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(See the Major Article by Havers et al on pages 774–82.)

Influenza is an important cause of morbidity and mortality related to annual epidemics and intermittent pandemics of respiratory viral infections. Whereas most of the 25 million annual cases of influenza result in self-limited infections, influenza is responsible for an excess 31.4 million outpatient visits, 226 000 excess hospitalizations, and up to 48 614 excess deaths annually in the United States [1–5]. Risk factors for serious illness and death include age <2 years or ≥65 years, and medical conditions including compromised immunity, pregnancy, and morbid obesity [3, 5]. Influenza vaccination remains the most important tool in preventing influenza. Unfortunately, influenza vaccine rates remain suboptimal and breakthrough infections, despite appropriate vaccination, do occur [5, 6].

Antiviral therapy with one of the neuraminidase inhibitors (oseltamivir or zanamivir) is recommended for the treatment of patients who develop influenza infections [7, 8]. Prospective studies in ambulatory adults and children have demonstrated that the neuraminidase inhibitors are associated with shorter time to alleviation of illness and with reductions in severity of illness, duration of fever, time to return to normal activity, and quantity of shed virus [9]. Data also suggest that antiviral therapy is associated with reduction in the frequency of complications leading to antibiotic use, particularly bronchitis, compared with placebo in previously healthy adults [10–12]. In ambulatory adults and children, antiviral therapy is generally effective only if started within the first 48–72 hours after symptom onset [9, 13, 14]. Moreover, earlier initiation of oral oseltamivir therapy is associated with increased therapeutic effects [13].

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