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
...reventi...
...Influenza Vaccines — United States, 2020â...
...Contraindications and Precautions to...
...Volumes for Inactivated Influenza Vaccines Licens...
...1. Influenza Vaccine Dosing Algorit...
...evention...
...hemoprophylaxis...
...gs should NOT be used for routine or widespread ch...
...Clinicians can consider antiviral chemo...
...n consider antiviral chemoprophylaxis for the...
...ns can consider short-term antiviral...
...linicians can consider short-term antivi...
...Clinicians can consider educating patients and p...
...should use an NAI (oral oseltamivir or inhaled...
...inicians should administer pre-expos...
...Clinicians should test for influenza and...
...ans can consider post-exposure antiviral chemoprop...
...icians can consider post-exposure an...
...icians can consider educating patients and arran...
...hylaxis is given, clinicians should a...
...ans should not administer once-daily...
...ans should administer post-exposure ant...
Clinicians should test for influenza and swi...
...inicians should administer an NAI (inhaled zanam...
Treatment
...eatment
...ntiviral Dosing...
...rsons of any age who are hospitalized with in...
...nts of any age with severe or progressive illness,...
...Outpatients who are at high risk of complicatio...
...n younger than 2 years and adults ≥65 year...
...nant women and those within 2 weeks postpartum (...
...ts with illness onset ≤2 days before presentatio...
...ptomatic outpatients who are household contac...
...healthcare providers who care for patient...
...reatment for Suspected or Confirmed Influe...
...ians should start antiviral treatment as soon...
...icians should NOT routinely use higher doses of US...
Clinicians should treat uncomplicated...
...ns can consider longer duration of antiviral treat...
...rial Coinfection...
...s should investigate and empirically treat bacteri...
...s should investigate and empirically trea...
Clinicians can consider investigating b...
Antiviral Fai...
...ould investigate other causes besides influenza vi...
...tiviral-resistant Infectio...
...s who develop laboratory-confirmed influenza whi...
...tients with an immunocompromising con...
...with laboratory-confirmed influenza who inadv...
...Patients with severe influenza who do...
...inicians should remain informed on c...
...tive Therapy...
...hould NOT administer corticosteroid adjunctive th...
...Clinicians should NOT routinely...
...viral Agents and Dosing Recommendations for Tre...
Institutional Outbreak Control
...utional Outbreak Control...
...stitutional Outb...
...e surveillance for additional cases...
...control measures should be implemented as soon...
...mentation of outbreak control measures can be...
...When an influenza outbreak has been identi...
...ric antiviral treatment should be admin...
...chemoprophylaxis should be administered as soon...
...chemoprophylaxis should be administered to reside...
...can consider antiviral chemoprophylaxi...
...ians can consider antiviral chemoprophylaxis...
...icians can consider antiviral chemoprophy...
...s should administer antiviral chemoprophy...
...5. Control Measures for Managing Institutional I...
Diagnosis
...agnosis...
Testing
...ents (including emergency department patients)...
...uld test for influenza in high-risk patients,...
...icians should test for influenza i...
...nicians can consider influenza testing for p...
...low influenza activity without any link to an...
...spitalized Patie...
...should test for influenza on admission in...
...s should test for influenza on admission in all pa...
Clinicians should test for influenza on admiss...
...cians should test for influenza in...
...nicians should test for influenza on admi...
...onsider testing for influenza in patients w...
...gns and Symptoms of Uncomplicated Influenz...
...ble 7. Clinical Manifestations and Complications...
.... Persons Who Are at High Risk of Complica...
...ble 9. Groups in Whom to Consider a Di...
...enza Diagnostic Tests for Respiratory SpecimensHa...
...iplex Assays Authorized for Simultaneous Detecti...
...Interpretation of Influenza Testing Results on Res...
...13. List of Differential Diagnoses...
...Guide for Considering Influenza Testin...
...ecimens
...inicians should collect upper respiratory tract sp...
...Clinicians should collect nasopharyngeal (op...
...should collect endotracheal aspirate or broncho...
...cians should NOT collect or routinely test s...
...icians should NOT collect serum spec...
Diagnostic Tes...
...linicians should use rapid molecular ass...
...ians should use reverse-transcription...
...icians should use multiplex RT-PCR assays target...
...inicians can consider using multiplex RT-...
...ns should NOT use immunofluorescence...
...-up testing with RT-PCR or other molecular assay...
...should NOT use RIDTs in hospitalized pat...
...p testing with RT-PCR or other molecular ass...
Clinicians should NOT use viral cu...
...ure can be considered to confirm negative test re...
...linicians should NOT use serologic testing for...