Influenza Update for the 2020 - 2021 Flu Season

Publication Date: March 13, 2019

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


Prevention

Prevent...

Table 1. Influenza Vaccines — United States...


Table 2. Contraindications and Prec...


...3. Dose Volumes for Inactivated Influenza Vaccine...


...uenza Vaccine Dosing Algorithm for Children...


...evention...

...prophylaxis...

...ntiviral drugs should NOT be used for...

...n consider antiviral chemoprophylax...

...ans can consider antiviral chemoprophylaxis for...

...Clinicians can consider short-term antiviral che...

...s can consider short-term antivira...

...linicians can consider educating patients and...

...ians should use an NAI (oral oseltam...

...Clinicians should administer pre-exp...

...ould test for influenza and switch to antiv...

...ns can consider post-exposure antiviral...

...n consider post-exposure antiviral chemoproph...

...s can consider educating patients and arran...

If chemoprophylaxis is given, clinician...

...icians should not administer once-daily pos...

...ans should administer post-exposure an...

...Clinicians should test for influen...

...ians should administer an NAI (inha...


Treatment

...eatmen...

Antiviral Dos...

Persons of any age who are hospitalized wit...

...f any age with severe or progressive illnes...

...s who are at high risk of complications from in...

...nger than 2 years and adults ≥65...

...Pregnant women and those within 2 weeks postpart...

...tpatients with illness onset ≤2 days before pr...

...utpatients who are household contac...

...ptomatic healthcare providers who care for pa...


...iviral Treatment for Suspected or C...

...ans should start antiviral treatment as soo...

...ns should NOT routinely use higher doses o...

...Clinicians should treat uncomplicated influenza...

...an consider longer duration of antiviral treatme...


...ial Coinfection...

...Clinicians should investigate and empirically t...

...ans should investigate and empirically t...

...linicians can consider investigating bacterial co...


...iviral Failure...

...Clinicians should investigate oth...


...resistant Infection Testin...

...nts who develop laboratory-confirmed in...

...tients with an immunocompromising conditi...

...ts with laboratory-confirmed influenza wh...

...th severe influenza who do not improve with N...

...Clinicians should remain informed on...


...junctive Ther...

...icians should NOT administer cortic...

...hould NOT routinely administer immun...


...4. Antiviral Agents and Dosing Recommendati...


Institutional Outbreak Control

...ional Outbreak Control

...utional Outbreak...

...llance for additional cases should...

Outbreak control measures should be...

...lementation of outbreak control me...

...When an influenza outbreak has been iden...

...Empiric antiviral treatment shoul...

...ral chemoprophylaxis should be administered as soo...

...l chemoprophylaxis should be administered to resid...

...ns can consider antiviral chemoprop...

...nicians can consider antiviral chemoprophylaxi...

...Clinicians can consider antiviral c...

...ns should administer antiviral chemoprophylaxis fo...


...5. Control Measures for Managing Institutiona...


Diagnosis

...agnosis

Testin...

...nts (including emergency departmen...

...ians should test for influenza in h...

...icians should test for influenza in patients w...

...icians can consider influenza testing for patie...

...w influenza activity without any link...

...alized Patients...

...ians should test for influenza on admissio...

...should test for influenza on admission...

...should test for influenza on admissio...

...linicians should test for influenza in all...

...ians should test for influenza on adm...

...consider testing for influenza in patients with...


...Signs and Symptoms of Uncomplicated Influen...


...cal Manifestations and Complications Associ...


...sons Who Are at High Risk of Complications From In...


...Groups in Whom to Consider a Diagnosis of...


...Influenza Diagnostic Tests for Re...


...ultiplex Assays Authorized for Simultaneous D...


...nterpretation of Influenza Testing Resu...


...13. List of Differential Diagnoses to Conside...


...for Considering Influenza Testing...


...pecime...

...inicians should collect upper respiratory tract s...

...ns should collect nasopharyngeal (opt...

...inicians should collect endotracheal aspi...

...should NOT collect or routinely test speci...

...hould NOT collect serum specimens, including s...


Diagnostic Te...

...ians should use rapid molecular assays (i.e., nucl...

...s should use reverse-transcription polymerase...

...linicians should use multiplex RT-PCR assays targ...

...Clinicians can consider using multiplex...

...ns should NOT use immunofluorescence as...

...d follow-up testing with RT-PCR or o...

...should NOT use RIDTs in hospitalized patien...

...low-up testing with RT-PCR or other molecu...

...ns should NOT use viral culture for...

...ut viral culture can be considered to conf...

...should NOT use serologic testing for diagnosis o...