Submitted by Allison Baroco, MD, Augusta Health Medical Director of Infectious Diseases
Below are a few updates and reminders in regards to this Influenza season , as well as reports of a norovirus-like illness circulating and RSV.
Influenza: As many of you are aware from your daily work as well as the media, influenza activity is now considered widespread in Virginia, and outpatient visits for influenza-like illness (fever with cough and/or sore throat) have been increasing in our area. The Virginia Department of Health is reporting that the majority of the influenza cases in the state are Influenza A (H1 dominating over H3 at the moment). Augusta Health has diagnosed and reported > 330 cases thus far. .
The Centers for Disease Control and Prevention (CDC) annual recommendations on seasonal influenza include to 1) remind clinicians to include influenza high on their list of possible diagnoses for ill patients because influenza activity is increasing nationwide and 2) advise clinicians that treatment with a neuraminidase inhibitor antiviral as soon as possible is the recommended approach for all hospitalized patients and all high-risk patients (either hospitalized or outpatient) with suspected influenza. The CDC Health Advisory includes the following key messages:
- CDC recommends antiviral medications for treatment of influenza as an important adjunct to annual influenza vaccination.
- Treat any patient with suspected or confirmed influenza in the following categories as soon as possible with a neuraminidase inhibitor:
- Any patient who is hospitalized—treatment is recommended for all hospitalized patients;
- Any patient who has severe, complicated, or progressive illness—this may include outpatients with severe or prolonged progressive symptoms or who develop complications such as pneumonia but who are not hospitalized;
- Any patient who is at higher risk for influenza complications but not hospitalized. Please refer to the CDC Health Advisory for additional details, including categories of high risk patients, information about testing, specific agents that can be prescribed, possible adverse events, and information for patients.
- Clinical benefit is greatest when antiviral treatment is administered as early as possible after illness onset. Therefore, start antiviral treatment as soon as possible after illness onset and avoid delay even for a few hours to wait for the results of testing. Ideally, initiate treatment within 48 hours of symptom onset. However, antiviral treatment initiated later than 48 hours after illness onset can still be beneficial for some patients.
Please recommend the influenza vaccine to your patients if they have not received it already this season, advise them to stay home while sick with influenza, and to cover their coughs and wash their hands to protect others from the virus. It is NOT too late to vaccinate ! Protect your family, friends, and community.
Unvaccinated Augusta Health employees can still report to Employee Health for their flu vaccine. As we know, the flu vaccine does not always prevent the flu, however it can decrease viral shedding and symptoms that lead to hospitalization and other morbidities. If an Augusta Health employee has Influenza symptoms or is diagnosed with the flu, theyshould call or report to Employee Health. Those unfortunate enough to get the flu should“be a hero” stay home until afebrile for 24 hours and respiratory symptoms associated with flu have resolved.
Norovirus-like illness: There have been reports of possible norovirus circulating at some area assisted living facilities, however no confirmed reports thus far. For any patient presenting to AH with GI symptoms, if norovirus is on the differential or they are coming from a group facility , please consider use of droplet/contact precautions while assessing for the etiology. Norovirus is one of the most infectious pathogens and it is TOO late to isolate after the diagnosis is made. (norovirus prominently includes vomiting, however we should consider isolating anybody with unexplained diarrhea with or without nausea and vomiting)
Respiratory Syncytial Virus (RSV): over 70 laboratory identified events have been identified at AH this season. RSV season frequently parallels Influenza season and this should be considered especially in infants with bronchiolitis. There are no vaccines and no treatments for most people, serving as a reminder that antibiotics will not help this condition, though high risk patients may require evaluation and supportive care if they develop severe symptoms.
Thank you to all of those helping to keep our community well this season, especially those on the front lines!