Influenza Prevention

1.Handwashing with soap and water is the most appropriate way to prevent infection by an influenza virus.
2.Touching of eyes or nose before washing hands should be avoided.
3.Personal items should not be shared with another person during an influenza outbreak.
4.Chemoprophylaxis is a less desirable alternative and is only effective against influenza A virus.
5.Influenza vaccination in targeted high-risk populations is the best means of preventing severe disease caused by influenza virus.
Guidelines regarding the prevention and control of influenza have been established by the Advisory Committee on Immunization Practices.

Vaccines made using inactivated influenza virus provide 60-90% protection against influenza when the vaccine matches the epidemic strain.

The antigenic composition is reviewed annually so that the current vaccine contains the most recently circulating strains, usually one or more subtypes of influenza A virus and a subtype of influenza B virus.

Vaccine efficacy for preventing infection in elderly persons is 30-40%. Efficacy in preventing hospitalization for pneumonia and influenza is 50-60% in elderly persons living in nursing homes and 30-70% in elderly persons living outside of nursing homes. Efficacy in preventing death in elderly patients who live in nursing homes is 80%.

Indications for influenza vaccine include the following:
1.Persons aged 65 years and older (and recommended for those aged 50-64 y)
2.Residents of nursing homes and other long-term–care facilities
3.Patients with chronic pulmonary (eg, asthma) or cardiac disorders (except hypertension)
4.Patients with chronic metabolic disease (eg, diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression (eg, human immunodeficiency virus [HIV])
5.Children and teenagers (6 mo to 18 y) with long-term use of aspirin
6.Persons who have any condition (eg, cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that may compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration
7.Pregnant women who will be in their second or third trimester during influenza season
8.Physicians, nurses, and other health care providers
9.Employees of nursing homes and long-term care facilities
10.Providers of home care to persons at high risk
11.Household members (eg, children aged <5 years) of persons at high risk
12.Providers of essential community services (eg, police, fire)
13.International travelers
14.Students and dormitory residents
15.Anyone wishing to reduce risk of influenza

The CDC recommends that the following groups receive priority for inactivated influenza vaccine:
1.Persons aged 50 years and older
2.Residents of long-term–care facilities
3.Persons aged 2-64 years with comorbid conditions
4.Children aged 6 months to 4 years (59 months)7,6
5.Women who will be pregnant during the influenza season
6.Health care providers who provide direct patient care
7.Household contacts and out-of-home caregivers of children younger than 6 months

Administration of influenza vaccine includes the following:
For adults and older children, the recommended site of vaccination is the deltoid muscle.
The preferred site for infants and young children is the anterolateral aspect of the thigh.

Influenza vaccine should be administered during the autumn season.
Vaccination is recommended in children aged 6 months or older.
Two doses administered at least 1 month apart are recommended in children 6 months to 8 years who are receiving influenza vaccine for the first time.
Other children or adults may be vaccinated with one shot.

Annual immunization is recommended because of declining immunity during the year after immunization and because, in most years, at least one of the antigens is changed in the vaccine to increase the antigenic similarity between the vaccine and circulating strains. The optimal time for influenza vaccination is usually between October and November.

Influenza vaccine should not be administered to persons known to have severe anaphylactic hypersensitivity to egg protein or to other components of the influenza vaccine.

The presence of minor illnesses with or without fever is not a contraindication to the use of influenza vaccine.

Influenza vaccine may be administered with pneumococcal vaccine and with other routine vaccinations of childhood.

Influenza vaccine is also available as a nasal spray (FluMist) for healthy children aged 2 years or older, adolescents, and adults aged 49 years or younger. Children aged 2-8 years who have not previously received influenza vaccine as a nasal spray require 2 doses at least 1 month apart. Those who only received 1 dose in their first year of vaccination should receive 2 doses in the following year.

Children who take aspirin, have asthma, or have had a wheezing episode in the preceding 12 months should not receive the FluMist vaccine.

Complications
Primary influenza viral pneumonia
Secondary bacterial pneumonia
Croup
Exacerbation of chronic pulmonary disease
Myositis
Myocarditis
Toxic shock syndrome
Guillain-Barré syndrome
Reye syndrome

Prognosis
The prognosis for recovery is excellent, although full return to normal levels of activity and freedom from cough usually requires weeks rather than days.

Patient Education
For excellent patient education resources, visit eMedicine's Cold and Flu Center. Also, see eMedicine's patient education article Flu in Children.

Miscellaneous
Special Concerns
In children younger than 16 years who have symptoms of influenza or colds, aspirin is not recommended because of an association with Reye syndrome.

source: Influenza: Follow-up
http://emedicine.medscape.com/article/972269-followup
Author: Hakan Leblebicioglu, MD, Chairman, Professor, Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey
Coauthor(s): Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine

Updated: Apr 27, 2009