For Clinicians
Flu surveillance in California is now being conducted all year round. California Department of Public Health recommends healthcare providers should:
- Continue to test for influenza in patients with respiratory illness and exposure risk factors for avian influenza (A)H5N1, and if positive for influenza A, arrange for subtyping at a public health laboratory.
- Continue to test for influenza in hospitalized patients with severe respiratory illness (particularly those in the ICU) regardless of exposure history and arrange for all influenza A positive specimens to be sent to a clinical, commercial, or local public health laboratory for subtyping.
- Report suspected cases of novel influenza, particularly avian influenza A(H5N1), to local health department of the patient’s residence based on symptoms and relevant exposure, OR if an influenza A test was positive, and subtyping was attempted but did not identify a seasonal influenza A subtype (this includes unsubtypeable results).
- In patients with combination of respiratory illness and conjunctivitis, please test for influenza even in the absence of avian risk factor.
Prevention
Vaccinate! Both intranasal and different injectable formulations are available. Encourage patients to get their flu vaccine. Refer to Vaccine Information for additional information on vaccine composition, dosing, storing, and administration or the comprehensive Advisory Committee on Immunization Practices (ACIP) guidelines, Prevention and Control of Influenza with Vaccines for the 2021-22 season.
Flu Vaccine from ACPHD: Each year, we distribute flu vaccine to providers who agree to certain guidelines about to whom they will administer the vaccine and how and when to report usage. Visit our Flu Vaccine Distribution Program page for more information.
Masks remain a critical component for protecting the most vulnerable people in our communities, including older adults, people who are immunocompromised, have certain disabilities or underlying health conditions, and are otherwise at increased risk of getting severe COVID-19 and other respiratory infections.
ACPHD recommends residents wear a mask:
- Around others if you have respiratory symptoms (e.g., cough, runny nose, and/or sore throat),
- If you've had a significant exposure to someone who has tested positive for COVID-19, wear a mask for 10 days.
- If you test postive for COVID-19, see guidance for mask wearing in the CDPH Guidance for Isolation and Quarantine of the General Public.
In addition, wearing a mask is increasingly important for those who are at higher risk for getting very sick from COVID-19, and as the risk for transmission increases in the community. Examples of settings where it may be important to wear a mask:
In indoor public settings where people who are older or have medical conditions that put them at higher risk of severe illness may reside or are cared for (such as hospitals, skilled nursing facilities, and long term-care facilities).
In crowded indoor public settings that may have poor ventilation, including public transportation and other congregate settings.
See additional information on how to assess your risk in indoor public settings and exposure risks.
Treatment
Early antiviral treatment is recommended for any person who has severe illness, is at high risk for severe illness or complication, or is hospitalized for influenza. It is ideal to start treatment with oseltamivir or zanimivir within 48 hours of onset, but may still be of benefit up to 4 to 5 days after onset. If you suspect influenza in a patient, don’t wait for lab results to begin treatment.
For more information refer to the Centers for Disease Control and Prevention (CDC): Influenza Antiviral Medications: Summary for Clinicians.
Pregnant and Postpartum Women
Pregnant and postpartum women are at high risk for serious complications from influenza virus. Health care providers should encourage all women who might be pregnant, who are pregnant and who are postpartum to get vaccinated. Influenza vaccination can be administered at any time during pregnancy, before and during the influenza season. Influenza vaccination can also help protect against premature labor and delivery. Antivirals are recommended for treating influenza in pregnant women. For more information and an algorithm for dosing in this age group please refer to the ACIP guidelines.
Influenza Vaccine Dosage
Children aged 6 months through 8 years who are receiving influenza vaccine for the first time, and some in this age group who have previously been vaccinated, require two doses of vaccine administered ≥4 weeks apart. Refer to Vaccine Information for additional information on vaccine composition, dosing, storing, and administration or the comprehensive Advisory Committee on Immunization Practices (ACIP) guidelines. For more information and an algorithm for dosing in this age group please refer to the ACIP guidelines.
Influenza Vaccination of Persons with a History of Egg Allergy
Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine. The ACIP Guidelines recommend watching these and non-allergic persons for 15 minutes following vaccination to decrease the risk of injury due to syncope. Persons with severe egg allergy should be vaccinated under the supervision of a medical provider who is able to recognize and manage severe allergic conditions.
Laboratory Specimens
When submitting individual specimens for influenza testing to the Alameda county public health lab, please use this form:
Infection Control
Clinics: Please provide masks and hand sanitizer for patients with suspected influenza and ask them to mask before sitting in waiting rooms.
Inpatient: Standard and droplet precautions should be implemented for patients with suspected or confirmed influenza, including placement in a private room and placing a surgical mask on patients if they must be transported to other areas of the facility.
- CDPH Guidance for Influenza Prevention in Health Care Settings (This 2010 document is still in effect.)