December 2024 Medical Director Report

INFLUENZA IS HERE!

There is at least one facility in Colorado Springs that has an outbreak of influenza and I ha

Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities | Influenza (Flu) | CDC

• Ask pharmacy to calculate the creatinine clearance for each resident and provide that list in case we need to utilize Tamiflu for an outbreak.
• Test any resident with symptoms of COVID-19 or influenza for both.
• When 2 cases of laboratory-confirmed influenza are identified within 72 hours of each other in residents on the same unit, outbreak control measures should be implemented asap.
• Implement Standard and Droplet Precautions for all residents with suspected or confirmed influenza.
• All long-term care facility residents who have confirmed or suspected influenza should receive antiviral treatment immediately (within 48-72 hours).
• When at least 2 patients are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should promptly initiate antiviral chemoprophylaxis with oral oseltamivir to all non-ill residents living on the same unit as the resident with laboratory-confirmed influenza (outbreak affected units), regardless of whether they received influenza vaccination during the current season. 
• Treatment: Oseltamivir (Tamiflu) 75mg po TWICE daily x 5 days.
• Prophylaxis: Oseltamivir 75mg po daily x 2 weeks and continuing for at least 7 days after the last known laboratory-confirmed influenza case was identified on affected units.
  • Oseltamivir must be renally dosed if Creatinine Clearance is < 60.
• According to manufacturer’s labeling, οѕеltamivir is not recommended in patients with end-stage kidney disease not on dialysis.
• For Hemodialysis patients: ~50% Dialyzable
  • Assumes HD 3 times per week.
  • If the usual indication-specific dose is 75 mg twice daily (eg, seasonal influenza treatment):
    • Oseltamivir 30 mg immediately and then 30 mg after every hemodialysis session for at least 5 days.
  • If the usual indication-specific dose is 75 mg once daily (eg, seasonal influenza prophylaxis):
    • Oseltamivir 30 mg immediately and then 30 mg after every other hemodialysis session for 2 weeks.

References:

• Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities | Influenza (Flu) | CDC
• Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa | Clinical Infectious Diseases | Oxford Academic
• Influenza Antiviral Medications: Summary for Clinicians | Influenza (Flu) | CDC
• Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating | Influenza (Flu) | CDC