Abstract
Background
Influenza is an acute respiratory virus that results in significant worldwide morbidity
and mortality each year. As emergency physicians, we are often the first to encounter
patients with seasonal influenza. It is therefore critical that we draw on the most
recent and relevant research when we make clinical decisions regarding the diagnosis,
treatment, and prophylaxis of this disease.
Methods
A MEDLINE literature search from August 2009 to August 2015 was performed using the
keywords influenza vaccination efficacy AND systematic, influenza AND rapid antigen testing, and Oseltamivir AND systematic, while limiting the search to human studies written in the English language. General
review articles and case reports were omitted. Each of the selected articles then
underwent a structured review.
Results
We identified 163 articles through our literature search, of which 68 were found to
be relevant to our clinical questions. These studies then underwent a rigorous review
from which recommendations were given.
Conclusions
Influenza vaccine efficacy continues to range between 40% and 80%. Vaccination has
the potential to decrease disease severity and is recommended for individuals older
than 6 months of age. If resources permit, vaccination can be offered to patients
presenting to the emergency department. Rapid antigen detection for influenza is a
simple bedside test with high specificity, but generally low sensitivity. If a patient
presents with a syndrome consistent with influenza and has negative rapid antigen
detection, they should either receive a confirmatory reverse transcriptase polymerase
chain reaction or be treated as if they have influenza. Treatment with neuraminidase
inhibitors can decrease the duration of influenza and is recommended in hospitalized
patients, or in those with high risk of complications.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Centers for Disease Control and Prevention. Severe influenza among children and young adults with neurologic and neurodevelopmental conditions—Ohio, 2011.MMWR Morb Mortal Wkly Rep. 2012; 60: 1729-1733
- Mandatory influenza vaccination for health care workers as the new standard of care: a matter of patient safety and nonmaleficent practice.Am J Public Health. 2014; 104: 2060-2065
- Seasonal influenza vaccine efficacy and its determinants in children and non-elderly adults: a systematic review with meta-analyses of controlled trials.Vaccine. 2012; 31: 49-57
- Effectiveness and harm of seasonal and pandemic influenza vaccines in children, adults, and the elderly.Hum Vaccine Immunother. 2012; 8: 851-862
- Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis.Lancet Infect Dis. 2012; 12: 36-44
- Universal immunisation against influenza in paediatrics, yes or no?.An Pediatr (Barc). 2013; 79: 261.e1-261.e11
- Efficacy of live attenuated influenza vaccine in children 6 months to 17 years of age.Influenza Other Respir Viruses. 2010; 4: 141-145
- A systematic review of the evidence on the effectiveness and risks of inactivated influenza vaccines in different target groups.Vaccine. 2011; 29: 9159-9170
- Vaccines for preventing influenza in the elderly.Cochrane Database Syst Rev. 2010; : CD004876
- Influenza vaccination for healthcare workers who work with the elderly.Cochrane Database Syst Rev. 2010; : CD005187
- Cochrane re-arranged: support for policies to vaccinate elderly people against influenza.Vaccine. 2013; 31: 6030-6033
- Determinants of uptake of influenza vaccination among pregnant women—a systematic review.Vaccine. 2014; 32: 4602-4613
- Influenza vaccination in cancer patients undergoing systemic therapy.Clin Med Insights Oncol. 2014; 8: 57-64
- Effectiveness of influenza vaccination in institutionalized older adults: a systematic review.J Am Med Dir Assoc. 2014; 15: 226.e1-226.e6
- Efficacy and effectiveness of maternal influenza vaccination during pregnancy: a review of the evidence.Matern Child Health J. 2014; 18: 1599-1609
- Booster and higher antigen doses of inactivated influenza vaccine in HIV-infected patients.Ann Pharmacother. 2013; 47: 1712-1716
- Vaccines for preventing influenza in people with asthma.Cochrane Database Syst Rev. 2013; 2: CD000364
- Value of rapid antigen test for pandemic influenza A (H1N1) 2009 in the pediatric emergency department.Pediatr Emerg Care. 2013; 29: 612-616
- Diagnostic tests for influenza infection.Curr Opin Pediatr. 2011; 23: 91-97
- Rapid testing for pandemic influenza A (H1N1): diagnostic test utility and specimen source.Infect Control Hosp Epidemiol. 2010; 31: 663-664
- Rapid diagnosis of influenza: state of the art.Clin Lab Med. 2014; 34: 365-385
- The role of rapid antigen testing for influenza in the era of molecular diagnostics.Mol Diagn Ther. 2010; 14: 205-214
- Recent advances in the diagnosis and treatment of influenza pneumonia.Curr Infect Dis Resp. 2012; 14: 275-283
- Evaluation of a rapid antigen detection point-of-care test for respiratory syncytial virus and influenza in a pediatric hospitalized population in the Netherlands.Diagn Microbiol Infect Dis. 2014; 80: 292-293
- Performance of five FDA-approved rapid antigen tests in the detection of 2009 H1N1 influenza A virus.J Med Virol. 2012; 84: 1699-1702
- Evaluation of five rapid diagnostic kits for influenza A/B virus.J Virol Methods. 2013; 187: 51-56
- Diagnostic performance of the BinaxNow Influenza A&B rapid antigen test in ED patients.Am J Emerg Med. 2012; 30: 1955-1961
- Update on influenza diagnostics: lessons from the novel H1N1 influenza A pandemic.Clin Microbiol Rev. 2012; 25: 344-361
- Evaluation of the ESPLINE(R) Influenza A & B-N assay for the detection of influenza A and B in nasopharyngeal aspirates.Eur J Clin Microbiol Infect Dis. 2012; 31: 761-766
- Performance of influenza rapid antigen testing in influenza in emergency department patients.Emerg Med J. 2010; 27: 5-7
- Diagnostic performance of rapid influenza antigen assays in patients infected with the new influenza A (H1N1) virus.Clin Chem Lab Med. 2010; 48: 53-56
- Rapid antigen tests for diagnosis of pandemic (Swine) influenza A/H1N1.Clin Infect Dis. 2009; 49: 1090-1093
- Clinical evaluation of rapid point-of-care testing for detection of novel influenza A (H1N1) virus in a population-based study in Spain.Clin Microbiol Infect. 2010; 16: 1358-1361
- Diagnosis of 2009 pandemic influenza A (pH1N1) and seasonal influenza using rapid influenza antigen tests, San Antonio, Texas, April-June 2009.Clin Infect Dis. 2011; 52: S116-S122
- The diagnosis of viral respiratory disease in older adults.Clin Infect Dis. 2010; 50: 747-751
- Comparison of Xpert Flu rapid nucleic acid testing with rapid antigen testing for the diagnosis of influenza A and B.J Virol Methods. 2012; 186: 137-140
- Clinical characteristics of 2009 pandemic influenza A (H1N1) infection in children and the performance of rapid antigen test.Korean J Pediatr. 2011; 54: 405-408
- Molecular diagnosis of respiratory virus infections.Crit Rev Clin Lab Sci. 2011; 48: 217-249
- Validity of two rapid point of care influenza tests and direct fluorecence assay in comparison of real time PCR for swine of origin Influenza virus.J Infect Public Health. 2011; 4: 7-11
- Monitoring epidemic viral respiratory infections using one-step real-time triplex RT-PCR targeting influenza A and B viruses and respiratory syncytial virus.J Med Virol. 2011; 83: 695-701
- Comparison of influenza vaccine effectiveness using different methods of case detection: clinician-ordered rapid antigen tests vs. active surveillance and testing with real-time reverse-transcriptase polymerase chain reaction (rRT-PCR).Vaccine. 2011; 29: 387-390
- Sensitivity of rapid influenza antigen tests in the diagnosis of pandemic (H1N1) 2009 compared with the standard rRT-PCR technique during the 2009 pandemic in Turkey.Scand J Infect Dis. 2010; 42: 902-905
- Failure of routine diagnostic methods to detect influenza in hospitalized older adults.Infect Control Hosp Epidemiol. 2010; 31: 683-688
- Detecting pandemic 2009 influenza A (H1N1) virus infection: availability of diagnostic testing led to rapid pandemic response.Clin Infect Dis. 2011; 52: S36-S43
- Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests.2014 (Available at:) (Accessed June 15, 2015)
- Near point-of-care administration by the attending physician of the rapid influenza antigen detection immunochromatography test and the fully automated respiratory virus nucleic acid test: contribution to patient management.Diagn Microbiol Infect Dis. 2013; 76: 445-449
- Analytical detection of influenza A(H3N2)v and other A variant viruses from the USA by rapid influenza diagnostic tests.Influenza Other Respir Viruses. 2013; 7: 491-496
- Systematic review of influenza resistance to the neuraminidase inhibitors.BMC Infect Dis. 2011; 11: 134
- Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children.Cochrane Database Syst Rev. 2014; 4: CD008965
- Antivirals for treatment of influenza: a systematic review and meta-analysis of observational studies.Ann Intern Med. 2012; 156: 512-524
- Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials.BMJ. 2009; 339: b3172
- Prescription of anti-influenza drugs for healthy adults: a systematic review and meta-analysis.Lancet Infect Dis. 2009; 9: 537-545
- Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials.Fam Pract. 2013; 30: 125-133
- The value of neuraminidase inhibitors for the prevention and treatment of seasonal influenza: a systematic review of systematic reviews.PLoS One. 2013; 8: e60348
- Oseltamivir and risk of lower respiratory tract complications in patients with flu symptoms: a meta-analysis of eleven randomized clinical trials.Clin Infect Dis. 2011; 53: 277-279
- Neuraminidase inhibitors for preventing and treating influenza in healthy adults.Cochrane Database Syst Rev. 2010; : CD001265
- Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis.BMJ. 2009; 339: b5106
- Oseltamivir dosing in critically ill patients with severe influenza.Ann Pharmacother. 2014; 48: 1011-1018
- Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments.BMJ. 2014; 348: g2545
- Influenza outbreak control practices and the effectiveness of interventions in long-term care facilities: a systematic review.Influenza Other Respir Viruses. 2014; 8: 74-82
- Neuraminidase inhibitors for preventing and treating influenza in children (published trials only).Cochrane Database Syst Rev. 2012; 4: CD002744
- Neuraminidase inhibitors for preventing and treating influenza in children.Cochrane Database Syst Rev. 2012; 1: CD002744
- Oseltamivir, zanamivir and amantadine in the prevention of influenza: a systematic review.J Infect. 2011; 62: 14-25
- Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children.Cochrane Database Syst Rev. 2012; 1: CD008965
- Antivirals for influenza: a summary of a systematic review and meta-analysis of observational studies.Influenza Other Respir Viruses. 2013; 7: 76-81
- Systematic review: safety and efficacy of extended-duration antiviral chemoprophylaxis against pandemic and seasonal influenza.Ann Intern Med. 2009; 151: 464-473
- Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2011; 60: 1-24
- Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant.Health Technol Assess. 2010; 14: 109-182
Article info
Publication history
Published online: January 04, 2016
Accepted:
October 13,
2015
Received in revised form:
October 10,
2015
Received:
August 31,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
