Influenza in adults

Prophylaxis - For prophylaxis of influenza in adults and adolescents 13 years of age and older. 

Oseltamivir formulation (additional indication) For Prophylaxis of influenzae in adult and children >14 years of age... 

In contrast to zanamivir (8), oseltamivir (9) is an oral anti-viral drug for the treatment cf uncomplicated influenza in patients whose flu symptoms have not lasted more than 2 days (15, 16). This product treats types A and B influenza however, the majority of patients in the United States are infected with type A. FTTit ay of oseltamivir (9) in the treatment of influenza in subjects with chronic cardiac disease and/or respiratory disease has not been established. Oseltamivir (9) is also approved for the prevention of influenza in adults and adolescents older than 13 years. Efficacy of oseltamivir (9) for the prevention of influenza has not been established in immune-compromisedpatients. 

Viruses are a common cause of CAP in children (-65%) and much less common in adults ( 15%).8 Viruses often associated with pneumonia in adults include influenza A and B and adenoviruses, whereas less common causes include rhinoviruses, enteroviruses, cytomegalovirus, varicella-zoster virus, herpes simplex virus, and others. In children, viral pneumonia is caused more commonly by respiratory syncyntial virus, influenza A virus, and parainfluenza virus. The viruses associated with CAP in adults are much less common causes of pneumonia in children. 

H. influenzae type b conjugate vaccine is a recommended routine childhood vaccine given at 2,4, 6, and 12 to 15 months of age. Adolescents and adults with functional or anatomic asplenia should also receive a booster dose of H. influenzae type b vaccine. The currently available vaccines are labeled for pediatric use, but can be used in adults when vaccination is indicated. There are several H. influenzae type b vaccines on... 

The vaccination rate in adults is much lower than that in children. Only 50% to 60% of adults who meet criteria have received pneumococcal or influenza vaccination. Comprehensive initiatives need to be implemented to increase the adult vaccination rate. Some proven concepts are providing reminders to patients that vaccines are due and implementation of standing orders for vaccines. This latter concept allows nurses and pharmacists to screen patients to see if pneumococcal, influenza, or other vaccines are needed and to vaccinate without a physician s order. 

The pharmacogenomics analysis of samples from a clinical study with an aluminum hydroxide-adsorbed vaccine (diphtheria-tetanus-acellular pertussis/polio/ Haemophilus influenzae) in infants is described. These instructions can easily be adapted to clinical studies of other vaccines with changes to the type of administered vaccine, administration route, vaccination ages, and so on. This method is therefore also suitable for assessing vaccine responses in adults and to study the cellular reactions in clinical subjects who have experienced adverse reactions. 

Influenza treatment Treatment of uncomplicated acute illness caused by influenza A and B virus in adults and children 7 years of age and older who have been symptomatic for no more than 2 days. 

Influenza prophylaxis The recommended oral dose of oseltamivir for influenza prophylaxis in adults and adolescents 13 years of age and older following close contact with an infected individual is 75 mg once daily for at least 7 days. Therapy should begin within 2 days of exposure. The recommended dose for prophylaxis during a community outbreak of influenza is 75 mg once daily. Safety and efficacy have been demonstrated for up to 6 weeks. The duration of protection lasts for as long as dosing is continued. 

Drug resistance - In clinical studies of naturally acquired infection with influenza virus, 1.3% of posttreatment isolates in adults and adolescents, and 8.6% in children from 1 to 12 years of age showed emergence of influenza variants with decreased neuraminidase susceptibility to oseltamivir carboxylate. 

Acute exacerbations of chronic bronchitis in adults - Acute exacerbations of chronic bronchitis in adults caused by susceptible strains of/-/, influenzae and S. pneumoniae. 

Jefferson TO, Demicheli V, Di Pietrantonj C, Jones M, Rivetti D. Neuraminidase inhibitors for preventing and treating influenza in healthy adults. Cochrane Database Syst Rev 2006. 

Jefferson T, Demicheli V, Rivetti D, et al. Antivirals for influenza in healthy adults systematic review. 

Antiviral spectrum Ribavirin is used in treating infants and young children infected with severe RSV infections. [Note It is not indicated for use in adults.] Favorable responses of acute hepatitis A virus and influenza A and B infections have also been reported. Ribavirin may reduce the mortality and viremia of Lassa fever. 

Gluck, U., Gebbers, J. O., and Gluck, R. (1999), Phase I evaluation of intranasal viro-somal influenza vaccine with and without Escherichia coli heat-labile toxin in adult volunteers, J. Virol., 73,7780-7786. 

Current recommendations for the use of influenza vaccine in adults are based on a single injection. This may not be valid in case of a new pandemic caused by an antigenic shift of the influenza virus. Currently, the only group for whom a second dose is recommended comprises children who have never been immunized. However, when two-dose regimens in adults have been studied, the second dose of vaccine has not been associated with higher rates of reactions than the first. People who have a stronger local reaction after a first injection are more likely to have another such reaction after a second injection (31). 

Rimantadine hydrochloride, an alpha-methyl derivative of amantadine (alpha-methyl-l-adamantane methylamine hydrochloride), is more active than amantadine against influenza A viruses in vitro and in laboratory animals. It is an alternative to amantadine for the prevention and treatment of influenza A virus infections in adults and for the prevention of influenza in children. Adverse effects have been considered to be less common with rimantadine (SEDA-8, 143), and it is generally tolerated better than amantadine, because it causes fewer nervous system adverse effects (1). Unfortunately, rimantadine is more costly, which has led many institutions to develop influenza treatment guidelines. Both drugs work by blocking the M2 ion channel, which is needed to affect a pH change that helps to initiate viral uncoating. 

It is extremely common on average adults suffer 2-4 colds per year, and children up to 12 per year Incidence is mainly in autumn and winter, but it can occur at any time of year Up to 15% of the population may develop influenza in any one year Influenza occurs in epidemics (400/100 000 population affected in a 4-week period) roughly every 3 years and pandemics (worldwide epidemics) about every 10 years It normally occurs in the winter months... 

Adamantanes. Amantadine hydrochloride (Symmetrel, EXP IO5), now released by the Food and Drug Administration, has been further examined in double-blind studies in volunteers infected with influenza Ag virus nd in epidemics caused by the same virus in adults nd in chll-... 

Tang LM, Chen ST, Wu YR. Hemophilus influenzae meningitis in adults. Diagn Microbiol Infect Dis 1998 32 27-32. 

All viral respiratory tract infections occur more commonly in the winter, and rapid person-to-person spread through susceptible populations is typical. Underlying cardiac or pulmonary disease predisposes to an increased incidence and severity of viral lower respiratory tract infection, especially with influenza virus in adults and RSV in children. Radiographic findings are nonspecific and include bronchial wall thickening and perihilar and diffuse interstitial infiltrates. Pleural effusions may be seen, especially in adenovirus and parainfluenza pneumonia. 

Dorrefl L, Hassan 1, Marshall S, et al. Chnical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers. Int J STD AIDS 1997 8 776-779. 

Nichol KL, Lind A, Margolis KL, et al. The effectiveness of vaccination against influenza in healthy, working adults (see comments). N Engl J Med 1995 333 889-893. 

Little work has been done concerning the immunomodulatory effects of pesticides on the developing immune system see review ( ). In some recent studies, mice exposed to chlordane ui utero displayed a decreased contact sensitivity response and an increased survival and antibody response to influenza as adults (25-28). 

Oral oseltamivir is effective in the treatment and prevention of influenza A and B virus infections. Treatment of previously healthy adults (75 mg twice daily for 5 days) or children aged 1 to 12 years (weight-adjusted dosing) with acute influenza reduces illness duration by about 1 to 2 days, speeds functional recovery, and reduces the risk of complications leading to antibiotic use by 40 to 50%. Treatment is associated with approximate halving the risk of subsequent hospitalization in adults. When used for prophylaxis during the influenza season, oseltamivir (75 mg... 

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