Employee Guidance On Pandemic Influenza Antiviral Medications

What are influenza antiviral medications?

Influenza antiviral medication (drug) reduces an influenza virus' ability to reproduce in the body. It is not a cure for influenza. When used appropriately, they can shorten the duration and lessen the severity of illness. They may also be used to prevent illness in people who are exposed to influenza.

How are antiviral medications used for influenza?

For Treatment: To be most effective, antivirals must be started within 48 hours of the start of symptoms.

For Prevention: During pandemic, health care workers, first responders, and others may be considered for prevention depending on their level of exposure to influenza, job duties, availability and prioritization of antivirals. There are two types of prevention: post-exposure prophylaxis, which is when a person has a known or suspected exposure, and starts antiviral medications to prevent disease, and outbreak prophylaxis, which is when a person is recommended to take antiviral medications for the entire duration of a pandemic outbreak. Currently, CDC is only recommending post-exposure prophylaxis for persons with certain underlying medical conditions.

Exposure is defined by CDC as close contact (less than six feet) from someone with influenza, but does not include walking by the infectious person or sitting across a room from them.

What are the types of antiviral medications available?

There are two categories of antivirals that can be obtained for treatment through DHS or a private health care provider: amantadines and neuraminidase inhibitors. Because a pandemic strain of influenza may be resistant to an amantadine, neuraminidase inhibitors are currently recommended for treatment and prevention. These are:

• Oseltamivir (Tamiflu®) - which is licensed for the prevention and treatment of influenza in persons greater than 1 year of age.
• Zanamivir (Relenza®) - which is licensed for the treatment of persons older than 7 years, and the prevention or treatment of influenza in persons aged greater than 5 years.

An Emergency Use Authorization from the FDA exists so that Doctors may treat children younger than one year of age if necessary.

Antiviral chemoprophylaxis for ten days after exposure can be considered for:

• Persons who are at high-risk for severe influenza and have been household close contacts of a confirmed, probable or highly suspected case.
• Health care personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with novel (H1N1) influenza virus infection (confirmed, probable, or suspected) during that person's infectious period.

Persons with suspected or probable H1N1 infection or anyone displaying symptoms of H1N1 influenza should be considered contagious for seven days or until 24-hours after symptoms have resolved, whichever is longer.

Prevention of the spread of novel influenza A (H1N1) virus infection relies on non-pharmacologic infection control measures. Employees who are feeling sick or ill are advised to seek medical care from a physician in order to determine the cause of their illness. It is imperative that sick or ill employees seek medical attention to identify their illness and any possible exposure of co-workers at their facility. If an employee exhibits influenza-like symptoms, the employee should limit interactions with others and remain home until symptoms have resolved for 24 hours.

DHS, Office of Health Affairs recommends treatment of persons with suspected influenza according to CDC guidelines, and prophylaxis of persons exposed with high risk medical conditions (see Guidance for Employees with High Medical Risk) with either oseltamivir or zanamivir to reduce the level of severe disease and mortality that may be caused by novel influenza A (H1N1) virus infection. The antiviral medicines Tamiflu® (oseltamivir) and Relenza® (zanamivir) can help alleviate H1N1 flu symptoms in those with severe illness or risk factors for complications from influenza. Most influenza lasts only a few days, and most people recover completely without medication.

Individuals should seek medical care for symptoms of more severe influenza, such as:

• difficulty breathing
• unable to take adequate fluids
• confusion or altered mental status; severe headache or other pain that is clearly not controlled by usual medications; sudden weakness, or change in vision
• rapid worsening of symptoms

The guidance on Post-Exposure Prophylaxis (PEP) is changing as the scientific knowledge of this virus grows. Although our employees are not necessarily “first responders,” DHS employees who have frequent, necessary face to face contact with the public have a risk profile and critical mission similar to first responders, and should follow this guidance. Those DHS employees that have healthcare responsibilities, such as Nurses, Doctors, and Emergency Medical Technicians, should follow the Healthcare guidance. DHS/OHA will provide updates on guidance as it is released. In certain high risk circumstances, Components in may update the post exposure prophylaxis guidance in concert with CDC and their Medical Oversight.

The best method for treatment or post exposure prophylaxis is for the employee to seek care from their Physician. DHS/OHA has procured enough antivirals to have a treatment or post exposure prophylaxis course available to all our personnel. Currently, there is no shortage of antivirals available in the communities where our employees live and work. DHS medications are an emergency supply, and will be made available if necessary.

For more information, please see http://www.cdc.gov/h1n1flu/recommendations.htm

This information provides general guidance only for employees covered by Title 5, United States Code, and does not, and is not intended to create or violate any legal rights.