiratory disease (eg, asthma, COPD) CDC. Available at Accessed January 9,

Strategies for a Successful Vaccination Program Postcard reminder when vaccine supply arrives at the clinic Reminder telephone call Standing order that vaccination is offered to every patient Active declination Inform those who decline vaccination that the health care provider would like to discuss their concerns Have office professionals get vaccinated and wear pins or equivalent to endorse vaccination Time the effort with public health messaging Use the influenza vaccination opportunity to get other vaccinations up to date