All about Flu. Meghan Brett, MD Hospital Epidemiologist (UNMH)

Transcription

1 All about Flu Meghan Brett, MD Hospital Epidemiologist (UNMH)

2 Objectives Learn about the influenza virus, epidemiology of influenza, and current influenza activity. Describe available influenza vaccinations and rationale for use of each. Recognize current testing methods for influenza at TriCore and relate limitations. Review treatment of influenza including timing and overall effectiveness. Recognize indications for chemoprophylaxis. Identify key resources for influenza.

3 Brief Background on Influenza

4 Neuraminidase Viral RNA Hemagglutinin

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6 Influenza Epidemiology Season: October March 31 seasons between 1976 and 2007 Estimated numbers of influenza deaths? 1 3,000-49,000 people Typically, ~90% of deaths occur in pts 65 yrs Estimated impact of Influenza in million cases with 31.4 outpatient visits 334,185 hospitalizations, 3.1 million hospital days 41,000 deaths 1 CDC MMWR 2010; 59: Molinari NAM et al. Vaccine 2007; 25:

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8 Current Influenza Activity

9 Current Flu Activity 3 cases of influenza A in Bernalillo county in the past month No evidence for sustained influenza transmission at the moment

10 Influenza Vaccination

11 Current Recommendations for Influenza Vax from ACIP Anyone 6 months of age No vaccine is currently preferred over another Vaccine should be given throughout the flu season It s OK to get your flu shot now NO NEED FOR A SECOND FLU VACCINE FOR ADULTS DURING THE FLU SEASON

12 Current Recommendations for Influenza Vax from ACIP 2 doses for vaccine naive children <9 years

13 Flu Vaccines, IIV3 High dose (subtype of IIV3) Quadrivalent (IIV4) Live-attenuated Influenza Vaccine (LAIV4) Recombinant (RIV4) (egg free!) Cell culture-based (cciiv3)

14 Flu Vaccine Information Trivalent vaccine purchased for this year Will review evidence and cost/benefit again at Antimicrobial Subcommittee again this year (Jan 2016) If interested in another variety, feel free to obtain from other sources! Vaccine on time delivery expected Planned activity will occur October 1 November 15, 2015 Vaccine Packaging anticipate multidose vials this year Egg-free vaccine For employees only at this time Available via appt in Occ Health Now FDA approved for anyone greater than 18 yrs of age

15 Contraindications/Precautions IIV RIV

16 LAIV Contraindications/Precautions

17 Why Should Anyone who Works in Healthcare Get the Flu Vaccine? Limit the amount of time that you re sick Flu vaccine prevents or limits duration of illness Prevent transmission of influenza to others Protect your patients, your family, and your coworkers Recommended by CDC especially for HCPs Supported by TJC, ANA, ACIP, APIC, SHEA, IDSA, and many others

18 Why Vaccination of HCP Works Vaccination is most effective in younger, healthier individuals. 70%-90% effective among healthy persons less than 65 years of age. Patients at highest risk (e.g. elderly and immunocompromised) least likely to develop an adequate response to vaccine 30-40% effective among elderly persons. They NEED your HELP CDC Epidemiology and Prevention of Vaccine-Preventable Diseases. 2011

19 Healthcare Personnel and Flu Vaccination Patient Safety Association between low flu vaccine uptake among HCP and flu outbreaks 1-3 Decrease in all cause mortality and rates of influenzalike illness in LTCFs 4-6 Benefits most vulnerable patients or family members: Who cannot receive vaccination Who respond poorly to vaccination For whom antiviral treatment is not available or indicated 1. Salgado CD. ICHE 2004; 25: Adal KA. ICHE 1996; 17: Cunney RJ. ICHE 2000; 21: Lemaitre M. J Am Geriatr Soc 2009; 57: Carman WF. Lancet 2000; 355: Potter J. JID 1997; 175: 1-6.

20 Healthcare Personnel and Flu Vaccination Your Health Up to 80% of HCP work while ill 1-3 Flu vaccination reduces absenteeism 4 Issue of presenteeism (i.e., don t work while ill) 1. MMWR 1999; 48: Wenzel RP. Pediatrics 1977; 60: Wilde JA. JAMA 1999; 281: Nichol KL. NEJM 1995; 333:

21 Influenza Testing

22 Testing for Flu from TriCore Respiratory Viral Swab Pink culture media (refrigerated) with E-Swab May be requested from Lab Instructions on obtaining swab on TriCore s website Three available testing methods DFA RESPAN FLURSV

23 Testing for Flu from TriCore RESPAN Tests for 8 different virus Extraction takes ~7 8 hours Turnaround time: hours FLURSV Tests only for Influenza A/Influenza B/RSV Should be used for any hospitalized patients Assist with implementation of isolation and cohorting with same viruses if indicated Turn around time: 2 4 hours

24 Isolation Precautions Guidance on Infection Prevention and Control s Website (UNMH Intranet) Contact and Droplet Peds (< 12 yrs) Adults (> 12 yrs) Immunocompromised Instructions about when to start and when to stop isolation

25 Influenza Treatment

26 Antiviral Medications Amantadine Rimantadine Zanamivir Oseltamivir TREATMENT OR PREVENTION

27 Oseltamivir and Zanamivir

28 New Tamiflu Guidelines for this year will be posted on Stewardship s website

29 Important DON Ts Best if treated within 48hrs of symptom onset For hospitalized patients, reasonable to start after this timeframe Don t wait for testing results if flu is clinically suspected

30 Influenza Chemoprophylaxis

31 Chemoprophylaxis Close monitoring is another reasonable method after possible exposure Widespread chemoprophylaxis not indicated Antivirals 70 90% effective in preventing disease Indicated if within 48 hrs of exposure Not indicated in those who have received vaccine

32 Influenza (or Other URIs) & You

33 What if You re Sick? If you have a fever, please stay home! If you have upper respiratory symptoms, strongly consider staying home. If you must work, please wear a surgical mask. Perform excellent hand and respiratory hygiene! When can you return to work? At least 24 hours without fever without use of fever-reducing medications

34 Influenza Resources

35 Websites UNMH Intranet Influenza, Seasonal CDC Flu Information for Healthcare Professionals Flu Activity Influenza Control in Healthcare Settings hcaresettings.htm Google Flu Trends