Specificrecommendationsregardingtheuseof antivirals for chemoprophylaxis of pandemic (H1N1) 2009 influenzavirusinfectionareasfollows:
• When risk for human-to-human transmission of influenzaishighorlow,and the probability of complications of infection is high, either because of the influenzastrainorbecauseofthebaseline risk of the exposed group, use of oseltamivir or zanamivir may be considered as postexposure chemoprophylaxis for the affected community or group, for individuals in at-risk groups, or for healthcare workers (weak recommendation, moderate-quality evidence).
• Individuals in at-risk groups or healthcare personnel do not need to be offered antiviral chemoprophylaxis if the likelihood of complications of infection is low. This recommendation should be applied independent of risk for human-to-human transmission (weak recommendation, low-quality evidence).
For treatment of mild to moderate uncomplicated clinical presentation of infection with multiple cocirculating influenzaA subtypes or viruses with different antiviral susceptibilities, patients in at-risk groups should
be treated with zanamivir or oseltamivir plus M2 inhibitor (noting that amantadine should not be used in pregnant women). Otherwise-healthy patients with this presentation need not be treated.
When the clinical presentation of infection with multiple cocirculating influenzaAsubtypes or viruses with different antiviral susceptibilities is severe or progressive, all patients should be treated with oseltamivir plus M2 inhibitor, or zanamivir.
For treatment of mild to moderate uncomplicated clinical presentation of infection with sporadic zoonotic influenzaAviruses including H5N1, the at-risk population should be treated with oseltamivir or zanamivir, and the otherwise-healthy population with oseltamivir. All patients, regardless of risk status, with severe or progressive presentation of infection with sporadic zoonotic influenzaAviruses including H5N1 should be treated with oseltamivir plus an M2 inhibitor.
REFERENCES
1. WHO guidelines for pharmacological management of pandemic (H1N1) 2009 Influenzaandotherinfluenzaviruses, 2009. http://www.who.int/csr/swineflu/2009
2. http://cme.medscape.com/viewarticle/708032?src=cmenews&uac=62320HK