Posted Dec. 19, 2022. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.
Significantly elevated respiratory viral activity, including early increases in influenza viral infections, has contributed to a shortage of commonly used medications, including oseltamivir (Tamiflu ®). Many communities in Washington state may continue to experience shortages in the coming weeks.
To ensure an adequate supply of antiviral medications for individuals who are at high risk for severe influenza-associated complications, the Washington State Department of Health is providing the following recommendations on the use of oseltamivir when supply is limited. Preventative strategies to reduce the burden of influenza should be maintained, including influenza vaccination and messaging about general infection prevention. Key points from the recently published CDC Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir are included below. Click here to see the full CDC HAN document
*Given the increased circulation of numerous respiratory viruses in the community, we recommend testing to confirm the diagnosis of influenza as long as testing does not delay treatment for priority groups per CDC influenza antiviral medication guidance.
**Oral capsules come in 30, 45 and 75mg strengths. Attention should be paid to ensure appropriate weight-based dosing.
These recommendations are intended to provide guidance, but do not replace clinical judgement, expert consultation or other recognized guidelines (e.g. IDSA, AAP and CDC).
As you are aware, Washington is experiencing a significant surge in cases of respiratory syncytial virus (RSV) with a simultaneous early influenza season, causing strain on healthcare resources, most notably in pediatric acute care/ICU. Smaller or rural community hospitals are experiencing difficulties or delays in transferring pediatric patients. The Washington State Medical Association and other professional organizations have released a statement discussing this issue. We have also assembled a list of resources that may be useful, particularly those facilities and providers that do not routinely care for infants and children with respiratory illnesses who need higher acuity care.
See CDC HAN on increased respiratory virus activity
CDC provides an algorithm for SARS-CoV-2 and influenza testing when both viruses are circulating. For patients who would benefit from antiviral treatment for influenza, early treatment is essential. As a result, empiric treatment may be preferable; influenza testing may not be necessary in the outpatient setting if it will not change clinical management. Given the lack of available treatment options, RSV testing may not be helpful in the outpatient setting if it will not change clinical management.
RSV usually causes a mild upper respiratory illness but can cause more serious lower respiratory tract disease in young children, older adults, or adults with chronic medical conditions. In young children, bronchiolitis is a common manifestation of lower respiratory tract disease, though pneumonia can also occur. While there are no directed treatments for RSV infection, eligible infants at higher risk of severe disease should receive palivizumab prophylaxis. The resources below provide further information on clinical management and prophylaxis.
As noted above, for patients who would benefit from antiviral treatment for influenza, early treatment is essential. As a result, empiric treatment is often preferable (rather than awaiting influenza testing). The resources below provide guidance on influenza treatment for children and adults.
AAP does not recommend routine use of antibiotics for viral respiratory illnesses and does not recommend cough and cold medicines be used in young children.
American Academy of Pediatrics | Choosing Wisely (recommendations 1 and 2)
The resources below can help preparation and management of situations in which pediatric healthcare resources are strained.
Given the shared modes of transmission for respiratory viruses, the same infection prevention measures can help prevent transmission of multiple viruses. In all settings, COVID-19 vaccination, influenza vaccination, staying home when sick, mask use in crowded indoor settings, good hand hygiene, respiratory etiquette (i.e., covering coughs and sneezes), and routine surface cleaning can help to limit transmission. CDC provides specific guidance on reducing influenza transmission in schools, which may be helpful for K-12 school partners.
The AAP’s HealthyChildren.org site provides a range of resources for parents, including a dedicated RSV page as well as a comparison of COVID-19, influenza, and RSV
