Prevention and Treatment of Seasonal Influenza

Fever developed in a previously healthy 15-year-old girl, with a peak temperature of 102°F (38.9°C) and mild upper respiratory congestion. Oseltamivir therapy was initiated, but the fever persisted, and she began to vomit. She was taken to an emergency room, where she was found to be hypotensive. Despite intensive resuscitative efforts, she died 12 hours later. A viral culture confirmed influenza A (H1N1) infection. Rates of hospitalization due to influenza have increased steadily. The standard, risk-based strategy of vaccination does not effectively prevent serious illness and death. This review presents the case for universal vaccination, summarizes the evidence, and gives detailed recommendations for the prevention and treatment of seasonal influenza. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage In February 2007, fever developed in a previously healthy 15-year-old girl, with a peak temperature of 102°F (38.9°C) and mild upper respiratory congestion. The next day she was seen by her primary care physician. A rapid screening test for group A streptococcus was negative, and oseltamivir was prescribed. After two doses, she continued to have fever and also had nausea and emesis, malaise, and restlessness but could not get out of bed. Two days later, she was taken to the local emergency room, where she was found to be hypotensive. Despite intensive resuscitative efforts, she died 12 hours later; . . .