A new IDSA guideline for seasonal influenza in adults and children provides evidence-based recommendations for diagnosis, treatment, chemoprophylaxis, and institutional outbreak management.
The guideline addresses diagnostic issues, such as who should be tested, which tests should be used, and interpretation of results. Recommendations for determining which specimens should be collected for influenza tests, and when they should be collected, are also provided. For instance, obtaining respiratory tract specimens at the onset of illness should be done within five days of diagnosis. The guideline cautions that in order to properly perform and analyze influenza tests, clinicians should understand the limitations of the tests and the rate of influenza activity among the population being tested.
Several recommendations are outlined regarding who should be considered for antivirals, both for treatment and for chemoprophylaxis. Although influenza vaccination is the primary tool to prevent influenza, antiviral chemoprophylaxis can be considered for high-risk individuals who are in jeopardy of developing complications from influenza (e.g., persons who are immunocompromised) and who cannot receive vaccine. The guideline states that clinicians should be aware of local patterns of influenza throughout their communities when determining who should receive antiviral drugs and which antivirals should be administered.
The guideline also discusses the occurrence of outbreaks in institutional settings, which can occur even when there is only one reported case of influenza. In such cases, the recommendation is that all residents and institutional employees should be tested for influenza when symptomatic, and all residents should receive chemoprophylaxis whether or not they have previously been vaccinated. Individuals receiving antiviral chemoprophylaxis in an institutional outbreak should remain on medication for at least 14 days.
The guideline’s performance measures emphasize that all persons with acute febrile respiratory symptoms should be tested for influenza, and health care institutions should offer influenza vaccine to all employees. Additional performance measures are outlined in the guideline to help health care practitioners measure the effectiveness of the guideline recommendations.
The guideline is available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
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