Thread by @MedIQCME

1/26 See below for this #Flu #CME #Tweetorial supported by an educational grant from Genentech and contributed to by @RogerSeheult.

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2/Let’s begin!

1918 Pandemic: Naomi Barnett of Brockton, MA, learned her fiancé Jacob Julian (a soldier at Camp Upton, NY, about to go to war) had influenza, so she raced to help him. She died 2 days after arriving at the camp from influenza. He died 30 minutes later.

3/Influenza is an acute respiratory illness with significant morbidity and mortality, especially via transmission from loved ones. The CDC estimated that in the 2019-2020 (pre-COVID) US flu season, 62,000 flu-related deaths occurred.

4/Prevention is key when talking about influenza infections.

Time for our first poll. Please vote for the single best option.

What are the chances of contracting influenza if someone in the house is already infected?

5/If you picked C, you are correct. We can reduce transmission risk through:
- Vaccinations
- Medications
- Simple lifestyle choices

Remember that reducing the risk of transmission will lead to less infection, disease, and even death.

6/Time for another poll! Please vote for the single best option.

In your estimation, what percentage of privately insured children and adolescents aged 1-17 years received an influenza vaccine in 2019-2020?

7/If you picked D, you are correct. Data suggest that children with private insurance have the highest vaccination rate at 56.6%, followed by 48.6% for those with public insurance and 34.2% for those without insurance.

8/The simultaneous administration of all age-appropriate vaccines is recommended if no specific contraindications exist at the time of the healthcare visit. This means that COVID-19 primary vaccines and boosters can be given at the same time as the flu shot.

9/While vaccines don’t prevent 100% of infections, if infection does occur, they can prevent severe disease. In a 2021 study of adults hospitalized with flu, vaccinated patients had a 26% lower risk of ICU admission and a 31% lower risk of death from flu vs unvaccinated patients.

10/What can you do once someone has flu symptoms? Several oral antivirals can speed up the resolution of symptoms in people infected with influenza A or B. Baloxavir marboxil (baloxavir), oseltamivir, peramivir, and zanamivir are all FDA-approved drugs that may be used.

11/In 2018, a novel antiviral agent, baloxavir, was approved by the FDA for the early treatment of acute, uncomplicated influenza caused by A or B viruses in outpatients aged at least 5 years.

12/Baloxavir uses a new mechanism to attack the flu virus (and treat previously resistant strains); it also reached similar endpoints to oseltamivir and reduced the viral load faster than both oseltamivir and placebo in a single dose vs a 5-day course.

13/Oseltamivir, zanamivir, and baloxavir can be used to prevent someone from becoming infected in the first place, with enough lead time to protect household members.

14/But what do you do if you have a patient like Naomi, who lives with someone who is sick with the flu? What steps can you take to help prevent Naomi from getting infected and sick? Answer: Prophylaxis.

15/Before we talk about chemoprophylaxis, let us also mention some simple measures that you can employ that have been shown to reduce the transmission of the influenza virus.

16/In a 2016 study, good handwashing was associated with a 74% to 97% reduction of influenza compared with poor handwashing. Good ventilation has also been known for decades as a way to reduce influenza transmission. Therefore, wash hands regularly and open windows if possible.

17/A 2021 study showed a negative relationship between sunlight exposure and increased influenza incidence. Therefore, spending time outdoors in sunlight and fresh air may be a way of reducing your risk of getting influenza, even in the fall or winter when sunlight is scarce.

18/Now that we know of some simple measures that we can take to prevent influenza infection and spread, let’s discuss the medications that also help reduce the risk of transmission.

19/It turns out that baloxavir, oseltamivir, and zanamivir can not only treat flu symptoms after they occur, but also prevent those symptoms if taken by people already exposed to influenza. This is known as postexposure prophylaxis.

20/It’s time for a poll!

On average, what percentage of influenza infection transmission occurs among household members?

21/If you answered C, 30%, you are correct. This number is higher in households with several children, which also lengthens the interval between the presentation of primary and secondary diagnosed cases. This leads to longer duration of illness for the entire family.

22/Having a medication that reduces symptoms and transmission in children would be beneficial in reducing overall household transmission, especially because data show that children shed the virus for at least a day before becoming symptomatic.

23/Postexposure antiviral chemoprophylaxis may be appropriate in the outpatient setting for adults and children aged 3 months and older (particularly those at high risk) after exposure to influenza; it should be administered within 48 hours of exposure.

24/In August 2022, baloxavir joined the ranks of oseltamivir and zanamivir as an FDA-approved medication for chemoprophylaxis for children. It is now approved for children over age 5.

25/Time for our last poll. Should primary care and pediatric healthcare practitioners should play a more active role in the medical management of their patients with influenza?

26/Yes, it is always good to play a more active role in the medical management of your patients.

Thank you for joining this #CME #Tweetorial!

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