What are the prevention and treatment options for viral infections, particularly for individuals at high risk of infection with viruses?

From the Guidelines

Prevention and treatment of viral infections, especially for high-risk individuals, involves multiple strategies, with the most effective approach being vaccination, good hygiene practices, and consideration of prophylactic medications in certain situations, as well as antiviral medications for specific infections and supportive care. For prevention, vaccination is key, with specific vaccines available for influenza (annual shots), hepatitis A and B, HPV, and COVID-19 1. Good hygiene practices like frequent handwashing with soap for 20 seconds, avoiding close contact with sick individuals, and wearing masks in high-risk settings can reduce transmission. High-risk individuals should consider prophylactic medications in certain situations, such as oseltamivir (Tamivir, 75mg daily) for influenza exposure or pre-exposure prophylaxis (PrEP) with medications like emtricitabine/tenofovir (Truvada) for HIV prevention.

For treatment, antiviral medications are available for specific infections: oseltamivir (75mg twice daily for 5 days) for influenza, acyclovir (400mg three times daily for 7-10 days) for herpes simplex, and various antiretroviral combinations for HIV 1. Supportive care is crucial and includes rest, adequate hydration (at least 2-3 liters daily), and fever management with acetaminophen (up to 3000mg daily in divided doses) or ibuprofen (up to 2400mg daily in divided doses). These medications work by targeting specific viral replication mechanisms, while supportive measures help maintain body function while the immune system fights the infection.

Early intervention is particularly important for high-risk individuals, including the elderly, pregnant women, immunocompromised patients, and those with chronic medical conditions, as outlined in guidelines for the prevention and control of influenza and other viral infections 1. The use of nonpharmacological interventions such as mask use, hand hygiene, and social distancing is also strongly recommended to reduce viral transmission 1.

In terms of specific recommendations for high-risk individuals, guidelines suggest that those at higher risk for influenza complications, such as children aged <2 years, adults aged ≥65 years, and persons with chronic pulmonary, cardiovascular, renal, hepatic, hematologic, or metabolic disorders, should receive antiviral treatment as soon as possible if they have confirmed or suspected influenza 1. Similarly, individuals with certain underlying medical conditions, such as immunosuppression, should consider prophylactic medications and receive prompt treatment if they develop symptoms of a viral infection 1.

Overall, a comprehensive approach to prevention and treatment, incorporating vaccination, good hygiene practices, prophylactic medications, antiviral treatments, and supportive care, is essential for reducing the risk of viral infections and their complications in high-risk individuals.

From the FDA Drug Label

Oseltamivir phosphate for oral suspension is indicated for the treatment of acute, uncomplicated illness due to influenza A and B infection in patients 2 weeks of age and older who have been symptomatic for no more than 48 hours. Oseltamivir phosphate for oral suspension is indicated for the prophylaxis of influenza A and B in patients 1 year and older. The prevention and treatment options for viral infections, particularly for individuals at high risk of infection with viruses, include:

• Oseltamivir phosphate for oral suspension for the treatment of influenza A and B infection in patients 2 weeks of age and older
• Oseltamivir phosphate for oral suspension for the prophylaxis of influenza A and B in patients 1 year and older
• The recommended dosage for treatment is 75 mg twice daily for 5 days for adults and adolescents 13 years and older, and varies by weight for pediatric patients
• The recommended dosage for prophylaxis is 75 mg once daily for at least 10 days following close contact with an infected individual and up to 6 weeks during a community outbreak for adults and adolescents 13 years and older, and varies by weight for pediatric patients 2

From the Research

Prevention of Viral Infections

• Individuals at high risk of infection with viruses can take several measures to prevent infection, including practicing good hygiene, avoiding close contact with individuals who are infected, and getting vaccinated against certain viruses 3.
• Risk assessment is an important element of infection prevention and control, and nurses have a crucial role in identifying patients who are at high risk of infection 3.

Treatment Options for Viral Infections

• Current therapies for herpes simplex virus infections include episodic treatment and chronic suppressive therapy, and are generally well tolerated and effective 4.
• Antiviral agents such as valacyclovir, acyclovir, and famciclovir are commonly used to treat herpes simplex virus infections, and have established a remarkable safety record 5, 6.
• Novel antiviral approaches, including therapeutic vaccines and small molecule inhibitors, are being developed for the treatment of genital or labial HSV infections 7, 6.

Management of Viral Infections

• Nurses have a crucial role in infection prevention and control, and should be aware of the importance of controlling the spread of infections, while reinforcing the challenges involved in the care of patients who already have an infection 3.
• Measures such as risk assessment, the use of personal protective equipment, the role of surveillance, and outbreak management are important elements of infection prevention and control 3.
• The treatment of viral infections should be tailored to the individual patient's needs, and should take into account the severity of the infection, the patient's medical history, and the potential for complications 5, 4, 6.