Influenza Update for the 2020 - 2021 Flu Season
Key Points
Key Points
- Seasonal influenza A and B virus epidemics are associated with significant morbidity and mortality each year in the United States and worldwide. During 2010-2019, annual seasonal influenza epidemics of variable severity were associated with an estimated 9.3 million to 45 million illnesses, 140,000 to 810,000 hospitalizations, and 12,000 to 61,000 deaths in the U.S. Source: [ cdc.gov/flu/about/burden/index.html ]
- Most people recover from uncomplicated influenza, but influenza can cause complications that result in severe illness and death, particularly among very young children, older adults, pregnant and postpartum women within 2 weeks of delivery, people with neurologic disorders, and people with certain chronic medical conditions including chronic pulmonary, cardiac, and metabolic disease, and those who are immunocompromised.
- Early treatment with antivirals reduces the duration of symptoms and risk of some complications (bronchitis, otitis media, and pneumonia) and hospitalization, and may decrease mortality among high-risk populations.
- Annual vaccination is the best method for preventing or mitigating the impact of influenza, but in certain situations chemoprophylaxis with antiviral medications can be used for pre-exposure or post-exposure prevention and can help control outbreaks in certain populations.
- Because prevention and control of influenza is a dynamic field, clinicians should consult the website of the Centers for Disease Control and Prevention (CDC) [ cdc.gov/flu/index.htm ] for the latest information about influenza vaccines, influenza tests, and approved antiviral medications.
Testing and Treatment of Influenza When SARS-CoV-2 and Influenza Viruses are Co-circulating
- Consolidated Clinical Algorithm for Outpatient Clinic or Emergency Department Patients with Acute Respiratory Illness Symptoms (With or Without Fever): cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians.htm
- Clinical Algorithm for Outpatient Clinic or Emergency Department Patients with Acute Respiratory Illness Symptoms (With or Without Fever) Not Requiring Hospital Admission: cdc.gov/flu/professionals/diagnosis/testing-guidance-for-outpatient.htm
- Clinical Algorithm for Patients with Acute Respiratory Illness Symptoms Requiring Hospital Admission (With or Without Fever): cdc.gov/flu/professionals/diagnosis/testing-guidance-for-clinicians-hospitaized.htm
- Testing and Management Considerations for Nursing Home Residents: cdc.gov/flu/professionals/diagnosis/testing-management-considerations-nursinghomes.htm
- NIH COVID-19 Treatment Guidelines on Influenza and COVID-19: covid19treatmentguidelines.nih.gov/special-populations/influenza/
Prevention
...vention...
...uenza Vaccines — United States, 2020â€...
...ontraindications and Precautions to t...
...3. Dose Volumes for Inactivated Influenza Vaccine...
...e 1. Influenza Vaccine Dosing Algorithm for Chil...
...vention...
...hemoprophylaxi...
...gs should NOT be used for routine or widespread...
...nicians can consider antiviral chemoprophylaxi...
...ians can consider antiviral chemopr...
Clinicians can consider short-t...
...icians can consider short-term antiviral...
...ns can consider educating patients a...
...linicians should use an NAI (oral osel...
...icians should administer pre-exposure ant...
...Clinicians should test for influenza and switch...
...s can consider post-exposure antiviral chemopr...
...an consider post-exposure antiviral...
...Clinicians can consider educating...
...oprophylaxis is given, clinicians shoul...
...nicians should not administer once-daily po...
...ans should administer post-exposure antiviral che...
...ans should test for influenza and switch to antiv...
...ould administer an NAI (inhaled zanamivir...
Treatment
...eatmen...
...viral Dosing
...Persons of any age who are hosp...
...of any age with severe or progressive illnes...
...ents who are at high risk of complications fr...
...Children younger than 2 years and adults â...
...nt women and those within 2 weeks postpartum...
...atients with illness onset ≤2 days...
...matic outpatients who are household contacts of...
...healthcare providers who care for pat...
...ral Treatment for Suspected or Confirmed...
...nicians should start antiviral treatmen...
...ould NOT routinely use higher doses of US FDA-ap...
...ians should treat uncomplicated influenza...
...s can consider longer duration of antiviral trea...
Bacterial Coinfec...
...ould investigate and empirically treat ba...
...hould investigate and empirically tr...
...Clinicians can consider investigating bacterial co...
...iral Failure...
...Clinicians should investigate oth...
...sistant Infection Testing
...tients who develop laboratory-confirmed...
...Patients with an immunocompromising condition...
...atients with laboratory-confirmed in...
...atients with severe influenza who do not imp...
...ians should remain informed on curre...
...junctive Therap...
...s should NOT administer corticosteroid a...
...hould NOT routinely administer immunomo...
...iral Agents and Dosing Recommendations for Treat...
Institutional Outbreak Control
...tional Outbreak Contro...
...itutional Outbreak...
...ctive surveillance for additional case...
...ntrol measures should be implemented as soo...
...Implementation of outbreak control measu...
...n an influenza outbreak has been identif...
...ic antiviral treatment should be administ...
...tiviral chemoprophylaxis should be admin...
...moprophylaxis should be administered to resid...
...ians can consider antiviral chemoprophyl...
...n consider antiviral chemoprophylaxis for st...
...Clinicians can consider antiviral c...
...ans should administer antiviral chemoprophyl...
...e 5. Control Measures for Managing Instit...
Diagnosis
...iagnosi...
...sting...
...patients (including emergency department patients...
...ns should test for influenza in high-risk pat...
...d test for influenza in patients who present...
...consider influenza testing for patie...
...low influenza activity without any link to...
...spitalized Patients...
...uld test for influenza on admission...
...hould test for influenza on admissio...
...ns should test for influenza on admission in...
...ans should test for influenza in all pa...
...ould test for influenza on admission i...
...ns can consider testing for influe...
.... Signs and Symptoms of Uncomplicat...
...le 7. Clinical Manifestations and Comp...
...ons Who Are at High Risk of Complications F...
...Groups in Whom to Consider a Diagnosis...
...0. Influenza Diagnostic Tests for R...
...Multiplex Assays Authorized for Simultan...
...able 12. Interpretation of Influenza Testing Res...
Table 13. List of Differential Diagnoses to Cons...
...e 2. Guide for Considering Influenza Te...
Specim...
...s should collect upper respiratory tract specimen...
...icians should collect nasopharyngeal (optimally...
...inicians should collect endotracheal aspi...
...Clinicians should NOT collect or routinely test s...
...should NOT collect serum specimens, including si...
...nostic Tests...
...ans should use rapid molecular assays...
Clinicians should use reverse-tr...
...cians should use multiplex RT-PCR assays tar...
Clinicians can consider using mul...
...ns should NOT use immunofluorescence...
...low-up testing with RT-PCR or other molecula...
...nicians should NOT use RIDTs in hospitali...
...nd follow-up testing with RT-PCR or other...
...should NOT use viral culture for initial or prim...
...ral culture can be considered to confirm n...
...icians should NOT use serologic testing for diagn...