Health Alert
GUIDANCE ON THE USE OF ANTIVIRAL AGENTS AGAINST INFLUENZA

The Delaware Division of Public Health (DPH) is notifying clinicians of the need to restrict the use of neuraminidase inhibitor antivirals – Oseltamivir (Tamiflu) and Zanamivir (Relenza) – given the potential shortage caused by an early and severe flu season.

During a widespread flu outbreak, demand for influenza antivirals may exceed available supplies. Antiviral supplies can be limited and DPH is recommending that clinicians restrict their use of neuraminidase inhibitors in treatment and chemoprophylaxis in order to conserve available medication for persons at higher risk for influenza complications.

Persons with influenza who present with an uncomplicated febrile illness typically do not require treatment with antivirals.

Treatment is recommended for any person with confirmed or suspected influenza who requires hospitalization, even if the patient presents >48 hours after illness onset. Generally early initiation of treatment (<2 days from illness onset) is associated with best clinical outcomes. Among outpatients, antiviral treatment is recommended for all persons with suspected or confirmed influenza who are at higher risk for influenza complications because of age or underlying medical conditions. These 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, seizure disorders, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
• persons with immunosuppression, (including that due to medication or 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., BMI ≥40); and
• residents of nursing homes and other chronic-care facilities.

Chemoprophylaxis

Providers are reminded that vaccination, rather than antivirals, should be used for prevention of influenza in the vast majority of individuals

At this time, DPH is recommending that the use of antivirals for prophylaxis be restricted to the following groups:

1. Long term care facilities where an ongoing influenza outbreak has been documented
2. Individuals who are severely immunocompromised (such as hematopoietic stem cell transplant recipients) and who either have a contraindication to vaccination OR received vaccination less than 2 weeks prior to exposure to an influenza case

”Long-term care facilities” refers to nursing homes and skilled nursing facilities that provide health care to people who are unable to live independently in the community.

All residents fitting the eligibility criteria above should receive antiviral chemoprophylaxis as soon as an influenza outbreak is determined. (When at least 2 patients are ill with influenza-like symptoms within 72 hours of each other and at least one resident has laboratory-confirmed influenza). In this situation, the facility should promptly initiate antiviral chemoprophylaxis to all non-ill residents, regardless of whether or not they received influenza vaccination. Priority should be given to residents living in the same unit or floor as an ill resident. However, since staff and residents may spread influenza to residents on other units, floors, or buildings of the same facility, all non-ill residents are recommended to receive antiviral chemoprophylaxis to control influenza outbreaks.

For further information on recommended indications, dosage and duration of antiviral use for treatment or chemoprophylaxis of influenza please visit:

• http://www.cdc.gov/flu/pdf/professionals/antivirals/antiviral-dosage-duration.pdf
• http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

Please call DPH at 302-744-1050 for additional information, or visit the CDC @

• http://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
• http://www.cdc.gov/flu/professionals/antivirals/index.htm

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