Transcript Influenza Prevention and Treatment for the 2012

Influenza Prevention and
Treatment for the 2012-2013
Faculty
Season
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?
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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;61:613-618.
Flu Season Activity
Percentage of Visits for Influenza-like Illness Reported by the US
Outpatient Influenza-like Illness Surveillance Network, Weekly
National Summary, 2012-2013 and Selected Previous Seasons
CDC. FluView. http://www.cdc.gov/flu/weekly/
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/m2)
• Residents of nursing homes and chronic-care facilities
CDC. Available at: http://www.cdc.gov/flu/professionals/antivirals/summaryclinicians.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 85-100%).
• 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: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
Accessed January 9, 2013.
Antiviral Agents for Treatment and
Chemoprophylaxis of Seasonal
Influenza
Antiviral
Agent
Use
FDA
Approved
for (age)
Treatment
≥ 2 week
Chemoprophylaxis
≥ 1 year
Oseltamivir
Treatment
≥ 7 years
Chemoprophylaxis
≥ 5 years
Zanamivir
Adverse Events
Adverse effects: Nausea,
vomiting
Sporadic, transient
neuropsychiatric events (self
injury or delirium) mainly reported
among Japanese adolescents
and adults
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
CDC. Available at http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
Accessed January 9, 2013.
Antiviral Agent Dosages in Adults
Antiviral Agent
Use
Dosage
Treatment
75 mg twice daily
Chemoprophylaxis
75 mg once daily
Oseltamivir
Zanamivir[a]
Treatment
Chemoprophylaxis
10 mg (2 inhalations)
twice daily
10 mg (2 inhalations)
once daily
a. Not recommended for use in people with underlying respiratory disease
(eg, asthma, COPD)
CDC. Available at http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
Accessed January 9, 2013.
Strategies for a Successful
Vaccination Program
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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