CDC Summary Influenza Antiviral Treatment Recommendations for 2011-2012
- 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; or
- is at higher risk for influenza complications.
- Persons at higher risk for influenza complications recommended for antiviral treatment include:
- children aged <2 years;*
- adults aged ≥65 years;
- persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
- persons with immunosuppression, including that caused by medications or by HIV infection;
- women who are pregnant or postpartum (within 2 weeks after delivery);
- persons aged <19 years who are receiving long-term aspirin therapy;
- American Indians/Alaska Natives;
- persons who are morbidly obese (i.e., body-mass index ≥40); and
- residents of nursing homes and other chronic-care facilities.
- 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 still be beneficial in patients with severe, complicated or progressive illness and in hospitalized patients when given after 48 hours of illness onset. For example, antiviral treatment of pregnant women (of any trimester) with influenza A (2009 H1N1) has been shown to be most beneficial in preventing respiratory failure and death when started within less than 3 days of illness onset, but still provided benefit when started 3– 4 days after onset compared to 5 or more days (Siston, et al JAMA 2009). A larger study reported similar findings and showed that starting oseltamivir treatment up to 4 days after illness onset provided benefit in reducing the risk of severe illness compared to later treatment of 2009 H1N1 (Yu, et al. Clinical Infectious Diseases 2011).
- Treatment should not wait for laboratory confirmation of influenza.
- Also note that because influenza vaccination is not 100% effective in preventing influenza, a history of influenza vaccination does not rule out the possibility of influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza.
- Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.
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