Influenza (Flu)

Antiviral Medications for Influenza Treatment and Prevention: Long-Term Care

Guidance can be found at Influenza Antiviral Medications: Summary for Clinicians. Attention: Non-MDH link . Antiviral medications may be used in the treatment and/or prevention of seasonal influenza in long-term care facilities. Treatment and chemoprophylaxis recommendations may be different, based on the influenza virus causing illness and the individuals affected (e.g., staff vs. residents).

Antiviral Treatment

If indicated, antivirals should be started as soon as possible. Maximum benefit occurs when started within the 48 hours of symptom onset. However, antivirals should not be withheld if symptoms began more than 48 hours prior and the individual meets criteria for antiviral treatment.
Duration of antiviral treatment is five days. Extending the treatment may be needed among those with prolonged illness or who are immunosuppressed. Automatic “stop orders” should be implemented after five days, and the resident’s status re-evaluated.
Influenza testing of residents with symptoms of influenza-like illness may assist in the management of an outbreak however, initiation of treatment should not wait for laboratory confirmation of influenza.

Antiviral Chemoprophylaxis

Residents

Antiviral chemoprophylaxis should be limited to those who have close contact with residents or staff with influenza-like illness, including those who share meals together or reside in the same ward or unit in the facility.
Chemoprophylaxis should be prescribed for ten days and an automatic “stop order” initiated after day ten.
Antiviral chemoprophylaxis should be re-evaluated after 10 days. If no further exposures have occurred, antivirals should be discontinued. If close contact* has continued with others who are ill with influenza-like illness, continued use of chemoprophylaxis may be indicated.

Staff

Staff who have an occupational exposure without using appropriate personal protective equipment (PPE) should be counseled about the early signs and symptoms of influenza.
- These staff must be advised to immediately notify their supervisor, leave the work setting and contact their healthcare provider for evaluation and possible early treatment if clinical signs or symptoms develop.
- Alternatively, post-exposure antiviral chemoprophylaxis can be considered for staff who did not use appropriate PPE during a recognized, close contact exposure to a person with influenza-like illness during the ill person’s infectious period as an alternative to early initiated therapy.

*Close contact, for the purposes of this document, is defined as having cared for or lived with a person who has influenza-like illness, or having been in a setting where there was a high likelihood of contact with respiratory droplets and/or body fluids of such a person. Examples of close contact include sharing eating or drinking utensils, physical examination, or any other contact between persons likely to result in exposure to respiratory droplets. Close contact typically does not include activities such as walking by an infected person or sitting across from a symptomatic patient in a waiting room or office.

The following factors should be considered when determining which antiviral agent is appropriate for chemoprophylaxis:

Influenza virus type and sub-type
Antiviral resistance

There are unique antiviral resistance profiles for each of the influenza strains expected to circulate during this influenza season (see table below). The choice of an antiviral should be based on the frequency of particular influenza strain circulating in the state in addition to factor specific to the patient. For the most up-to-date information on circulating influenza strains, see the MDH Weekly Influenza Activity.

Antiviral Dosing, Contraindications, Side effects, and Adverse Events

Treatment (Antiviral Drugs) for Influenza
Antiviral dosing information for treatment and chemoprophylaxis as well as information on contraindications, side effects, and adverse events. Attention: Non-MDH link