Flu Part 2: Information for Providers

Submitted by Allison Baroco, MD, Augusta Health Infectious Disease

Last month, we discussed the most commonly asked questions about influenza vaccination, and I was asked to address CDC recommendations for flu antiviral use this month.

Healthcare Workers & Flu Vaccination

A reminder: Tamiflu use is no substitution to obtaining the flu vaccine! I have been encouraged that our hospital’s quality nurses and employee health nurses are making rounds, and this morning they reported over 350 vaccines (as of 10/2/17!) which is phenomenal for this early in the season. We have already had a handful of flu cases, which means NOW is the time to get vaccinated, so you will have a full immune response to the vaccine.

I was discouraged to learn about some front line staff members that deal with critically ill and immunosuppressed hosts that have declined the vaccine this year. As physicians and advanced practice providers, please help answer questions and encourage our clinical staff to get vaccinated. It is our ethical duty to best protect our patients.

British researchers who tested people for influenza antibodies before and after each flu season for 5 years found that an average of 18% of them appeared to have contracted a flu infection each season, but only 23% of that group got sick, according to a report in The Lancet Respiratory Medicine.

This means as healthcare workers, we are high risk for being asymptomatic shedders of influenza and leaving our immunocompromised patients at risk for getting the flu.

Antiviral Recommendations

CDC Summary of Influenza Antiviral Treatment Recommendations

  • Clinical trials and observational data show that early antiviral treatment can shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, and respiratory failure).
  • Early treatment of hospitalized patients can reduce death.
  • In hospitalized children, early antiviral treatment has been shown to shorten the duration of hospitalization.
  • Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset.
  • Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who:
    • is hospitalized
    • has severe, complicated, or progressive illness
    • is at higher risk for influenza complications

Persons at higher risk for influenza complications recommended for antiviral treatment include:

  • Children aged younger than 2 years
  • Adults aged 65 years and older
  • Persons with chronic diseases that pose increased risk of complications including diabetes, COPD and lung disorders, neurological disorders, developmental delay
  • Persons with immunosupression, including that caused by medications or by HIV infection
  • Women who are pregnant or postpartum (within 2 weeks after delivery)
  • Persons aged younger than 19 years who are receiving long-term aspirin therapy
  • American Indians/Alaska Natives
  • Persons who are morbidly obese (i.e., body mass index is equal to or greater than 40)
  • Residents of nursing homes and other chronic care facilities
  • Spinal cord injury

Other Pearls on Antivirals from the CDC:

Three influenza antiviral medications approved by the U.S. Food and Drug Administration (FDA) are recommended for use in the United States during the 2016-2017 influenza season: oral oseltamivir (available as a generic version or under the trade name Tamiflu®), inhaled zanamivir (trade name Relenza®), and intravenous peramivir (trade name Rapivab®). These drugs are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses. Generic oseltamivir was approved by the FDA in August of 2016 and became available in December of 2016.

  • Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients.
  • When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might have some benefits in patients with severe, complicated or progressive illness, and in hospitalized patients when started after 48 hours of illness onset.
  • The recommended treatment course for uncomplicated influenza is two doses per day of oral oseltamivir or inhaled zanamivir for 5 days, or one dose of intravenous peramivir for 1 day.


Hayward AC, Fragaszy EB, Birmingham A, et al. Comparative community burden and severity of seasonal and pandemic influenza; results of the Flu Watch cohort study. Lancet Respir Med 2014 Mar 17.

“Influenza (Flu).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Sept. 2017, www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.