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Influenza surveillance by static and local health departments and CDC can provide information regarding the presence of influenza viruses in the community. Tamiflu is indicated for the treatment of acute, uncomplicated illness due to influenza infection in patients 2 weeks of age and older who have been symptomatic for no more than 2 days. Influenza can be associated with a variety of neurologic and behavioral symptoms, which can include events such as hallucinations, delirium and abnormal behavior, in some cases resulting in fatal outcomes.
Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. The concurrent use of Tamiflu with live attenuated influenza vaccine (LAIV) intranasal has not been evaluated. Rapid influenza diagnostic tests (RIDTs) are immunoassays that can identify the presence of influenza A and B viral nucleoprotein antigens in respiratory specimens, and display the result in a qualitative way (positive vs.
Although specificity is high, false positive results can also occur, especially during times when influenza activity is low. RIDTs may be used to help with diagnostic and treatment decisions for patients in clinical settings, such as whether to prescribe antiviral medications. Testing is not needed for all patients with signs and symptoms of influenza to make antiviral treatment decisions (See Figures 1-4). Having clinical signs and symptoms consistent with influenza increases the pre-test probability of influenza virus infection, which increases the reliability of a positive RIDT result. Testing specimens collected within 3-4 days of illness onset (when influenza viral shedding is highest) is more likely to yield positive RIDT results if the patient has influenza. RIDTs must also ensure that the appropriate viral transport media or other media is used, consistent with test specifications, if testing is done at a different location from where the specimen is collected from the patient.
Proper interpretation of RIDT results is very important for clinical management of patients and for assessing suspected influenza outbreaks.
Sensitivities of RIDTs are generally approximately 50-70%, but a range of 10-80% has been reported compared to viral culture or RT-PCR. Negative results of RIDTs do not exclude influenza virus infection and influenza should still be considered in a patient if clinical suspicion is high based upon history, signs, symptoms and clinical examination.
A positive result in a person who recently received intranasal administration of live attenuated influenza virus vaccine (LAIV) may indicate detection of vaccine virus. False-positive (and true-negative) results are more likely to occur when disease prevalence in the community is low, which is generally at the beginning and end of the influenza season and during the summer. The negative predictive value of an RIDT (the proportion of patients with negative results who do not have influenza) is highest when influenza activity is low.
The positive predictive value of an RIDT (the proportion of patients with positive results who have influenza) is lowest when influenza activity is low. Follow-up negative results with confirmatory tests (RT-PCR or viral culture) if a laboratory-confirmed influenza diagnosis is desired.
Clinicians should contact their local or state health department for information about current influenza activity.
A patient tests negative by RIDT when community influenza activity is high and laboratory confirmation of influenza is desired. A patient tests positive by RIDT and the community prevalence of influenza is low, and a false positive result is a consideration.
Detection of influenza virus infection and prompt implementation of infection prevention and control measures is critical to prevention of nosocomial influenza outbreaks. For suspected influenza outbreaks in institutions, respiratory specimens should be collected from patients with suspected influenza as early as possible once the outbreak is suspected (See Figure 2).
Laboratory-based surveillance for influenza viruses by viral culture is critically important to the selection of viruses for the next season's influenza vaccine. Confirmation of influenza virus infection by diagnostic testing is not required for clinical decisions to prescribe antiviral medications.
Influenza like-illness (history of feverishness or documented fever with either cough or sore throat), fever with other respiratory symptoms, etc. In settings where persons at high-risk of influenza complications reside, a single case of suspected influenza is sufficient for triggering influenza testing and consideration of implementation of empiric infection prevention and control measures, including active surveillance for new illness cases. During periods when influenza activity is high and influenza viruses are circulating among persons in the community (see 3.
Influenza virus infection may include seasonal influenza A (H3N2), A(H1N1)pdm09, influenza B, or rarely, a novel influenza A virus infection.
During periods when influenza activity is low and there is low influenza virus circulation among persons in the community, the positive predictive value of a rapid influenza diagnostic test is low (that is, the chance that a positive result indicates that the patient has influenza is low), and the negative predictive value is high (the chance that a negative result is a true negative is high). Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, et al. Perez-Padilla R, de la Rosa-Zamboni, Ponce de Leon S, et al; INER Working Group on Influenza.
Cutler J, Schleihauf E, Hatchette TF, et al; Nova Scotia Human Swine Influenza Investigation Team. Morishima T, Togashi T, Yokota S, et al; Collaborative Study Group on Influenza-Associated Encephalopathy in Japan. To be effective at treating and reducing the duration of influenza symptoms, treatment should be initiated within 48 hours of the onset of flu symptoms. Rapid molecular assays are a new type of influenza diagnostic test that use isothermal nucleic acid amplification for viral detection.


However, due to the limited sensitivities, negative results of RIDTs do not exclude influenza virus infection in patients with signs and symptoms suggestive of influenza. Once influenza activity has been documented in the community or geographic area, a clinical diagnosis of influenza can be made for outpatients with signs and symptoms consistent with suspected influenza, especially during periods of peak influenza activity in the community.
Positive RIDT results from one or more ill persons with suspected influenza can support decisions to promptly implement infection prevention and control measures for influenza outbreaks. For more information about influenza activity in the United States during the influenza season, visit the Weekly U.S. When there is influenza activity in the community, clinicians should consider influenza testing, including viral culture, for patients who develop signs and symptoms of influenza while they are in a health care facility. Virus isolates are needed in order to characterize the circulating influenza A virus subtypes and influenza A and B virus strains and to determine how well they are matched antigenically to vaccine strains. Decisions to administer antiviral medications for influenza treatment or chemoprophylaxis, if indicated, should be based upon clinical illness and epidemiologic factors, and start of antiviral therapy should not be delayed pending testing results.
Consider additional influenza virus testing to confirm RIDT results, for subtyping of influenza A virus, to distinguish between influenza A and B viruses, or for more specific analyses, if indicated. Do not use negative RIDT results exclusively for clinical decision-making, or for public health decisions, including identifying influenza outbreaks, or for decisions on infection control measures.
The interpretation of RIDTs will, in part, depend on the test used – some will detect influenza A, some will detect influenza B and some will detect both A and B viruses. Additional influenza virus testing by RT-PCR or other molecular assays is recommended to confirm RIDT results, for subtyping of influenza A virus, to distinguish between influenza A and B viruses, or for more specific analyses, if indicated.
Even though RIDTs have high specificity, false positive RIDT results are more common when influenza activity is low. Alere i Influenza A&B was FDA cleared for use with both nasal swabs (direct) and NP or nasal swabs in VTM. Detection of influenza antigen with rapid antibody-based tests after intranasal influenza vaccination (FluMist).
Analytical detection of influenza A(H3N2)v and other A variant viruses from the USA by rapid influenza diagnostic tests. Shedding and immunogenicity of live attenuated influenza vaccine virus in subjects 5-49 years of age. Evaluation of rapid influenza diagnostic tests for influenza A (H3N2)v virus and updated case count--United States, 2012.
Evaluation of 11 commercially available rapid influenza diagnostic tests - United States, 2011-2012. Policy Statement—Recommendations for Prevention and Control of Influenza in Children, 2010–2011.
Seasonal influenza in adults and children—diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America.
WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and other Influenza Viruses.
Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Evaluation of rapid influenza diagnostic tests for detection of novel influenza A (H1N1) Virus—United States, 2009.
New vaccine technology is being developed.In April 2009, a new flu virus termed novel H1N1 swine flu developed in Mexico, rapidly spread worldwide, and caused the WHO to declare a flu pandemic. Perhaps the most striking feature of the pandemic so far is that fewer than half of those hospitalized or killed by this virus have had identifiable prior medical conditions or risk factors. Emergence of a novel swine-origin influenza A (H1N1) virus in humans [published correction appears in N Engl J Med. Transmission potential of the new influenza A(H1N1) virus and its age-specificity in Japan. Multiple lineages of antigenically and genetically diverse influenza A virus co-circulate in the United States swine population. Human infection with pandemic A (H1N1) 2009 influenza virus: clinical observations in hospitalized patients, Americas, July 2009—update. Intensive-care patients with severe novel influenza A (H1N1) virus infection—Michigan, June 2009. Investigation of the first cases of human-to-human infection with the new swine-origin influenza A (H1N1) virus in Canada.
Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness.
Neurologic complications associated with novel influenza A (H1N1) virus infection in children—Dallas, Texas, May 2009. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. Strategic Advisory Group of Experts on Immunization—report of the extraordinary meeting on the influenza A (H1N1) 2009 pandemic, 7 July 2009. Recommended composition of influenza virus vaccines for use in the 2009-2010 influenza season (northern hemisphere winter).


Update: infections with a swine-origin influenza A (H1N1) virus—United States and other countries, April 28, 2009. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial.
Oral oseltamivir treatment of influenza in children [published correction appears in Pediatr Infect Dis J. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations.
Pandemic (H1N1) 2009 briefing note 1 viruses resistant to oseltamivir (Tamiflu) identified. Therefore, antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative by RIDT and further influenza testing of respiratory specimens by molecular assays may be indicated. However, negative RIDT results do not exclude influenza virus infection as a cause of a respiratory outbreak because of the limited sensitivity of these tests. Since the nasal passages are infected with live influenza virus vaccine strains during LAIV administration, sampling the nasal passages within a few days after LAIV vaccination can yield positive influenza testing results. However, empiric antiviral treatment should be initiated as soon as possible for hospitalized patients with suspected influenza without the need to wait for any influenza testing results (see Antiviral Drugs, Information for Health Care Professionals).
This should be done as part of a broader surveillance strategy for influenza as discussed in Prevention Strategies for Seasonal Influenza in Heath Care Settings.
If RIDTs are used in these settings, clinical specimens should also be sent for influenza testing by viral culture and RT-PCR to provide detailed information on specific influenza A virus subtypes and strains, and antiviral susceptibility data and to verify RIDT test results. Respiratory specimens should be collected from an ill patient as early as possible after onset of symptoms (ideally <48-72 hours after onset) to help maximize influenza testing sensitivity. The presence of any influenza positives among persons with clinically compatible illnesses is supportive of influenza as the probable cause of the outbreak. If tests for both influenza A and influenza B are positive, refer specimen to a public health laboratory for resolution, as dual infections are uncommon. Llame al 1-800-CDC-INFO si tiene preguntas sobre la influenza estacional, cuyas respuestas no ha encontrado en este sitio. Diagnostic and treatment options for infections with the H1N1 swine-origin influenza virus (S-OIV) continue to change as the pandemic progresses. Testing respiratory specimens from several persons with suspected influenza will increase the likelihood of detecting influenza virus infection if influenza virus is the cause of the outbreak. Antiviral treatment should not be stopped based on negative RIDT results given the limited sensitivities of RIDTs.
Active daily surveillance for suspected influenza illness and collection of specimens from patients with suspected influenza should continue through at least 2 weeks after implementation of control measures to assess effectiveness of the measures and to monitor for potential emergence of antiviral resistance. This information is needed from specimens sent for viral culture and RT-PCR year round for identification of novel influenza A virus strains or antigenically-drifted  strains, including during times of low influenza activity such as at the beginning and end of influenza seasonal activity. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina.
Public health authorities should be notified promptly of any suspected institutional outbreak and respiratory specimens should be collected from ill persons (whether positive or negative by RIDT) and sent to a public health laboratory for more accurate influenza testing by molecular assays and viral culture. Infection prevention and control measures should be implemented immediately upon admission for any hospitalized patient with suspected influenza even if RIDT results are negative (see Prevention Strategies for Seasonal Influenza in Heath Care Settings). Confirmation of RIDT results by more RT-PCR  or viral culture specific influenza testing is indicated.
However, RIDTs have limited sensitivity to detect influenza virus in respiratory specimens compared to RT-PCR or viral culture and negative RIDT test results should be interpreted with caution given the potential for false negative results, especially during peak influenza activity in a community.
Respiratory specimens can be tested for influenza by immunofluorescence, RT-PCR or viral culture.
These severe outbreaks occur when a portion of the human population is exposed to a flu strain against which the population has little or no immunity because the virus has become altered in a significant way. Clinicians should understand that negative results of influenza testing do not exclude influenza virus infection, especially if the time from illness onset to collection of respiratory specimens is more than 3  days, or if upper respiratory specimens were tested and the patient has lower respiratory tract disease. Unusually severe worldwide outbreaks (pandemics) have occurred several times in the last hundred years since influenza virus was identified in 1933.
By an examination of preserved tissue, the worst influenza pandemic (also termed the Spanish flu or Spanish influenza) occurred in 1918 when the virus caused between 40-100 million deaths worldwide, with a mortality rate estimated to range from 2%-20%.In April 2009, a new influenza strain against which the world population has little or no immunity was isolated from humans in Mexico. It quickly spread throughout the world so fast that the WHO declared this new flu strain (first termed novel H1N1 influenza A swine flu, often later shortened to H1N1 or swine flu) as the cause of a pandemic on June 11, 2009. Fortunately, there was a worldwide response that included vaccine production, good hygiene practices (especially hand washing) were emphasized, and the virus (H1N1) caused far less morbidity and mortality than was expected and predicted.
Colds can be caused by over 100 different virus types, but only influenza viruses (and subtypes) A, B, and C cause the flu. In addition, colds do not lead to life-threatening illnesses like pneumonia, but severe infections with influenza viruses can lead to pneumonia or even death.Flu season officially begins in October of each year and extends to May of the following year.



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