MMS Flu Advisory: January 13, 2013

Sign up to receive MMS Flu Advisories by emailDuring the first week of 2013 (December 30-January 5), Influenza-like illness (ILI) activity in Massachusetts has decreased from the previous week but is still much higher than what is typically seen at this time of year.  In the U.S., influenza activity remained elevated, but may be decreasing in some areas.

The proportion of outpatient visits for influenza-like illness (ILI) was 4.3%; above the national baseline of 2.2%.

Twenty-four states and New York City experienced high ILI activity; 16 states, including Massachusetts, experienced moderate ILI activity; 5 states experienced low ILI activity; 5 states experienced minimal ILI activity, and the District of Columbia had insufficient data. Forty-seven states, including Massachusetts, reported widespread geographic influenza activity.

Antiviral efficacy and supply: According to the CDC, the majority of currently circulating influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications oseltamivir and zanamivir; however, rare sporadic cases of oseltamivir-resistant 2009 H1N1 and A (H3N2) viruses have been detected worldwide.

Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at greater risk for serious influenza-related complications.

Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at http://www.cdc.gov/flu/antivirals/index.htm.

Not everyone with influenza needs to be treated with antivirals. DPH advises that clinicians should appropriately evaluate patients, typically through an inperson assessment, prior to prescribing antivirals for a patient. Prescribing antivirals indiscriminately by phone is not advised. Additionally, antiviral treatment should be considered for previously vaccinated individuals if indicated, particularly for patients over the age of 65.

There may be occasional temporary shortages of oseltamivir and zanamivir at the pharmacy level in specific locations. Pediatric suspension of oseltatnivir is in critically short supply. To meet demand for pediatric patients, pharmacists must compound the antiviral medication as needed.

In light of these factors, MDPH recommends that practitioners who choose to prescribe oseltamivir and zanamivir do so electronically or by verbal order over the phone so that the patient’s pharmacy has adequate time to prepare the drug for patient pick-up or can inform the clinician if that pharmacy is unable to fulfill the prescription.

Flu Vaccine Availability

Flu vaccine is still available for purchase from distributors and manufacturers.  A list of distributors with flu vaccine can be found at http://www.preventinfluenza.org/ivats/.

Please see the table below for a list of manufacturers and the formulations they have available.

Manufacturer

Trade Name

Dose/ Presentation

Age Group

Sanofi Pasteur:  800-822-2463 Fluzone High-Dose® 0.5 mL prefilled syringe

> 65 yrs

Sanofi Pasteur:  800-822-2463 Fluzone
Intradermal®
0.1 mL prefilled microinjection syringe

18-64 yrs

Novartis:  800-244-7668 Agriflu® 0.5 mL prefilled syringe

> 18 yrs

GlaxoSmithKline: 866-475-8222 FluLuval™, Inactivated 5.0 mL multidose vial

> 18 yrs

CSL Biotherapies: 888-435-8633 Afluria®, Inactivated 0.5 mL prefilled syringe and 5.0 mL multidose vial

> 9 yrs

MedImmune: 877-358-6478 FluMist®  Live attenuated intranasal 0.2 mL sprayer,divided dose

2–49 yrs

Standing orders, VISs, screening forms and other materials are available at http://www.mass.gov/eohhs/provider/guidelines-resources/services-planning/diseases-conditions/influenza/school-flu-clinics.html.

Early finding of vaccine efficacy

Findings from early data released today suggest that this season’s vaccine so far is reducing the risk of having to go to the doctor for influenza by about 60% for people who got vaccinated. (See MMWR Report, Interim Vaccine Effectiveness Estimates section.)

For flu resources for physicians and patients, visit www.massmed.org/flu

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