Influenza Update 2016 Season

Many may not know there are changes this year regarding vaccination, we will no longer use the nasal spray. The reason for this as it was found to have decreased efficacy by the CDC therefore the new recommendation is for injection only. Wasn’t INCREASED efficacy why we were using the nasal spray in the first place? Yes, this is an important recommendation that will make it a little harder to vaccinate our kids, but always worth it!! Between 1976-2007 there were between 3,300 and 49,000 influenza related deaths per year (Grohskopf et al,2016). That is a scary prospect. For all of us, especially those in healthcare, please get your flu vaccine today.

Review on influenza



Recommended vaccination populations are persons 6 months old and greater. Specific groups who are at high risk are emphasized. Patients between 6 months and 8 years may require a 2nd dose, please refer to guidelines for pediatrics. Ideally, all patients will be vaccinated before November.


Patients with the flu are more likely to prevent to an urgent care setting because of the acuteness of their illness. It is difficult or impossible for these patients to wait for an appointment at the primary care office. If the patient or provider suspects the flu, the patient should be evaluated quickly as treatment is time dependent. Typical symptoms abrupt onset are fever, fatigue, myalgias, headache, sore throat and mild cough.


Transmission of influenza virus is through respiratory droplets. Typically when an infected person sneezes or coughs at close contact. Transmission can likely also occur through air droplets for short periods of time. Most infected patients can infect other people one day after symptoms develop to 7 days into illness. This means patients are contagious for a long period.  Patients whom are immunosuppressed will have an increased likelihood of disease development.

Diagnosis Options:

Influenza can be a diagnosis of history, physical and clinical judgement alone. There are multiple rapid influenza test kids available. Advantages of using the kits are that they provide quick results for providers and patients. Disadvantages are they can be falsely positive or negative, leading to improper treatment. They can be a useful tool for guidance of medication use.

Treatment Guidelines:

We treat patients whom we suspect have the flue for three reasons:

  • Reduce Complications in otherwise healthy patients
  • Shorten the duration of the Illness
  • Reduce Complications among hospitalized or severely ill patients

Treatment Indications:

-Patients Less than 2 years old or greater than 65 years old

-Patients with immunosuppression

-Patients with chronic illness or mental disability

-Patients who are pregnant or within 2 weeks postpartum

-Patients who reside in long term care or nursing home facilities

-Patients who have a BMI greater than 40

-Patients who are less than 19 on chronic ASA therapy

-Patients of Alaskan/Native American descent

Available Treatments:

Osteltamivir- oral

Treatment- any age, chemoprophylaxis- 3 months old or greater

Adult dosing 75 mg TWICE daily x 5 days (pediatric dosing – weight based, see package insert)

Chemoprophylaxis- Adult 75mg ONCE daily x 7 days


Zanamivir- nasal inhalation

Treatment- 7 years old chemoprophylaxis 5 years and older

Adult dosing- 10 mg ( 2 inhalations) TWICE daily x 5 days   (pediatric dosing- see insert)

Chemoprophylaxis – 10 mg (2 inhalations-) ONCE daily x7 days


Peramivir– IV drug- treatment- 18 years +

Accessed on 10/5/2016

Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016;65(No. RR-5):1–54. DOI: