Influenza primary prevention: Difference between revisions

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Revision as of 16:53, 24 October 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Primary Prevention

Vaccination

Vaccination against influenza with a flu vaccine is strongly recommended for high-risk groups, such as children and the elderly.

Chemoprophylaxis

Annual influenza vaccination is the best way to prevent influenza because vaccination can be given well before influenza virus exposures occur, and can provide safe and effective immunity throughout the influenza season.
Antiviral medications are approximately 70% to 90% effective in preventing influenza and are useful adjuncts to influenza vaccination.
CDC does not recommend widespread or routine use of antiviral medications for chemoprophylaxis so as to limit the possibilities that antiviral resistant viruses could emerge. Indiscriminate use of chemoprophylaxis might promote resistance to antiviral medications, or reduce antiviral medication availability for treatment of persons at higher risk for influenza complications or those who are severely ill.
In general, CDC does not recommend seasonal or pre-exposure antiviral chemoprophylaxis, but antiviral medications can be considered for chemoprophylaxis in certain situations.
The following are examples of situations where antiviral medications can be considered for chemoprophylaxis to prevent influenza:

Prevention of influenza in persons at high risk of influenza complications during the first two weeks following vaccination after exposure to an infectious person.
Prevention for people with severe immune deficiencies or others who might not respond to influenza vaccination, such as persons receiving immunosuppressive medications, after exposure to an infectious person.
Prevention for people at high risk for complications from influenza who cannot receive influenza vaccine due to a contraindication after exposure to an infectious person.
Prevention of influenza among residents of institutions, such as long-term care facilities, during influenza outbreaks in the institution.

An emphasis on close monitoring and early initiation of antiviral treatment if fever and/or respiratory symptoms develop is an alternative to chemoprophylaxis after a suspected exposure for some persons.
To be effective as chemoprophylaxis, an antiviral medication must be taken each day for the duration of potential exposure to a person with influenza and continued for 7 days after the last known exposure. For persons taking antiviral chemoprophylaxis after inactivated influenza vaccination, the recommended duration is until immunity after vaccination develops (antibody development after vaccination takes about two weeks in adults and can take longer in children depending on age and vaccination history).
Antiviral chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the first exposure to an infectious person.
Patients receiving antiviral chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.

References

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Influenza}}
-{{CMG}}
+{{CMG}}; {{AE}} {{AL}}
+==Overview==
 ==Primary Prevention==
-===Vaccination and infection control===
+===Vaccination===
 {{further|[[Flu vaccine]]}}
-[[Image:Vaccination.jpg|thumb|240px|left|U.S. Navy personnel receiving influenza vaccination]]
-Vaccination against influenza with a [[flu vaccine]] is strongly recommended for high-risk groups, such as children and the elderly.
+*Vaccination against influenza with a [[flu vaccine]] is strongly recommended for high-risk groups, such as children and the elderly.
-Flu vaccines can be produced in several ways; the most common method is to grow the virus in fertilised hen eggs. After purification, the virus is inactivated (for example, by treatment with detergent) to produce an inactivated-virus vaccine. Alternatively, the virus can be grown in eggs until it loses [[virulence]] and the avirulent virus given as a live vaccine. The effectiveness of these flu vaccines is variable. Due to the high mutation rate of the virus, a particular flu vaccine usually confers protection for no more than a few years. Every year, the [[World Health Organization]] predicts which strains of the virus are most likely to be circulating in the next year, allowing [[pharmaceutical company|pharmaceutical companies]] to develop vaccines that will provide the best immunity against these strains. Vaccines have also been developed to protect poultry from [[avian influenza]]. These vaccines can be effective against multiple strains and are used either as part of a preventative strategy, or combined with culling in attempts to eradicate outbreaks.<ref>{{cite journal | last = Capua | first = I | coauthors = Alexander D | title = The challenge of avian influenza to the veterinary community. | url= http://taylorandfrancis.metapress.com/media/gmuaahtvwk6vweuhugdh/contributions/t/2/n/2/t2n2431j4u176p7g.pdf | journal = Avian Pathol | volume = 35 | issue = 3 | pages = 189–205 | year = 2006 | id = PMID 16753610}}</ref>
+===Chemoprophylaxis===
-It is possible to get vaccinated and still get influenza.  The vaccine is reformulated each season for a few specific flu strains, but cannot possibly include all the strains actively infecting people in the world for that season.  It takes about six months for the manufacturers to formulate and produce the millions of doses required to deal with the seasonal epidemics; occasionally, a new or overlooked strain becomes prominent during that time and infects people although they have been vaccinated (as by the [[Fujian flu|H3N2 Fujian flu]] in the 2003–2004 flu season).<ref>{{cite journal | last = Holmes | first = E | coauthors = Ghedin E, Miller N, Taylor J, Bao Y, St George K, Grenfell B, Salzberg S, Fraser C, Lipman D, Taubenberger J | title = Whole-genome analysis of human influenza A virus reveals multiple persistent lineages and reassortment among recent H3N2 viruses | journal = PLoS Biol | volume = 3 | issue = 9 | pages = e300 | year = 2005 | id = PMID 16026181}}</ref> It is also possible to get infected just before vaccination and get sick with the very strain that the vaccine is supposed to prevent, as the vaccine takes about two weeks to become effective.
+* Annual influenza vaccination is the best way to prevent influenza because vaccination can be given well before influenza virus exposures occur, and can provide safe and effective immunity throughout the influenza season.
+* Antiviral medications are approximately 70% to 90% effective in preventing influenza and are useful adjuncts to influenza vaccination.
-The 2006–2007 season is the first in which the CDC has recommended that children younger than 59 months receive the annual flu vaccine.<ref name=cdcreport> [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)] CDC report (MMWR 2006 Jul 28;55(RR10):1–42) accessed 19 Oct 2006.</ref> Vaccines can cause the [[immune system]] to react as if the body were actually being infected, and general infection symptoms (many cold and flu symptoms are just general infection symptoms) can appear, though these symptoms are usually not as severe or long-lasting as influenza. The most dangerous side-effect is a severe [[allergy|allergic reaction]] to either the virus material itself, or residues from the hen eggs used to grow the influenza; however, these reactions are extremely rare.<ref>[http://www.cdc.gov/flu/about/qa/flushot.htm  Questions & Answers: Flu Shot] CDC publication updated Jul 24, 2006. Accessed 19 Oct 06.</ref>
+* CDC does not recommend widespread or routine use of antiviral medications for chemoprophylaxis so as to limit the possibilities that antiviral resistant viruses could emerge. Indiscriminate use of chemoprophylaxis might promote resistance to antiviral medications, or reduce antiviral medication availability for treatment of persons at higher risk for influenza complications or those who are severely ill.
+* In general, CDC does not recommend seasonal or pre-exposure antiviral chemoprophylaxis, but antiviral medications can be considered for chemoprophylaxis in certain situations.
-[[Influenza pandemic#Personal health and hygiene|Good personal health and hygiene habits]] are reasonably effective in avoiding and minimizing influenza. People who contract influenza are most infective between the second and third days after infection and infectivity lasts for around 10 days.<ref name=Carrat>{{cite journal |author=Carrat F, Luong J, Lao H, Sallé A, Lajaunie C, Wackernagel H |title=A 'small-world-like' model for comparing interventions aimed at preventing and controlling influenza pandemics |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17059593 |journal=BMC Med |volume=4 |issue= |pages=26 |year= |pmid=17059593}}</ref> Children are notably more infectious than adults, and shed virus from just before they develop symptoms until 2 weeks after infection.<ref name=Carrat/><ref>{{cite journal |author=Mitamura K, Sugaya N |title=[Diagnosis and Treatment of influenza—clinical investigation on viral shedding in children with influenza] |journal=Uirusu |volume=56 |issue=1 |pages=109-16 |year=2006 |pmid=17038819}}</ref>
+* The following are examples of situations where antiviral medications can be considered for chemoprophylaxis to prevent influenza:
+:* Prevention of influenza in persons at high risk of influenza complications during the first two weeks following vaccination after exposure to an infectious person.
-Since influenza spreads through [[particulate|aerosols]] and contact with contaminated surfaces, it is important to persuade people to cover their mouths while sneezing and to wash their hands regularly.<ref name=cdcreport/> Surface sanitizing is recommended in areas where influenza may be present on surfaces.<ref>{{cite journal |author=Hota B |title=Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? |journal=Clin Infect Dis |volume=39 |issue=8 |pages=1182–9 |year=2004 |id=PMID 15486843}}</ref> [[Alcohol]] is an effective sanitizer against influenza viruses, while [[quaternary ammonium]] compounds can be used with alcohol, to increase the duration of the sanitizing action.<ref name=McDonnell>{{cite journal |author=McDonnell G, Russell A |title=Antiseptics and disinfectants: activity, action, and resistance |url=http://cmr.asm.org/cgi/content/full/12/1/147?view=long&pmid=9880479 |journal=Clin Microbiol Rev |volume=12 |issue=1 |pages=147-79 |year=1999 |id=PMID 9880479}}</ref> In hospitals, [[quaternary ammonium]] compounds and halogen-releasing agents such as [[sodium hypochlorite]] are commonly used to sanitize rooms or equipment that have been occupied by patients with influenza symptoms.<ref name=McDonnell/> During past pandemics, closing schools, churches and theaters slowed the spread of the virus but did not have a large effect on the overall death rate.<ref>{{cite journal |author=Hatchett RJ, Mecher CE, Lipsitch M |title=Public health interventions and epidemic intensity during the 1918 influenza pandemic |url=http://www.pnas.org/cgi/content/full/104/18/7582 |journal=Proc Natl Acad Sci U S A. |volume=104 |issue=18 |pages=7582–7587 |year=2007 |pmid=17416679}}</ref><ref>{{cite journal |author=Bootsma MC, Ferguson NM |title=The effect of public health measures on the 1918 influenza pandemic in U.S. cities |url=http://www.pnas.org/cgi/content/full/104/18/7588 |journal=Proc Natl Acad Sci U S A. |volume=104 |issue=18 |pages=7588–7593 |year=2007 |pmid=17416677}}</ref>
+:* Prevention for people with severe immune deficiencies or others who might not respond to influenza vaccination, such as persons receiving immunosuppressive medications, after exposure to an infectious person.
-A yearly [[vaccine]] is recommended for children older than 6 months, adolescents, and adults.
+:* Prevention for people at high risk for complications from influenza who cannot receive influenza vaccine due to a contraindication after exposure to an infectious person.
+:* Prevention of influenza among residents of institutions, such as long-term care facilities, during influenza outbreaks in the institution.
-The [[vaccine]] is available as a [[flu shot]] or a [[nasal]] spray-type [[flu vaccine]].
+* An emphasis on close monitoring and early initiation of antiviral treatment if fever and/or respiratory symptoms develop is an alternative to chemoprophylaxis after a suspected exposure for some persons.
+* To be effective as chemoprophylaxis, an antiviral medication must be taken each day for the duration of potential exposure to a person with influenza and continued for 7 days after the last known exposure. For persons taking antiviral chemoprophylaxis after inactivated influenza vaccination, the recommended duration is until immunity after vaccination develops (antibody development after vaccination takes about two weeks in adults and can take longer in children depending on age and vaccination history).
-===Flu shots===
+* Antiviral chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the first exposure to an infectious person.
-===Who should get the flu shot?===
+* Patients receiving antiviral chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.
-Get a [[flu shot]] every year if you are age 50 or older. For many people, the [[flu]] is a mild [[illness]]. But in older adults, the [[flu]] can sometimes lead to
-*Serious [[infections]] like [[pneumonia]]
-*[[Hospitalizations]]
-*[[Death]]
-This is especially true for older adults with:
-*[[Diabetes]]
-*[[Heart disease]]
-*[[Breathing]] problems
-===When should one get the flu shot?===
-October or November is the best time to get a [[flu shot]], but one can still get the shot in December or later. Flu season can last as late as May.
-===Are there any side effects?===
-[[Side effects]] from the [[flu shot]] are mild. Some people feel sore at the spot where they got the shot. There is no reason to worry. You cannot get the [[flu]] from the [[flu shot]]. The [[flu shot]] is made from dead [[flu]] [[virus]] that will not cause the [[flu]].
 ==References==
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-[[Category:Mature chapter]]
 [[Category:Pulmonology]]
 [[Category:Influenza| ]]
 [[Category:Infectious disease]]
 [[Category:Primary care]]
-[[Category:Needs overview]]
 {{WH}}
 {{WS}}

Influenza primary prevention: Difference between revisions

Revision as of 16:53, 24 October 2014

Overview

Primary Prevention

Vaccination

Chemoprophylaxis

References

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