What are the prevention, treatment, and management strategies for influenza and other respiratory tract viruses?

Prevention, Treatment, and Management Strategies for Influenza and Other Respiratory Tract Viruses

The most effective strategy for preventing influenza and other respiratory viruses is a combination of annual vaccination, proper hand hygiene, respiratory hygiene/cough etiquette, and appropriate use of personal protective equipment in healthcare settings. 1

Prevention Strategies

Personal Hygiene Measures

• Perform hand hygiene (alcohol-based hand rub or handwashing with soap and water) frequently, especially after contact with respiratory secretions 1
• Cover nose/mouth when coughing or sneezing; cough or sneeze into elbow rather than hand 1
• Use tissues to contain respiratory secretions and dispose of them properly in the nearest waste receptacle 1
• Avoid touching eyes, nose, and mouth with unwashed hands 1

Social Distancing and Environmental Controls

• Maintain at least 3 feet of distance between symptomatic individuals and others in common waiting areas when possible 1
• Avoid contact with individuals known to have respiratory infections 1
• Restrict young children from visiting high-risk patients as they may have higher risk of virus exposure and prolonged shedding 1
• Consider postponing routine healthcare visits during peak epidemic periods 1

Mask Use and Personal Protective Equipment

• Mask use in community settings probably makes little or no difference to influenza-like illness outcomes based on moderate-certainty evidence 2
• In healthcare settings, healthcare workers should consider wearing masks when examining patients with suspected influenza or other respiratory infections 1
• In healthcare facilities, provide masks to symptomatic patients to prevent respiratory droplet dispersal 1
• For healthcare workers caring for patients with respiratory infections, appropriate PPE includes gloves, gowns, masks, and eye protection 1

Vaccination

• Annual vaccination remains the most effective strategy for preventing influenza 1
• Vaccination should be prioritized for high-risk groups and their contacts 1
• New vaccines for respiratory syncytial virus (RSV) and updated COVID-19 vaccines should be administered according to current recommendations 3

Treatment Strategies

Antiviral Medications for Influenza

• Zanamivir (Relenza) is indicated for:
  • Treatment of uncomplicated influenza A and B in patients ≥7 years who have been symptomatic for no more than 2 days 4
  • Prophylaxis of influenza in patients ≥5 years 4
• Important limitations of zanamivir use:
  • Not recommended for patients with underlying airways disease (asthma, COPD) due to risk of bronchospasm 4
  • Not proven effective for prophylaxis in nursing home settings 4
• For non-severe influenza with high risk of severe illness, baloxavir is conditionally recommended 5
• For severe influenza, oseltamivir is conditionally recommended 5
• Antivirals are not generally recommended for low-risk patients with non-severe influenza 5

Supportive Care

• Maintain adequate hydration and rest 1
• Use antipyretics and analgesics as needed for symptom relief 1
• Monitor for complications, especially in high-risk patients 1

Antibiotics

• Strong recommendation against antibiotics if bacterial co-infection is unlikely 5
• Consider antibiotics only if there is evidence of bacterial superinfection 5

Special Populations

Immunocompromised Patients

• Leukemia patients and hematopoietic stem cell transplant (HSCT) recipients should:
  • Avoid contact with individuals with respiratory tract infections 1
  • Be tested for community-acquired respiratory viruses (CARVs) if symptomatic 1
  • Consider deferral of conditioning therapy if infected 1
• For respiratory syncytial virus (RSV) in HSCT patients, consider ribavirin treatment 1

Healthcare Settings

• Implement infection control measures for symptomatic patients:
  • Isolation rooms with strict protection measures 1
  • Separate facilities for outpatients with respiratory infections 1
  • Restrict healthcare workers with respiratory infections from patient contact 1
• Consider screening high-risk patients during peak respiratory virus seasons 1

Diagnostic Approach

• For suspected non-severe influenza, use nucleic acid amplification tests (NAAT) or digital immunoassay (DIA) 5
• For suspected severe influenza, use nucleic acid amplification test (NAAT) 5
• Specimens should be taken from the site of clinical involvement (pooled swabs for upper respiratory tract infections, bronchoalveolar lavage for lower respiratory tract infections) 1

Common Pitfalls and Caveats

• Overuse of antibiotics for viral respiratory infections contributes to antimicrobial resistance 5
• Antiviral medications are most effective when started within 48 hours of symptom onset 4
• Zanamivir has not been proven to reduce transmission of influenza to others 4
• Mask use alone without other hygiene measures may provide limited protection 2
• Hand hygiene shows modest but significant reduction in respiratory illness burden (11% relative reduction) 2

By implementing these comprehensive prevention and treatment strategies, the burden of influenza and other respiratory viruses can be significantly reduced in both community and healthcare settings.