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Last Updated: 2/12/2015  


  • Recommend annual influenza vaccination to all persons aged ≥6 months who do not have contraindications to the vaccine, and ensure vaccination of those at high risk for complications of influenza.

  • Note that patients at high risk for complications of influenza include

    • Children aged 6 months through 4 years

    • Adults over age 50

    • Women who are or will be pregnant during the influenza season

    • Patients with chronic medical conditions such as cardiac disease, pulmonary disease including asthma, CKD, diabetes or other endocrine disorders, morbid obesity (BMI of 40 or greater) hematologic disorders, or neurologic disease

    • Patients with immunodeficiencies, immunosuppression, and institutionalized adults

    • Residents of nursing homes and other long-term care facilities

    • Children aged 6 months through 18 years receiving long-term aspirin therapy

    • Native Americans or native Alaskans

  • Give two doses of influenza vaccine at least 4 weeks apart to children between the ages of 6 months and 8 years during their first season of vaccination.

  • Provide antiviral agents to residents of institutions during institutional outbreaks of influenza.

  • Consider antiviral prophylaxis for high-risk patients or close contacts of high-risk patients who are exposed to influenza.

  • Suspect influenza in adults and children who present with the typical symptoms, particularly the acute onset of fever and cough, during influenza season.

  • Use specific diagnostic tests in patients with suspected influenza when there is diagnostic uncertainty, to investigate outbreaks, or to make decisions about treatment, beginning with PCR or a rapid test depending on the situation.

  • Institute antiviral therapy with oseltamivir, zanamivir, or an amantadine in hospitalized patients with influenza and in patients at risk for severe disease who present within 48 hours of symptom onset.

  • Consider use of antiviral agents such as oseltamivir, zanamivir, or an amantadine in adults and children with influenza who present within 48 hours of symptom onset during influenza outbreaks in order to shorten the duration of illness.

DOI: 10.7326/d193
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
John Treanor, MD University of Rochester Medical Center
Rochester, NY
received grants from Protein Sciences Corporation, Merck, GlaxoSmithKline, has pending grant through EpiVax.
Fred Hayden, MD has nothing to disclose. Margaret Trexler Hessen, MD, FACP has nothing to disclose. Mazen Bader, MD has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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