H1N1 Swine Flu Update
ACP Foundation Patient Information on Influenza
H1N1 FAQ’s from the ACP Adult Immunization Advisory Board
Triage algorithm for suspected H1H1 in adults
H1N1 Vaccine Coding Information
CDC 2009-2010 Recommendations for Use of Vaccine Against Novel H1N1
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) made the following recommendations for use of vaccine against novel influenza A (H1N1). The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:
- pregnant women,
- people who live with or care for children younger than 6 months of age,
- health care and emergency services personnel,
- persons between the ages of 6 months through 24 years of age, and
- people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.
Simultaneous administration of inactivated vaccines against seasonal and the 2009 H1N1 influenza viruses is permissible if different anatomic sites are used. Further guidance regarding time of administration of live, attenuated vaccines against both seasonal and 2009 H1N1 influenza viruses in the same individual are pending. Very little data is available.
If tested for the flu after receiving the live attenuated influenza vaccine (LAIV), a person could test positive on a rapid influenza diagnostic test because the tests are designed to detect influenza viruses and cannot differentiate between live attenuated viruses that could be recovered following administration of LAIV and wild-type flu viruses.
Updated Interim CDC Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
(more info at http://www.cdc.gov/h1n1flu/recommendations.htm)
The priority use of antiviral medications during this season continues to be in people who are hospitalized with influenza and those at increased risk of influenza-related complications. Current updates are inteneded to:
- Clarify treatment and chemoprophylaxis considerations for persons vaccinated with the 2009 H1N1 and seasonal influenza vaccines.
- Include women up to 2 weeks postpartum at higher risk for complications from 2009 H1N1 influenza.
- Provide additional oseltamivir dosing instructions for children younger than 1 year of age.
Recommendations Summary
Most healthy persons who develop an illness consistent with uncomplicated influenza, or persons who appear to be recovering from influenza, do not need antiviral medications for treatment or prophylaxis. However, persons presenting with suspected influenza and more severe symptoms such as evidence of lower respiratory tract infection or clinical deterioration should receive prompt empiric antiviral therapy, regardless of previous health or age.
Treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization. Early empiric treatment with oseltamivir or zanamivir should be considered for persons with suspected or confirmed influenza who are at higher risk for complications including:
- Children younger than 2 years old
- Persons aged 65 years or older
- Pregnant women and women up to 2 weeks postpartum (including following pregnancy loss)
- Persons of any age with certain chronic medical or immunosuppressive conditions
- Persons younger than 19 years of age who are receiving long-term aspirin therapy
Treatment, when indicated, should be initiated as early as possible because the benefits are greatest when started within the first 2 days of illness. However, some studies of hospitalized patients with seasonal and 2009 H1N1 influenza have suggested benefit of antiviral treatment even when treatment was started more than 48 hours after illness onset. Treatment should not wait for laboratory confirmation of influenza because laboratory testing can delay treatment and because a negative rapid test for influenza does not rule out influenza. The sensitivity of rapid tests in detecting 2009 H1N1 has ranged from 10% to 70%. Information on the use of rapid influenza diagnostic tests (RIDTs) can be found at http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm.
Testing for 2009 H1N1 influenza infection with real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) should be prioritized for persons with suspected or confirmed influenza requiring hospitalization and based on guidelines from local and state health departments.
Consideration for antiviral chemoprophylaxis should generally be reserved for persons at higher risk for influenza-related complications who have had contact with someone likely to have been infected with influenza. However, early treatment is an emphasized alternative to chemoprophylaxis after a suspected exposure.
Household or close contacts (with risk factors for influenza complications) of confirmed or suspected cases can be counseled about the early signs and symptoms of influenza, and advised to immediately contact their healthcare provider for evaluation and possible early treatment if clinical signs or symptoms develop.
Early recognition of illness and treatment when indicated is preferred to chemoprophylaxis for vaccinated persons after a suspected exposure.
Currently circulating 2009 H1N1 viruses are susceptible to oseltamivir and zanamivir, but resistant to amantadine and rimantadine; however, antiviral treatment regimens might change according to new antiviral resistance or viral surveillance information. For dosing recommendations go to http://www.cdc.gov/h1n1flu/recommendations.htm#table1
For more resources from CDC on Vaccine Supply, VIS’s, etc see http://www.cdc.gov/h1n1flu/clinicians/#vaccine
Acrobat PDF format.
Download Acrobat Reader
software for free from Adobe.
Problems with PDFs?