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Influenza in Urgent Care (Pharmacology CME)

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Points

The CDC defines influenza-like illness (ILI) as a temperature >37.8°C (100°F), with either cough or sore throat, in the absence of a known cause other than influenza.
Since the emergence of COVID-19, tracking of ILI has become significantly more complicated as healthcare-seeking behaviors for ILI symptoms has markedly changed. Overall, however, rates of seasonal influenza have been much lower than historic comparisons during the SARS-CoV-2 pandemic.6
The most common symptoms of influenza in adults are cough, fatigue, nasal congestion, and fever.
Sneezing is a negative predictor of influenza in adults.
In children, the most common presenting symptoms are fever, cough, and rhinitis. Vomiting and diarrhea are more common in children than adults.
When influenza is suspected, patients and clinicians should wear face masks to avoid spreading the virus
Isolation and droplet precautions should be maintained in the UC setting for suspected or confirmed infections.
Though influenza vaccine effectiveness is typically only 50%, this still translates to a significant decrease in influenza-related morbidity and mortality.
For mild-to-moderate disease and no underlying high-risk conditions, supportive therapy is usually sufficient.
For more-ill patients or those at substantial risk for complications, consider antiviral treatment.
Neuraminidase inhibitors (oseltamivir, zanamivir, peramivir) are associated with decreased duration of symptoms and complications, especially if started within 2 days of symptom onset.
Oseltamivir is approved for patients of all ages, and it reduces the duration of symptoms by one day if given within 48 hours of onset of symptoms.
Chemoprophylaxis with oseltamivir or zanamivir should be considered in patients who are immunocompromised or at elevated risk for complications and cannot receive the vaccination.
Consider oseltamivir for postexposure prophylaxis in pregnant women, as they are at high risk for complications from influenza.
During seasonal influenza season, monitor the CDC website frequently for current information on prevalence, circulating strains, and recommended treatments.
For patients who can be safely discharged from UC, clinicians should engage with the patient in shared decision making regarding the risks and benefits of available treatments and review return precautions and reasons to seek care in the ED.

Pearls

During peak flu season, clinical judgement may be as good as rapid testing, making rapid testing less necessary.
Rapid testing may be more beneficial in times of lower disease prevalence.
Empiric treatment of patients who are at high risk for complications of influenza and a more severe disease course should be considered even if rapid testing is negative.

Publication Information

Editor in Chief & Update Author

Keith Pochick, MD, FACEP
Editor-in-Chief; Attending Physician, Urgent Care
Joshua Russell, MD, MSc, FCUCM, FACEP
Update Author; Supervising Physician, Legacy-GoHealth Urgent Care; Staff Physician, NorthShore University Immediate Care, Vancouver, WA

Urgent Care Peer Reviewer

Michael Kim, DO;
Huai Lee Phen, MD

Charting Commentator

Brad Laymon, PA-C, CPC, CEMC

Publication Date

December 1, 2022

CME Expiration Date

December 1, 2025 CME Information

CME Credits

4 AMA PRA Category 1 Credits™. 4 AOA Category 2-A or 2-B Credits.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits

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