Outpatient and Emergency Room testing and treatment for influenza
December 21, 2012
During the last 2-3 weeks, there has been a substantial increase in the number of influenza-like illness and positive diagnostic tests for influenza accompanied by a substantial increase in visits to the CMC Dallas and Legacy Emergency Departments. The data from CMC is consistent with local epidemiological surveillance performed by the Dallas County Department of Health.
Given the high prevalence of influenza in the community and the understanding that children currently presenting with fever and symptoms of respiratory tract infection are most likely infected with influenza, the indications for testing pediatric patients for influenza are limited to the following:
Presence of underlying medical conditions associated with complications of influenza, including asthma, diabetes, cardio-pulmonary disease, renal disease, neurodevelopmental abnormalities; consider all children < 5 yrs. and especially < 2 yrs. of age to be high risk patients
Respiratory illness in a contact of a person who has severe underlying medical conditions.
The above guidelines are based, in part, on the "Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests" provided by the Center for Disease Control (CDC). (For full guidelines, click here.)
This figure (from the CDC) summarizes the recommendations for testing. Below are the highlights of the figure:
Confirmation of influenza virus infection by diagnostic testing is not required for clinical decisions to prescribe antiviral medications. Decisions to administer antiviral medications for influenza treatment or chemoprophylaxis, if indicated, should be based upon clinical illness and epidemiologic factors. Start of therapy should not be delayed pending testing results.
Since there may be false negatives with rapid flu testing, begin treatment of patients with severe disease or who are high risk if they have a flulike syndrome even if the rapid flu test is negative.
Antiviral therapy is most effective if begun within 48 hrs. of the onset of illness, but should be administered to severely ill or high risk patients even if the illness has been present for > 48 hours and they are not improving.
Note that some persons may have atypical presentations (e.g. very young infants, immunosuppressed, and patients with certain chronic medical conditions). Fever is not always present (e.g. premature infants, young infants, immunosuppressed).
These guidelines will be reassessed each week during the influenza season. Revised guidelines will be released if changes are made.