Microsoft word - ep cdc health advisory 101909.doc
For Information Contact:
Andrew T. Jewett, Director Hospital Preparedness Program Iroquois Healthcare Association 315-410-6470 / [email protected] October 19, 2009 CDC Health Advisory Recommendations for Early Antiviral Treatment in Persons with Suspected Influenza
This is an official CDC Health Advisory
Distributed via Health Alert Network October 19, 2009, 13:51 EDT (01:51 PM EDT) CDCHAN-00299-09-10-19-ADV-N
Recommendations for Early Empiric Antiviral Treatment in Persons with Suspected Influenza who are at Increased Risk of Developing Severe Summary Recommendations: When treatment of influenza is indicated in a patient with suspected influenza, health care providers should initiate empiric antiviral treatment as soon as possible. Waiting for laboratory confirmation of influenza to begin treatment with antiviral drugs is not necessary. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative rapid influenza test result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests for 2009 H1N1 virus can range from 10% to 70%, indicating that false negative results occur frequently. Situation The 2009 pandemic H1N1 influenza virus continues to be the dominant influenza virus in circulation in the U.S. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. Several recent reports have indicated two problems related to antiviral treatment: (1) some patients with suspected influenza who are at higher risk of developing severe complications, including hospitalized patients, were not treated at all with antiviral medications because of a negative rapid influenza diagnostic test result and (2) initiation of treatment was delayed for some patients with
suspected influenza who are at higher risk of developing severe complications, including hospitalized patients, because clinicians were waiting for results of real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) assay.
Who is prioritized for treatment with influenza antiviral drugs? Most healthy persons (i.e., those without a condition which puts them at higher risk for complications) who develop an illness consistent with uncomplicated influenza do not need to be treated with antiviral medications and will recover without complications. However, clinical judgment should be the ultimate guide in making antiviral treatment decisions for ill persons who are not at higher risk for complications from influenza.
Early empiric treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization. Prompt empiric outpatient antiviral therapy is also recommended for persons with suspected influenza who have symptoms of lower respiratory tract illness or clinical deterioration regardless of previous health or age. Early empiric treatment should be considered for persons with suspected or confirmed influenza who are at higher risk for complications, even if not hospitalized, including:
Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic,
hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus);
Disorders that that can compromise respiratory function or the handling of respiratory secretions or that
can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)
Immunosuppression, including that caused by medications or by HIV;
Persons younger than 19 years of age who are receiving long-term aspirin therapy, because of an
When should health care providers start treatment with antiviral drugs? Once the decision to administer antiviral treatment is made, oseltamivir or zanamivir should be initiated as soon as possible. Evidence for benefit from antiviral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of oseltamivir treatment of hospitalized patients with seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization, even for patients whose treatment was started more than 48 hours after illness onset.
When treatment is indicated, health care providers should not wait for laboratory confirmation of influenza to begin oseltamivir or zanamivir treatment of patients with suspected 2009 pandemic H1N1 influenza virus infection. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests to detect 2009 H1N1 virus in respiratory specimens ranges from 10% to 70%, and therefore false negative results occur frequently. Similarly, false negative results can also occur with immunoflorescence assays. What actions should health care providers take when waiting for influenza test results Health care providers should empirically treat persons with suspected influenza illness who are at increased risk for complications if clinically indicated while influenza test results are pending. Antiviral treatment is most effective when administered as early as possible in the course of illness. The rRT-PCR tests are the most sensitive and specific influenza diagnostic tests, but they may not be readily available, obtaining test results may take one to several days, and test performance depends on the individual rRT- PCR assay. Antiviral treatment should not be delayed until rRT-PCR test results are available. For More Information Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/recommendations.htm Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season: http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm Questions & Answers:
Antiviral Drugs, 2009-2010 Flu Season:http://www.cdc.gov/h1n1flu/antiviral.htm Influenza Diagnostic Testing: http://www.cdc.gov/h1n1flu/diagnostic_testing_clinicians_qa.htm Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm
Antiviral Drugs: Summary of Side Effects: http://www.cdc.gov/flu/protect/antiviral/sideeffects.htm
General information for the public on antiviral drugs is available in “2009 H1N1 and Seasonal Flu: What You Should Know About Flu Antiviral Drugs” at http://www.cdc.gov/H1N1flu/antivirals/geninfo.htm .
Downloadable brochures and informational flyers, including one on antiviral drugs, are available at http://www.cdc.gov/h1n1flu/flyers.htm .
For the FDA page on antiviral influenza drugs: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm
For additional information, you can also call CDC’s toll-free hotline, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.
Health Alert conveys the highest level of importance; warrants immediate action or attention. Health Advisory provides important information for a specific incident or situation; may not require immediate action. Health Update provides updated information regarding an incident or situation; unlikely to require immediate action.
##This Message was distributed to State and Local Health Officers, Public Information Officers, Epidemiologists and HAN Coordinators as well as Clinician organizations##
You have received this message based upon the information contained within our emergency notification data base. If you have a
different or additional e-mail or fax address that you would like us to use please contact your State-based Health Alert Network
program at your State or local health department.
The CDC and HHS logos are the exclusive property of the Department of Health and Human Services and may not be used for any purpose without prior express written permission. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organizations. Please send us your feedback or comments: http://www.cdc.gov/flu/coca/feedback.htm. Our Clinician Communication Team is committed to excellence in reporting our weekly updates. Please e-mail [email protected] should you note any written errors or discrepancies. If you need to unsubscribe or update your information, please go to our website: http://www.bt.cdc.gov/clinregistry. If you need further information or technical help, please send an e-mail message to: [email protected] Communicating With Clinicians CDC currently employs several mechanisms to communicate with clinicians on topics of urgent
concern and interest. Download this flyer to find out more
Web of Friends Preguntas Frecuentes Acerca de Reportar Violencia en Relaciones Adolescentes Tipos de Abuso Abuso Emocional – “juegos mentales”, amenazar con matarse él o ella misma si el novio/a se va, destruyendo algo que es importante al compañero/a, lastimando una mascota favorita, etc. Abuso Verbal – “menosprecios”, insultos, gritos para intimidar o asustar,
J Clin Anest hesiol ,September 2004 ,Vol. 20 ,No . 9 Comparison of BIS and AEP index f or monitoring depth of anesthesia during induction L i u Ji ng , Cao Jiangbei , et al . Depart ment of A nest hesiology , General Hospit al of PL A Beiji ng 100853 Abstract Objective To compare t he performance of bispectral index (B IS) and t he auditory e2voked response index ( AA I) in detecting