Influenza Management

Is Your Office Ready for Flu Season?

When influenza strikes, it can hit your practice with a flood of patients — and at the same time, threaten you and your staff. But with some advanced planning, you can help minimize the impact of influenza on your practice.

Stay apprised of the flu outbreaks in your area and get the information you need to help your staff prepare for the flu.

Office preparation steps

These tips can help you protect your practice this flu season. Don't forget to use the FluTracker to know when the flu is in your area.

  1. Start preparing by preventing.

    You and your staff should be vaccinated before the influenza season. Other target groups for influenza vaccination include the elderly; residents of nursing homes and other chronic-care facilities; adults and children with chronic underlying illnesses (such as asthma); and women who will be in the second or third trimester of pregnancy during the influenza season.2

  2. Refresh diagnostic skills.

    Promote influenza awareness in your practice, and aid your staff in recognizing the signs and symptoms of flu. Effective management with antiviral therapy relies upon prompt initiation of treatment, so rapid recognition of influenza is essential.10, 21 The onset of influenza is sudden: people describe feeling like they've "been hit by a truck." Fever, muscle aches and pains, and chills are common influenza clues and help differentiate influenza from other common respiratory viral infections, such as a cold.3 If there are reports of influenza in your area and a patient has these classic influenza symptoms, chances are increased that it is influenza.4

  3. Make time for telephone triage.

    Developing your own practice protocol for telephone triage will enable you and your triage nurse to:

    • Prioritize visits for patients by severity of illness.
    • Identify patients who are candidates for a prompt visit by asking questions regarding:
      • Recent (less than 2 days) onset of influenza.
      • Presence of classic influenza symptoms such as fever, aches, and myalgia.
    • Assess if patients are taking over-the-counter medications for symptomatic relief.

    During busy influenza seasons, you may want to assign one healthcare professional to field patient calls and schedule visits.

  4. Don't be caught short-staffed.

    Schedule to minimize staff absences during the influenza season. As the end of the year approaches, it's natural for people to try to take their vacation days — especially with all of the November and December holidays. A few staff members may also miss work due to the flu. Planning ahead can help to ensure coverage, reduce staff conflict, and make sure everyone gets their well-deserved time off while still providing quality care for your patients.

  5. Schedule office visits realistically.

    Take into account the influenza season, and Monday mornings. Don't overload your appointment book with regularly scheduled patients when experience tells you to expect a number of walk-in or call-in patients who must be seen that day. Try to avoid scheduling less urgent appointments, such as routine physicals, during influenza outbreaks.

  6. Schedule office hours conveniently.

    Know your patient demographics (or those of the patients you hope to attract to your practice) and schedule hours to accommodate them. Retirees may be able to visit any time during the day; however, employed people who are seeing you for nonemergency care are often unable to schedule visits during normal working hours. Similarly, parents must juggle not only their own schedules, but the needs of their children. In a primary care practice, accommodating these patients may mean extended morning or evening hours.

  7. Plan for prompt initiation of treatment.

    When a patient calls in, use the opportunity to identify if he or she meets your established protocols, and if he or she may be an appropriate candidate for antiviral treatment. Since early initiation is essential for treating influenza with antivirals, it is important to see the patient as soon as possible.10, 21

Next Step:Learn about prescribing Tamiflu for adults ›

Did you know?

In a clinical study, children aged 1-12 years who received Tamiflu within 48 hours of first flu symptoms recovered up to 26% (36 hours) faster than those who didn't receive Tamiflu.8

Learn more ›

Indications and Limitations of Use

TAMIFLU is indicated for the treatment of acute, uncomplicated illness due to influenza infection in patients 2 weeks of age and older who have been symptomatic for no more than 2 days.

TAMIFLU is also indicated for the prophylaxis of influenza in patients 1 year and older.

  • Efficacy of TAMIFLU in patients who begin treatment after 48 hours of symptoms has not been established.
  • TAMIFLU is not a substitute for early and annual vaccination as recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices.
  • There is no evidence for efficacy of TAMIFLU in any illness caused by agents other than influenza virus types A and B.
  • Influenza viruses change over time. Emergence of resistant mutations could decrease drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish clinical benefit of antiviral drugs. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use TAMIFLU.
Important Safety Information

Severe allergic reactions

  • TAMIFLU is contraindicated in patients who have had severe allergic reactions such as anaphylaxis or serious skin reactions such as toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme to any component of TAMIFLU.
  • In postmarketing experience, cases of anaphylaxis and serious skin reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme, have been reported with TAMIFLU. TAMIFLU should be stopped and appropriate treatment instituted if an allergic-like reaction occurs or is suspected.

Neurologic symptoms

  • Influenza can be associated with a variety of neurologic and behavioral symptoms, which can include events such as hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes. These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease.
  • There have been postmarketing reports (mostly from Japan) of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving TAMIFLU. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on TAMIFLU usage data. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution. The contribution of TAMIFLU to these events has not been established. Closely monitor patients with influenza for signs of abnormal behavior. If neuropsychiatric symptoms occur, evaluate the risks and benefits of continuing treatment for each patient.

Bacterial infections

  • Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. TAMIFLU has not been shown to prevent such complications.

Limitations of populations studied

  • Efficacy of TAMIFLU in the treatment of influenza in patients with chronic cardiac disease and/or respiratory disease has not been established. No difference in the incidence of complications was observed between the treatment and placebo groups in this population. No information is available regarding treatment of influenza in patients with any medical condition sufficiently severe or unstable to be considered at imminent risk of requiring hospitalization.
  • Efficacy of TAMIFLU for treatment or prophylaxis of influenza has not been established in immunocompromised patients.
  • Safety and efficacy of TAMIFLU for treatment of influenza in pediatric patients less than 2 weeks of age have not been established.
  • Safety and efficacy of TAMIFLU for prophylaxis of influenza have not been established for pediatric patients less than 1 year of age.

Concurrent use with live attenuated influenza vaccine

  • The concurrent use of TAMIFLU with live attenuated influenza vaccine (LAIV) intranasal has not been evaluated. However, because of the potential for interference between these products, LAIV should not be administered within 2 weeks before or 48 hours after administration of TAMIFLU, unless medically indicated.

Most common adverse reactions

  • The safety profile observed in pediatric patients 2 weeks to less than 1 year of age was consistent with the established safety profile of pediatric subjects aged 1 year and above, with vomiting, diarrhea, and diaper rash being the most frequently reported adverse reactions.
  • Adverse events that occurred more frequently in patients treated with TAMIFLU than in patients taking placebo and occurred in ≥2% of patients were (TAMIFLU %, placebo %):
    • Treatment in adults — nausea (10%, 6%), vomiting (9%, 3%).
    • Treatment in pediatrics — vomiting (15%, 9%), abdominal pain (5%, 4%), ear disorder (2%, 1%).
    • Prophylaxis of adults — nausea (7%, 3%), diarrhea (3%, 2%), vomiting (2%, 1%), abdominal pain (2%, 1%).
    • Prophylaxis of pediatrics — vomiting (10%, 2%), abdominal pain (3%, 0%), nausea (4%, 1%).

Please see the TAMIFLU full Prescribing Information for complete safety information.


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View CDC guidelines ›