What are the treatment and prevention options for common respiratory viruses?

Treatment and Prevention Options for Common Respiratory Viruses

Mask use and hand hygiene are strongly recommended as the most effective non-pharmacological interventions for preventing respiratory viral transmission. 1

Non-Pharmacological Prevention Strategies

Personal Protective Measures

• Hand hygiene:

  • Frequent handwashing is a strong recommendation for preventing viral transmission 1
  • Alcohol-based rubs are preferred for hand decontamination when hands are not visibly soiled 1
  • Alternative: washing with antimicrobial soap 1
  • Hand hygiene likely provides a modest 11-14% reduction in respiratory illness 2

• Masks and respiratory protection:

  • Medical/surgical masks are strongly recommended in healthcare settings 1
  • N95/P2 respirators are recommended for healthcare workers in high-risk settings 1
  • For immunocompromised patients, strict protection measures including gloves, gowns, masks, and eye protection are recommended 1

Environmental and Social Measures

• Social distancing is recommended, especially during outbreaks 1
• Isolation/cohorting of infected patients:
  • Isolation rooms for patients with respiratory infections 1
  • Cohorting (grouping) infected patients has been shown to reduce hospital-acquired infections 3
• Avoiding exposure:
  • Immunocompromised patients should avoid contact with individuals with respiratory infections 1
  • Restrict young children from visiting patients due to higher risk of viral exposure 1
  • Restrict visitors and healthcare workers with respiratory symptoms 1

Additional Preventive Measures

• Nasal washing with saline is an option for selected populations 1
• Gargling is an option for selected populations 1
• Avoid tobacco smoke exposure, particularly for infants 1
• Breastfeeding is recommended to decrease risk of lower respiratory tract disease in children 1

Pharmacological Treatment and Prevention

Antiviral Medications

1. Oseltamivir (Tamiflu):

   • For treatment of influenza in patients with symptoms for no more than 2 days 4
   • For prevention of influenza in exposed individuals 4
   • Begin treatment as soon as possible from first appearance of flu symptoms 4
   • Post-exposure prophylaxis should start as soon as possible after exposure 4

2. Zanamivir (Relenza):

   • For treatment of influenza in patients aged 7 years and older with symptoms for no more than 2 days 5
   • For prevention of influenza in people aged 5 years and older 5
   • Not recommended for patients with underlying breathing problems such as asthma and COPD 5

Special Populations

Immunocompromised Patients

• Higher priority for laboratory testing for respiratory viruses, especially influenza, RSV, and HPIV 1
• Specimens should be taken from the site of clinical involvement (pooled swabs for upper respiratory infections, BAL for lower respiratory infections) 1
• IVIG preparations may be considered for patients with hypogammaglobulinemia <4 g/L 1
• For pediatric patients <2 years during RSV outbreaks, monoclonal antibody (palivizumab) may be considered for monthly prophylaxis 1

Implementation Considerations

Healthcare Settings

• Implement strict infection control measures in healthcare facilities 1
• Outpatients with respiratory infections should be seen in facilities separated from other patients 1
• Education of staff and families about prevention of viral spread is essential 1

Common Pitfalls to Avoid

1. Inadequate hand hygiene: Ensure proper technique and frequency, especially before and after patient contact
2. Improper mask use: Ensure correct fitting and consistent usage in appropriate settings
3. Delayed antiviral treatment: Antivirals should be started within 48 hours of symptom onset for maximum effectiveness 5, 4
4. Neglecting environmental measures: Surface cleaning and proper ventilation are important adjuncts to personal protective measures
5. Overlooking vaccination: Antiviral medications are not substitutes for annual influenza vaccination 4

Monitoring and Follow-up

• For high-risk patients (immunocompromised, elderly, very young), closer monitoring for progression to lower respiratory tract disease is warranted
• Consider laboratory testing to guide treatment decisions and infection control measures 1

By implementing these evidence-based strategies, the morbidity, mortality, and quality of life impact of respiratory viral infections can be significantly reduced, particularly in vulnerable populations.