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The New Flu Review 2018-19

Lisa Patel, MD and Solomon Behar, MD

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Lisa and Sol review the latest recommendations issued by the American Academy of Pediatrics for the 2018-19 influenza vaccine and management of influenza illness.

Ian L., Dr -

A study in 2003by AokiFY et al eight authors J AntiMicob Chemotherapy 2003 Jan; 51 (1) 123-129 found that early administration of osteltamavir within 12 hours not 48 hrs reduced influenza illness by 74.6 hour (3.1 days )
The need if these studies are validated is to rapidly treat flu like illness in the flu season confirmed if possible by Rapid Turnaround PCR
in at risk patients eg Pregnant Women Elderly with CoMorbidities Children under 2 years especially premature and with congenital illness .
So a prior to flu season identification of at risk people with a system in place to react rapidly if they become ill is warranted .
Chemoprophylaxis opportunity has to be realised in at risk contacts and ought be administered within at most 48 hrs of exposure earlier likely to be more efficacious .
CDC recommendations 2017- 2018 are comprehensive and it would be instructive to study the adherence to those guidelines in the last influenza season and how many adverse outcomes followed Non -Adherence .

Margot M. -

What is your take on whether to give the flu vaccine to someone with cold symptoms? a temp >99? a cough? or current / recent antibiotic use?

I was taught to give it to anyone who doesn't require hospitalization and is willing to get it at the time you see them (with education about it not making them sick, but that they may feel off for a couple days and have a sore arm), but since being in practice I have heard numerous colleagues say they never give it when someone is even a little sick , if they have a temp 99 F or higher, or are getting over a URI. Their reasoning is even if there is no harm in the vaccine while ill, they feel it cuts down on people blaming the flu shot for making them sick, or concerns about flu shot reactions like fever.

Perhaps it is simply a difference with where I trained? we saw a lot of under-served during training, and getting children and adults alike up to date on vaccinations meant encouraging shots at sick visits, because often they could not afford to make a separate trip just for a vaccine at another time.

Is there any evidence that shows one way of doing it is better than the others for long term (multiyear) compliance with getting a flu shot? I expect in the short term my way gets more people vaccinated (regardless of setting), but if those same people feel ill afterwards are they less likely to get the shot the next year?

Neda F., MD -

Hi Margot. Thanks for your question. I'll check in with Lisa and Sol to see if they have any words of wisdom from their research. Based on my literature review, there is no clear-cut guideline as to how sick a patient needs to be with cold-like symptoms before they should wait to get the flu shot. The CDC offers this to patients: "If you are not feeling well, talk to your doctor about your symptoms." And Table 2 here, also from the CDC, also leaves it up to the provider's discretion. Most of what I found points to the safety of giving the flu shot if a person has mild or even moderate URI symptoms without fever. Hope this helps, and will keep you posted if we unearth anything else.

Margot M. -

This subject came up again on one of the provider message boards we have at work, and someone commented that when they were in ICU settings, near-death people on ventilators with pneumonias are given the flu shot in the hospital, which reinforces my idea that illness is no reason not to get a flu shot, particularly if there is proper education surrounding it.

Neda F., MD -

Excellent point! Thank you for following up!

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