Antiviral options remain the same
Once again this year, the CDC does not recommend the use of adamantane antivirals for prophylaxis or treatment of influenza, leaving the 2 neuraminidase inhibitors, oseltamivir (Tamiflu) and zanamivir (Relenza), for these purposes. Treating flu patients with these antivirals shortens the duration of symptoms and may reduce viral shedding.
The earlier the treatment is started, the better the results. There appears to be no—or only minimal—benefit for those with uncomplicated influenza if the treatment is started more than 2 days after the onset of illness.
Tips to help improve vaccination rates
The Task Force on Community Preventive Services (an independent group, whose members are appointed by the director of the CDC) indicates that there is evidence to support the use of the following methods for improving vaccination rates:4
- Provider reminders, including notations, stickers, or other prompts in clients’ charts that notify staff when a client is due for certain vaccinations, including the influenza vaccine
- A recall system to notify patients when vaccines are due, using telephone messages or mailings. (E-mail messages are not mentioned but should also work)
- Standing orders for adults that allow staff to administer vaccines without the patient seeing the physician
- Assessing provider performance in delivering vaccinations and supplying this data to the provider
- Decreasing out-of-pocket costs for vaccinations.
Consider antiviral prophylaxis for these patients
The CDC recommends that antiviral prophylaxis be considered for those who are susceptible, residing in an area with circulating influenza virus, and who:
- have not been vaccinated or were recently vaccinated (since it takes 2 weeks for immunity to develop after vaccination)
- are unvaccinated and providing care for high-risk individuals
- have a contraindication to the vaccine
- have immune deficiencies and may not respond adequately to the vaccine.
The CDC also recommends prophylaxis for all residents and staff in a long-term care facility where influenza is circulating, without regard to vaccine status. More complete information on indications, dose and duration of antivirals for prophylaxis, and treatment can be found in this year’s CDC recommendations.3
Another flu season approaches
The good news for the coming year is that the government expects that the supply of vaccine will exceed 100 million doses. This should be sufficient, unless unforeseen production problems arise.
Each year millions of doses of influenza vaccine go unused and are discarded. By following the CDC’s recommendations, and those of the Task Force on Community Preventive Services4 (top left), each of us can improve vaccination coverage in our area and minimize the number of hospitalizations and deaths from the flu.
Correspondence
Doug Campos-Outcalt, MD, MPA, 550 e. van buren, Phoenix, AZ 85004; dougco@u.arizona.edu.