Selected underlying medical conditions in patients hospitalized with laboratory-confirmed influenza, FluSurv-NET 2014–2015. Source: Centers for Disease Control and Prevention. FluView 2014–2015 Preliminary Data as of August 13, 2015. Available at: gis.cdc.gov/grasp/fluview/FluHospChars.html
↵a Vaccine strains did not change from previous influenza season.
People at Higher Risk of Influenza Complications Recommended for Antiviral Treatment of Suspected or Confirmed Influenza
Children <2 y
Adults ≥65 y
People with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematologic (including sickle cell disease), or metabolic disorders (including diabetes mellitus) or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
People with immunosuppression, including that caused by medications or by HIV infection
Women who are pregnant or postpartum (within 2 wk after delivery)
People <19 y who are receiving long-term aspirin therapy
American Indian/Alaska Native people
People who are morbidly obese (ie, BMI ≥40)
Residents of nursing homes and other chronic care facilities
Source: Centers for Disease Control and Prevention. Antiviral agents for the treatment and chemoprophylaxis of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-1):1–24
Recommended Seasonal Influenza Vaccines for Different Age Groups: United States, 2015–2016 Influenza Season
Thimerosal Mercury Content, microgram of Hg/0.5-mL dose
5.0-mL multidose vial
0.1-mL prefilled microinjection
0.5-mL prefilled syringe
Novartis Vaccines and Diagnostics
0.5-mL prefilled syringe
5.0-mL multidose vial
0.5-mL prefilled syringe
ID Biomedical Corporation of Quebec (distributed by GlaxoSmithKline)
Data sources: American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2014–2015. Pediatrics. 2014;134(5):e1503–e1519; and Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2015–2016 influenza season. MMWR Recomm Rep. 2015;64(30):818–825.
↵a Age indication per package insert is ≥5 years; however, the Advisory Committee on Immunization Practices recommends Afluria not be used in children 6 months through 8 years of age because of increased reports of febrile reactions noted in this age group. If no other age-appropriate, licensed inactivated seasonal influenza vaccine is available for a child 5 through 8 years of age who has a medical condition that increases the child’s risk of influenza complications, Afluria can be used; however, pediatricians should discuss with the parents or caregivers the benefits and risks of influenza vaccination with Afluria before administering this vaccine.
Recommended Dosage and Schedule of Influenza Antiviral Medications for Treatment and Chemoprophylaxis for the 2015–2016 Influenza Season: United States
Children (≥7 y for treatment, ≥5 y for chemoprophylaxis)
10 mg (two 5-mg inhalations) twice daily × 5 days
10 mg (two 5-mg inhalations) once daily × 10 days
↵a Oseltamivir is administered orally without regard to meals, although administration with meals may improve gastrointestinal tolerability. Oseltamivir is available as Tamiflu in 30-mg, 45-mg, and 75-mg capsules and as a powder for oral suspension that is reconstituted to provide a final concentration of 6 mg/mL. For the 6-mg/mL suspension, a 30-mg dose is given with 5 mL of oral suspension, a 45-mg dose is given with 7.5 mL oral suspension; a 60-mg dose is given with 10 mL oral suspension, and a 75-mg dose is given with 12.5 mL oral suspension. If the commercially manufactured oral suspension is not available, a suspension can be compounded by retail pharmacies (final concentration also 6 mg/mL), based on instructions that are present in the package label. In patients with renal insufficiency, the dose should be adjusted on the basis of creatinine clearance. For treatment of patients with creatinine clearance 10–30 mL/min: 75 mg, once daily, for 5 d. For chemoprophylaxis of patients with creatinine clearance 10–30 mL/min: 30 mg, once daily, for 10 d after exposure or 75 mg, once every other day, for 10 d after exposure (5 doses). See www.cdc.gov/flu/professionals/antivirals/antiviral-drug-resistance.htm.
↵b Approved by the FDA for children as young as 2 weeks of age. Given preliminary pharmacokinetic data and limited safety data, oseltamivir can be used to treat influenza in both term and preterm infants from birth because benefits of therapy are likely to outweigh possible risks of treatment.
↵c Oseltamivir dosing for preterm infants. The weight-based dosing recommendation for preterm infants is lower than for term infants. Preterm infants may have lower clearance of oseltamivir because of immature renal function, and doses recommended for full-term infants may lead to very high drug concentrations in this age group. Limited data from the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group provides the basis for dosing preterm infants using their postmenstrual age (gestational age + chronological age): 1.0 mg/kg per dose, orally, twice daily × 5 days, for those <38 weeks postmenstrual age; 1.5 mg/kg per dose, orally, twice daily × 5 days, for those 38 through 40 weeks postmenstrual age; 3.0 mg/kg per dose, orally, twice daily × 5 days, for those >40 weeks postmenstrual age. For extremely preterm infants (<28 wk), please consult a pediatric infectious diseases physician.
↵d Zanamivir is administered by inhalation using a proprietary “Diskhaler” device distributed together with the medication. Zanamivir is a dry powder, not an aerosol, and should not be administered using nebulizers, ventilators, or other devices typically used for administering medications in aerosolized solutions. Zanamivir is not recommended for people with chronic respiratory diseases, such as asthma or chronic obstructive pulmonary disease, which increase the risk of bronchospasm.
Sources: Centers for Disease Control and Prevention. Antiviral agents for the treatment and chemoprophylaxis of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-1):1–24; Kimberlin DW, Acosta EP, Prichard MN, et al. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Oseltamivir pharmacokinetics, dosing, and resistance among children aged <2 y with influenza. J Infect Dis. 2013;207(5):709–720.
Comparison of Types of Influenza Diagnostic Tests
Influenza Diagnostic Test
Typical Processing Time
Distinguishing Subtype Strains of Influenza A
Rapid influenza diagnostic tests
Direct and indirect immunofluorescence assays
Viral cell culture
Rapid cell culture (shell vials and cell mixtures)