Fiore AE, Fry A, Shay D, et al. Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices (ACIP)
This report updates previous recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of antiviral agents for the prevention and treatment of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2008;57[No. RR-7]).This report contains information on treatment and chemoprophylaxis of influenza virus infection and provides a summary of the effectiveness and safety of antiviral treatment medications. Highlights include recommendations for use of 1) early antiviral treatment of suspected or confirmed influenza among persons with severe influenza (e.g., those who have severe, complicated, or progressive illness or who require hospitalization); 2) early antiviral treatment of suspected or confirmed influenza among persons at higher risk for influenza complications; and 3) either oseltamivir or zanamivir for persons with influenza caused by 2009 H1N1 virus, influenza A (H3N2) virus, or influenza B virus or when the influenza virus type or influenza A virus subtype is unknown; 4) antiviral medications among children aged <1 year; 5) local influenza testing and influenza surveillance data, when available, to help guide treatment decisions; and 6) consideration of antiviral treatment for outpatients with confirmed or suspected influenza who do not have known risk factors for severe illness, if treatment can be initiated within 48 hours of illness onset. Additional information is available from CDC's influenza website at http://www.cdc.gov/flu, including any updates or supplements to these recommendations that might be required during the 2010-11 influenza season. Health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information. Recommendations related to the use of vaccines for the prevention of influenza during the 2010-11 influenza season have been published previously (CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices [ACIP], 2010. MMWR 2010;59[No. RR-8]).
Available from: Mercedes Pérez-Ruiz
- "Although seasonal patterns of virus activity could orientate the etiological diagnosis, several viruses can be cocirculating at the same time throughout the year (Ruuskanen et al., 2011). Rapid etiological diagnosis of ARI improves patients' management , as it allows for appropriate and on-time antiviral therapy, which has demonstrated a reduction of complications, duration of symptoms, and hospital stay (D'Heilly et al., 2008; Fiore et al., 2011). Indeed, rapid diagnosis avoids the use of unnecessary antibiotics and ancillary diagnostic studies (Ferronato et al., 2012; Benito-Fernández et al., 2006). "
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ABSTRACT: The analytical performance of mariPOC® respi test (ArcDia® Laboratories, Turku, Finland) was evaluated using nucleic acid amplification techniques (NAATs) as the gold standard. The mariPOC assay allows automated detection of antigens from 8 respiratory viruses: influenza A and B viruses, respiratory syncytial virus, adenovirus, human metapneumovirus, and parainfluenza viruses 1-3. Positive results from samples with high viral load are available in 20min. Nasopharyngeal aspirates (n=192) from patients with acute respiratory infection and from previously positive samples were analyzed by mariPOC and NAATs (Simplexa(TM) FluA/FluB & RSV kit [n=118] and Luminex® Respiratory virus panel xTAG® RVP FAST [n=74]). Sensitivity, specificity, positive predictive value, and negative predictive value of mariPOC were 85.4%, 99.2%, 95.9%, and 97%, respectively, and 84.6% of positive results were reported in 20min. The good analytical performance and extended portfolio of mariPOC show this rapid assay as a good alternative for the etiological diagnosis of acute respiratory infection in laboratories that are not equipped with molecular assays.
Copyright © 2015. Published by Elsevier Inc.
Available from: Barbara Rath
- "Future therapeutic developments may also increase the need for rapid combined RSV and influenza diagnostics. While antiviral treatment is already recommended for infants and children below the age of 2 years (Fiore et al., 2011), there are also several new antivirals in development for RSV-infected infants, children, and adults (Bawage et al., 2013; Geller et al., 2013; Tayyari and Hegele, 2012). The prospect of RSV antivirals or other treatment options, including immune modulators, will further increase the need for rapid diagnostics in the acute care setting (Hurwitz, 2011; Kimpen, 2002). "
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ABSTRACT: Acute respiratory infections represent common pediatric emergencies. Infection control warrants immediate and accurate diagnoses. In the past, first-generation respiratory syncytial virus (RSV) rapid tests (strip tests) have shown suboptimal sensitivities. In 2013, the Food and Drug Administration licensed a second-generation RSV rapid test providing user-independent readouts (SOFIA-RSV) using automated fluorescence assay technology known to yield superior results with influenza rapid testing. We are reporting the first point-of-care evaluation of the SOFIA-RSV rapid test. In the Charite Influenza-Like Disease Cohort, 686 nasopharyngeal samples were tested in parallel with SOFIA-RSV and SOFIA-Influenza A+B. Compared to real-time PCR, SOFIA-RSV sensitivities/specificities were 78.6%/93.9%, respectively (SOFIA-Influenza A: 80.6%/99.3%). Performance was greatest in patients below 2years of age with a test sensitivity of 81.8%. RSV sensitivities were highest (85%) in the first 2days of illness and with nasopharyngeal compared to nasal swabs (P=0.055, McNemar's test). Second-generation RSV and influenza rapid testing provides highly accurate results facilitating timely patient cohortation and management.
Available from: Paul E Kilgore
- "In ROK, the predominantly circulating strains were A/H3N2 in 2004-05, A/H1N1 in 2005-06, and A/H3N2 in 2006-07 and there were no reported oseltamivir-resistant strains of influenza during the study period of 2004-07. Notably, in the January 2011 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, either oseltamivir or zanamivir was recommended for use in patients hospitalized with suspected or confirmed influenza, whether it is 2009 H1N1 virus, influenza A (H3N2) virus, or influenza B virus or when the influenza virus type or influenza A virus subtype is unknown (41). In ROK, there is limited number of oseltamivir treatment guidelines or recommendations for seasonal influenza. "
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ABSTRACT: There are limited data evaluating the relationship between influenza treatment and hospitalization duration. Our purpose assessed the association between different treatments and hospital stay among Korean pediatric influenza patients. Total 770 children ≤ 15 yr-of-age hospitalized with community-acquired laboratory-confirmed influenza at three large urban tertiary care hospitals were identified through a retrospective medical chart review. Demographic, clinical, and cost data were extracted and a multivariable linear regression model was used to assess the associations between influenza treatment types and hospital stay. Overall, there were 81% of the patients hospitalized with laboratory-confirmed influenza who received antibiotic monotherapy whereas only 4% of the patients received oseltamivir monotherapy. The mean treatment-related charges for hospitalizations treated with antibiotics, alone or with oseltamivir, were significantly higher than those treated with oseltamivir-only (P < 0.001). Influenza patients treated with antibiotics-only and antibiotics/oseltamivir combination therapy showed 44.9% and 28.2%, respectively, longer duration of hospitalization compared to those treated with oseltamivir-only. Patients treated with antibiotics, alone or combined with oseltamivir, were associated with longer hospitalization and significantly higher medical charges, compared to patients treated with oseltamivir alone. In Korea, there is a need for more judicious use of antibiotics, appropriate use of influenza rapid testing.
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