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

...vention...

...le 1. Influenza Vaccines — United S...


...indications and Precautions to the Use of Influenz...


.... Dose Volumes for Inactivated Influenz...


...gure 1. Influenza Vaccine Dosing A...


...reventio...

...moprophylaxis...

...viral drugs should NOT be used for routine o...

...nicians can consider antiviral chemoprophylaxis f...

...an consider antiviral chemoprophylaxis...

...ans can consider short-term antiviral...

...ians can consider short-term antiviral chemopr...

Clinicians can consider educating patients and...

Clinicians should use an NAI (o...

...linicians should administer pre-exposure antivi...

...Clinicians should test for influenza and sw...

...ians can consider post-exposure anti...

...ans can consider post-exposure antiv...

...can consider educating patients and arrangin...

...moprophylaxis is given, clinicians should...

...Clinicians should not administer once-daily post...

...nicians should administer post-exposure antiviral...

...nicians should test for influenza and s...

...ians should administer an NAI (inhaled zana...


Treatment

...atment...

...ntiviral Dosing

...Persons of any age who are hospitalized with in...

...of any age with severe or progressive illness...

...patients who are at high risk of complicati...

...Children younger than 2 years and adults ≥65...

Pregnant women and those within 2 weeks postpar...

...utpatients with illness onset ≤2 days before p...

...c outpatients who are household contacts of pe...

...atic healthcare providers who care for patients wh...


...Treatment for Suspected or Confirme...

...inicians should start antiviral treatment as soo...

...ould NOT routinely use higher doses of US FDA-app...

...ould treat uncomplicated influenza...

...ns can consider longer duration of antivir...


...acterial Coinf...

...cians should investigate and empiricall...

...cians should investigate and empiri...

...ians can consider investigating bacterial coi...


...viral Failure...

...s should investigate other causes beside...


...viral-resistant Infection Testing

...develop laboratory-confirmed influenza while on or...

...an immunocompromising condition a...

...Patients with laboratory-confirmed influen...

...Patients with severe influenza who...

...Clinicians should remain informed on current CDC...


...djunctive Therap...

...should NOT administer corticosteroid adj...

...Clinicians should NOT routinely administer i...


...ntiviral Agents and Dosing Recomme...


Institutional Outbreak Control

...onal Outbreak Control...

...itutional Outbreak...

...ve surveillance for additional cases sh...

...ntrol measures should be implemented as soon as...

Implementation of outbreak cont...

When an influenza outbreak has been...

...antiviral treatment should be administered...

...ntiviral chemoprophylaxis should be admini...

...emoprophylaxis should be administered to reside...

...Clinicians can consider antiviral chem...

...nicians can consider antiviral chemoproph...

Clinicians can consider antiviral chemoprop...

...linicians should administer antiviral chemo...


...e 5. Control Measures for Managing Institu...


Diagnosis

...gnosis

...sting...

...cluding emergency department patien...

...cians should test for influenza in...

...ians should test for influenza in patients who p...

...can consider influenza testing for patients n...

...uring low influenza activity without any lin...

...spitalized Patient...

...ians should test for influenza on admission in al...

...ans should test for influenza on admission in...

...icians should test for influenza on admis...

...icians should test for influenza in...

...inicians should test for influenza on...

...nicians can consider testing for influenz...


...able 6. Signs and Symptoms of Uncomplicated Influ...


...Clinical Manifestations and Complications Asso...


...e 8. Persons Who Are at High Risk of Complica...


Table 9. Groups in Whom to Consider a D...


...le 10. Influenza Diagnostic Tests for Respirat...


...plex Assays Authorized for Simultaneous...


...able 12. Interpretation of Influenza Testing Resul...


...13. List of Differential Diagnoses to Consider...


...ide for Considering Influenza Testing When Influe...


...ecimens...

...linicians should collect upper respi...

...Clinicians should collect nasophar...

...nicians should collect endotracheal aspirate...

Clinicians should NOT collect or routinely test...

...should NOT collect serum specimens, includi...


...nostic Tests...

...linicians should use rapid molecular...

...ans should use reverse-transcription po...

...hould use multiplex RT-PCR assays targeting a...

...s can consider using multiplex RT-PCR assa...

Clinicians should NOT use immunofluorescenc...

...-up testing with RT-PCR or other molecul...

...cians should NOT use RIDTs in hospitalized...

and follow-up testing with RT-PCR or...

...ld NOT use viral culture for initial or pri...

...culture can be considered to confirm nega...

...ns should NOT use serologic testing for d...