Influenza in High-Risk Populations: Diagnosis and Treatment

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Influenza in High-Risk Populations: Diagnosis and Treatment

Stefan Gravenstein, MD, MPH

Release Date: October 30, 2015

Expiration Date: October 29, 2016 (THIS ACTIVITY IS NO LONGER AVAILABLE FOR CREDIT)

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ACTIVITY DESCRIPTION

Join expert Stefan Gravenstein, MD, MPH, for this CME/CNE-certified activity and get an in-depth look at the latest protocols and processes for influenza diagnosis and management strategies for special populations including:

Antiviral therapies: when to start treatment in your high-risk patients
Adjunctive treatment for high-risk patients with comorbidities

LEARNING OBJECTIVES

Upon completion of this activity, learners should be better able to:

Develop protocols for influenza diagnosis that rely on empiric evidence, local flu surveillance, and diagnostic tests to determine patients who require antiviral therapy

Recognize how to optimize and individualize treatment strategies for infants and children, healthy adults, elderly people, pregnant women, and individuals with comorbidities who have probable influenza

FACULTY

Stefan Gravenstein, MD, MPH

Professor of Medicine
Director, Center for Geriatrics and Palliative Care
University Hospitals and Case Western Reserve University
Cleveland, OH
Adjunct Professor of Medicine, Brown University
Providence, RI

FACULTY BIOGRAPHY

Stefan Gravenstein, MD, MPH, is Professor of Medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio. He serves as interim Chief of the Division of Geriatrics and Palliative Care at Case Western Reserve University and as Director of the Center for Geriatrics and Palliative Care at University Hospitals-Case Medical Center. He is also Adjunct Professor of Medicine at The Warren Alpert Medical School and School of Public Health at Brown University in Providence, Rhode Island. Dr Gravenstein received his medical degree from The Ohio State University in Columbus. He completed his residency at University of Wisconsin Hospitals and Clinics, followed by a geriatrics fellowship and postdoctoral training at William S. Middleton Veterans Hospital, both in Madison, Wisconsin. He received his master of public health from Eastern Virginia Medical School/Old Dominion University in Norfolk.

Dr Gravenstein has a longstanding interest in immunity, inflammation, and aging, especially in the context of influenza, vaccination, and nursing-home care. He also has a specific interest in quality improvement in healthcare, the culture of care, and how to improve care across care transitions. He has served as Principal Investigator or Co-Investigator on multiple research grants and clinical trials, investigating these topics with uninterrupted competitive funding since 1989. He has authored more than 120 peer-reviewed articles and 20 books and book chapters. In addition, Dr Gravenstein currently serves as clinical section editor for Gerontology, and he is a reviewer for several journals. He is a member of many professional societies including the American College of Physicians, American Geriatrics Society, Gerontological Society of America, American Medical Directors Association, and American Medical Association.

DISCLOSURE STATEMENTS

According to the disclosure policy of the Academy, all faculty, planning committee members, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity, and levels of evidence. Disclosures are as follows:

Stefan Gravenstein, MD, MPH
Advisory Board, consultant – for marketing purposes: Sanofi-Aventis
Advisory Board – for scientific information: Janssen, Pfizer
Consultant – for clinical trial design: Merck
Grant Recipient/Research Support: Sanofi-Aventis
Promotional Speaker’s Bureau: Sanofi-Aventis
Other grant support: Agency for Healthcare Research and Quality, The Cleveland Foundation, The McGregor Foundation, and National Institute of Allergy and Infectious Diseases

Independent Clinical Peer Reviewer
Christianne N. Fowler, BSN, MS, DNP
Assistant Professor, Old Dominion University, School of Nursing
Assistant Professor, Eastern Virginia Medical School
Norfolk, VA
No relevant financial relationships with any commercial interests.

Planning Committee

American Academy of CME
John JD Juchniewicz, MCIS, CHCP
No relevant financial relationships with any commercial interests.

Natalie Kirkwood, RN, BSN, JD, Lead Nurse Planner
No relevant financial relationships with any commercial interests.

Spire Learning
Lisa Conklin
No relevant financial relationships with any commercial interests.

Jeanne Prater
Shareholder (spouse/partner): Johnson & Johnson
Employee (spouse/partner): Novo Nordisk

Jaime Symowicz, PhD
No relevant financial relationships with any commercial interests.

Lauren Waters
No relevant financial relationships with any commercial interests.

DISCLAIMER

The opinions expressed in this educational activity are those of the faculty, and do not represent those of Academy, Spire Learning, or American Nurses Credentialing Center’s Commission on Accreditation. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.

Recommendations made in this educational activity were based on guidance from the CDC for the 2014-2015 influenza season. Participants are encouraged to also consult the guidance for the 2015-2016 influenza season below:

Updates for the 2015-2016 Influenza Season

Click here for recommendations from the CDC’s Advisory Committee on Immunization Practices. http://www.cdc.gov/flu/professionals/acip/index.htm

Updated information for 2015-2016 includes:

Antigenic composition of U.S. seasonal influenza vaccines
Information on influenza vaccine products expected to be available for the 2015–2016 season
An updated algorithm for determining the appropriate number of doses for children aged 6 months through 8 years
Recommendations for the use of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) when either is available, including removal of the 2014–2015 preferential recommendation for LAIV for healthy children aged 2 through 8 years.

OFF-LABEL STATEMENT

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the FDA, specifically the use of neuraminidase inhibitors beyond 48 hours of influenza symptom onset. Faculty have been asked to indicate such discussion at the time of their mention. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. The opinions expressed in this educational activity are those of the faculty, and do not represent those of the Academy or Spire Learning. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.

LEVELS OF EVIDENCE

Levels of evidence are provided for any patient care recommendations made during this program.

Level A (randomized controlled trial/meta-analysis):

High-quality, randomized controlled trial (RCT) that considers all important outcomes. High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies

Level B (other evidence):

A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower-quality RCTs, clinical cohort studies, and case-controlled studies with nonbiased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings, is also included

Level C (consensus/expert opinion):

Consensus viewpoint or expert opinion

DISCLAIMER: Please note that the polling questions in this enduring activity are informational only and are not interactive.

TARGET AUDIENCE

Emergency medicine physicians
Hospitalists
Primary care providers
Pediatricians
Geriatricians
Obstetricians
NPs
PAs
Nurses

ACCREDITATION

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of American Academy of CME, Inc., (Academy) and Spire Learning. American Academy of CME, Inc., is accredited by the ACCME to provide continuing medical education for physicians.

American Academy of CME, Inc., designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses

American Academy of CME, Inc., is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

American Academy of CME, Inc., designates this educational activity for 0.50 contact hours

(0.5 pharmacotherapeutic contact hours).

ANCC Accreditation Feedback Line:

1-866-262-9730

The Accreditation Program of the American Nurses Credentialing Center is interested in the opinions and perspectives of the participants in accredited continuing nursing education activities, particularly those perspectives related to the presence of perceived bias* in the continuing education. For this reason, we are now providing a toll-free telephone number. Participants may access this number at any time to:

Tell us of any noted bias or conflict of interest in the education
Tell us of any concerns, compliments, or opinions
Tell us of a great experience
Tell us of an unpleasant experience
Tell us your thoughts on the process

Just call and tell us!

1-866-262-9730

*Bias is defined as preferential influence that causes a distortion of opinion or of facts.
Commercial bias may occur when an educational activity promotes one or more product(s) (drugs, devices, services, software, hardware, etc). This definition is not all inclusive and participants may use their own interpretation in deciding if a presentation is biased.

NOTE: Statements of commercial support and/or conflict of interest disclosures do not represent bias. Such statements inform the learner that the provider has implemented a mechanism to identify and resolve all conflicts of interest prior to delivery of the educational material.

METHOD OF PARTICIPATION

This activity has no fee and should take approximately 30 minutes to complete. Participants should first read the objectives and other introductory CE information, then complete the pre-assessment and participate in the online case activity. To receive credit for this activity, participants must complete the post-assessment with a passing score of 70% and then complete the evaluation. Your certificate can be printed immediately. This activity is valid through October 29, 2016. No credit will be awarded after this date.

This educational activity is jointly provided by American Academy of CME, Inc. and Spire Learning.

This activity is supported by an educational grant from Genentech.

CONTACT

For any CE questions, please contact: CEServices@academycme.org.

For technical question, please contact info@rapidcme.com.

PRIVACY

For more information about the American Academy of CME privacy policy, please access http://www.academycme.org/privacy.htm.

HARDWARE/SOFTWARE REQUIREMENTS

Hardware-software Requirements

Copyright

©2015. This CME/CNE-certified activity is held as copyrighted by American Academy of CME and Spire Learning. Through this notice, the Academy and Spire Learning grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).

References for Influenza in High-Risk Populations: Diagnosis and Treatment

American Academy Pediatrics; Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2014-2015. Pediatrics. 2014;13:e1503-e1519.

CDC. 2014 Ebola Outbreak in West Africa - Case Counts. Updated August 3, 2015. www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. Accessed August 3, 2015.

CDC. Measles Vaccination. Updated July 1, 2015. www.cdc.gov/measles/vaccination.html. Accessed August 3, 2015.

CDC. CDC Recommendations for Influenza Antiviral Medications Remain Unchanged. Published April 10, 2014. www.cdc.gov/media/haveyouheard/stories/Influenza_antiviral2.html. Accessed August 3, 2015.

CDC. People at High Risk of Developing Flu–Related Complications. Updated January 8, 2015. www.cdc.gov/flu/about/disease/high_risk.htm. Accessed August 3, 2015.

CDC. Laboratory-Confirmed Influenza Hospitalizations. http://gis.cdc.gov/grasp/fluview/FluHospChars.html. Accessed August 3, 2015.

CDC. Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests. Updated November 13, 2014. http://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm. Accessed August 3, 2015.

CDC. Flu Activity & Surveillance. Updated December 4, 2014. http://www.cdc.gov/flu/weekly/fluactivitysurv.htm. Accessed August 3, 2015.

CDC. Why CDC Recommends Influenza Antiviral Drugs. Updated March 3, 2015. www.cdc.gov/media/haveyouheard/hyh-antiviraldrugs.html. Accessed August 3, 2015.

CDC; Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM. Antiviral agents for the treatment and chemoprophylaxis of influenza — recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60:1-24.

Cox N, Subbarao K. Influenza. Lancet. 1999;354:1277-1282.

Cox N, Fukuda K. Influenza. Infect Dis Clin North Am. 1998;12:27-38.

Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385:1729-1737.

Jefferson T, Jones MA, Doshi P, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014;4:CD008965.

Lee N, Ison MG. Editorial commentary. “Late” treatment with neuraminidase inhibitors for severely ill patients with influenza: better late than never? Clin Infect Dis. 2012;55:1205-1208.

Louie JK, Yang S, Acosta M, et al. Treatment with neuraminidase inhibitors for critically ill patients with influenza A (H1N1)pdm09. Clin Infect Dis. 2012;55:1198-1204.

Muthuri SG, Venkatesan S, Myles PR, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014;2:395-404.