Questions 1: Influenza antiviral medications are recommended for people at high risk for influenza complications, including pregnant women with influenza.
Answer: True. CDC recommends antiviral drugs for high-risk people with influenza, including pregnant women for whom oseltamivir is the preferred treatment. CDC also recommends antivirals for all hospitalized patients and anyone who has severe, complicated or progressive illness. Studies have shown that antiviral drugs are under-prescribed for high-risk people with influenza, while antibiotics may be overprescribed. Antiviral treatment of high-risk people with influenza can result in milder illness compared to serious illness that could result in a hospital stay.
Question 2: Influenza antiviral medications can be prescribed to people without high-risk influenza complications.
Answer: True. While current CDC guidance focuses treatment on those with severe illness or at high risk of complications from influenza, antiviral treatment may be considered on the basis of clinical judgment for any previously healthy (not "high-risk"), symptomatic outpatient with confirmed or suspected influenza. Neuraminidase inhibitors (i.e., oseltamivir, zanamivir and peramivir) can reduce the duration of symptoms by ~1 day in healthy persons with uncomplicated influenza.
Question 3: Influenza antiviral drugs should not be given to young children due to possible side effects outweighing benefits.
Answer: False. Both CDC and AAP recommend oral oseltamivir for treatment of influenza in children and infants of any age. Data indicate that the potential benefits of taking oseltamivir outweigh the potential side effects. The most common side effects of oral oseltamivir include nausea and vomiting. Influenza infection may also cause some of these side effects. Pediatric studies (ages 1 to 12) of oseltamivir have shown a ~5% increase in vomiting in children who took oseltamivir compared with children who took placebo. Taking the drug with food helps reduce these effects.
Question 4: A negative rapid influenza diagnostic test (RIDT) result should exclude a diagnosis of influenza during flu season.
Answer: False. The results of rapid influenza diagnostic tests (RIDTs) may not be accurate. (Note: The RIDTs mentioned here refer to "immunoassays" and do not include "rapid molecular assays".) Test sensitivities for RIDTs are approximately 50-70% when compared to viral culture or reverse transcription-polymerase chain reaction (RT-PCR). Other factors such as the quality of the specimen and timing of specimen collection can also affect test results. A negative RIDT result does not exclude a diagnosis of influenza in a patient with suspected influenza.
Question 5: A patient with a history of influenza vaccination can be ruled out for influenza infection and does not require antivirals.
Answer: False. Although influenza vaccination is the first and best way to prevent influenza illness, a history of influenza vaccination does not rule out the possibility of influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza.
Question 6: Decisions about starting antiviral treatment should wait for laboratory confirmation of influenza.
Answer: False. Because antivirals work best when used early, decisions about starting antiviral treatment should not wait for laboratory confirmation. Treatment will generally be initiated empirically (without test results). During influenza season especially, providers should advise high risk patients to call promptly if they develop symptoms of influenza.
Question 7: Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who is hospitalized.
Answer: True. CDC recommends antiviral treatment for all hospitalized patients with influenza.
Question 8: Antiviral treatment only provides benefit when started within 48 hours of illness onset.
Answer: False. Observational studies of hospitalized patients suggest that while the greatest benefit occurs when antiviral treatment is initiated within 48 hours of illness onset, treatment might still be beneficial when initiated up to 4 or 5 days after symptom onset. A study of pregnant women also has shown antiviral treatment can still provide benefit when started 3-4 days after onset. A randomized placebo-controlled study among febrile children with uncomplicated influenza suggested clinical benefit when oseltamivir was initiated 72 hours after illness onset.
Question 9: Many observational studies have shown that antiviral drugs reduce the risk of death in hospitalized patients with influenza.
Answer: True. Observational studies from many countries have measured the benefits of antiviral treatment among hospitalized patients with seasonal influenza or 2009 H1N1. These studies show that early oseltamivir treatment (within 48 hours of illness onset) results in greatest clinical benefit and reduces the duration of hospitalization and the risk of severe outcomes, such as mechanical ventilation or death. However, some studies show antiviral treatment started up to 4 or 5 days after illness onset can still provide clinical benefit.
Question 10: An influenza antiviral drug is available this season in an intravenous (IV) formulation for patients 18 years and older.
Answer: True. On December 19, 2014, the U.S. Food and Drug Administration (FDA) approved intravenous peramivir for the treatment of acute uncomplicated influenza in people 18 years and older. An FDA press release related to this announcement is available.
