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Influenza Experts Cautiously Optimistic About This Year's Season

C.D.C. Now Recommends Everyone 6 Months and Older Get Vaccinated

New York (Nov 18, 2010)

Artist's rendering of the H1N1 virus as seen under a microscope
Artist's rendering of the H1N1 virus as seen
under a microscope

Other than H1N1, no other atypical strains appear to be circulating this flu season, said Anne Moscona, M.D., Professor of Pediatrics and of Microbiology and Immunology, and Vice Chair for Research of Pediatrics at Weill Cornell Medical College, and an attending pediatrician at NewYork-Presbyterian/Weill Cornell Medical Center. "The avian influenza strain continues to infect small numbers of people sporadically worldwide, but doesn't seem to be spreading anymore than it has in the past," she said.

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This is a dramatic change from last year when H1N1 emerged in larger scale and the world experienced its first influenza pandemic in 40 years, causing health agencies in many nations including the United States to scramble to procure and distribute an updated vaccine and build stockpiles of antiviral drugs. It was a stressful time for health experts. "Many different government agencies were constantly communicating and dealing with the crisis in real time," Dr. Moscona said. "We did quite well and set some pathways in place that could be called upon again if there were an outbreak of that size or larger. The actions taken during the H1N1 pandemic show how the United States can handle the emergence of a new virulent strain."

This Year's Preparations

This year, in a move toward greater preparedness, the Centers for Disease Control and Prevention revised its guidelines on who should be vaccinated. The agency now recommends that everyone age six months and older receive an influenza vaccine. The recommendations were expanded because the flu can cause severe illness at any age and because there are still concerns that an H1N1-like virus will continue to circulate during this flu season leaving many young adults unprotected under previous guidelines. As always, vaccination is especially important for people who are at higher risk for developing serious flu-related complications including children younger than two years; people age 65 and older; pregnant and postpartum women; and people with chronic medical conditions, such as asthma, diabetes, or a weakened immune system.

Anne Moscona, M.D.
Anne Moscona, M.D.

"There is a lot to say about 'emergency preparedness' these days and influenza is a part of this," said Christine Kubin, Pharm.D., B.C.P.S., Clinical Pharmacy Manager for Infectious Diseases at NewYork-Presbyterian/Columbia University Medical Center. "The hospital has a multidisciplinary team of experts that continually monitors C.D.C. alerts, local Department of Health alerts, as well as other national agencies in terms of strains of influenza circulating and recommendations. Our previous work with other entities of emergency preparedness helped us prepare for last year. Everyone learned from it and this level of preparedness continues each year."

"Our first priority is prevention," continued Dr. Kubin. "We make sure that we have ample influenza vaccine for all age groups. These supplies are ordered months before the flu season begins. The hospital also makes sure to promote vaccination to patients as well as all staff members and the community. In addition, the hospital maintains supplies of antiviral medications for those patients who may require them."

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The influenza season first begins each year in the Southern Hemisphere (April to September) and later spreads north. The virus and its migration are under constant surveillance by researchers at the World Health Organization who watch for new strains and monitor how effective the current vaccine is at preventing influenza. At the beginning of each season, the agency releases a recommendation of what strains vaccine manufacturers should include in their vaccine.

Christine Kubin, Pharm.D., B.C.P.S.
Christine Kubin, Pharm.D.,
B.C.P.S.

The current influenza vaccine contains strains of the influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. The strains included in the vaccine match the strains that were circulating early this flu season, Dr. Moscona said. Unlike last year, when the H1N1 vaccine was given separately, only one vaccine is needed this year. The vaccine offers protection against strains currently circulating and may offer some "cross protection" against new strains that may emerge mid-way through an influenza season, lessening the severity of the illness.

This Year's Antiviral Drugs: Use Properly

Should an individual become infected with influenza, two primary antiviral medications physicians may prescribe – oseltamivir or zanamivir – are effective against the currently circulating strains with little treatment-resistant disease found, Dr. Kubin said. However, there is some concern that improper use of these agents (e.g., use at incorrect doses or for incomplete courses) may lead to more resistance. Thus, prudent use is essential.

Antiviral agents are used to lessen the severity and duration of influenza infection. The efficacy of these agents depends on how quickly a patient starts taking the medications and the patient's immune system, Dr. Kubin noted. The C.D.C. recommends starting treatment as soon as possible after symptom onset. "While the acceptable use of the drugs is up to two days after symptom onset, these agents are much more effective if used as soon as possible (within one day or less) after symptom onset," Dr. Moscona said.

Antivirals are specifically recommended for patients who are at high risk of complications from the flu, such as pregnant women, young children, people 65 and older, and people with certain chronic health conditions, Dr. Kubin said. However, any person can benefit from a reduction in severity and duration of illness, Dr. Moscona explained. Antivirals should be used at the directed dose and the treatment course should be completed to help avoid the risk of treatment-resistant influenza strains emerging.

Should resistance arise to oseltamivir or zanamivir, amantadine and rimantadine could be used for certain strains, although not for all influenza infections, Dr. Moscona said. These two older medications are approved for treatment and prevention of influenza A, but because strains are increasingly resistant to these agents, they are not recommended as first-line treatment.

Contributing faculty for this article:

Christine Kubin, Pharm.D., B.C.P.S., is the Clinical Pharmacy Manager for Infectious Diseases at NewYork-Presbyterian/Columbia University Medical Center.

Anne Moscona, M.D. is a Professor of Pediatrics and of Microbiology and Immunology, Chief of Pediatric Infectious Diseases, and Vice Chair for Research of Pediatrics at Weill Cornell Medical College and an Attending Pediatrician at NewYork-Presbyterian/Weill Cornell Medical Center.

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