CDC Recommendations for Clinicians:

Important guidance on treatment has been re-emphasized by the CDC:

1. Clinicians are advised to initiate antiviral therapy immediately on all patients with influenza-like illness who are hospitalized or who are at higher risk of complications.  For information on high risk groups, please visit the website above.
2. Hospitalized cases and influenza-related deaths associated with novel influenza H1N1 are reportable to public health.

• Guidance on Antiviral Treatment

CDC recommends that antiviral treatment for novel influenza A (H1N1) be given as soon as possible after onset of symptoms for all hospitalized patients with confirmed, probable, or suspected novel influenza A (H1N1) virus infection. All hospitalized patients with novel influenza A (H1N1) infection should be monitored carefully and treated with antiviral therapy, including patients who seek care more than 48 hours after illness onset. Influenza antiviral medicines should be initiated as soon as possible if influenza is suspected, and often before diagnostic test results (RT-PCR) are available, for maximum benefit. If bacterial co-infection is suspected, antibacterials should be directed at likely pathogens (e.g., S. pneumoniae, S. aureus) consistent with existing guidelines for the management of community-acquired pneumonia. Antibacterial therapy also should be initiated after appropriate diagnostic specimens are obtained, including blood, respiratory secretions (especially for intubated patients), and pleural fluid for culture and urine for pneumococcal antigen testing (in adults).

Patients who are at higher risk for seasonal influenza complications (including people 65 years and older, children younger than five years old, pregnant women, and people of any age with chronic medical conditions) are also recommended for treatment, regardless of whether they require hospitalization.

New interim guidance documents have been published by the UDOH.  These can all be found at www.health.utah.gov/h1n1flu/

• Utah Clinician Guidance
• Lab Form for Novel H1N1 Flu

• CDC recommends the use of oseltamivir (tamiflu) or zanamivir (relenza)  for the treatment and/or prevention of infection with Novel H1N1 Virus or S-0IV influenza viruses.

• Clinicians should continue to consider Novel H1N1 Virus or S-0IV influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed Novel H1N1 Virus or S-0IV flu, or who were in one of the U.S. states that have reported Novel H1N1 Virus or S-0IV flu cases or in Mexico during the 7 days preceding their illness onset.

• Patients who meet these criteria should be tested for influenza. At this point, specimens should be sent through the public health laboratory systems to conduct testing specific for Novel H1N1 Virus or S-0IV influenza virus.  

• The Novel H1N1 Virus or S-0IV influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not work against these Novel H1N1 Virus or S-0IV influenza documents.

• Laboratory testing on these Novel H1N1 Virus or S-0IV influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir.