Written by: Logan Wedel, MD (NUEM ‘22) Edited by: Laurie Aluce, MD (NUEM ‘21) Expert Commentary by: Gabrielle Ahlzadeh, MD (NUEM ‘19)
Expert Commentary
Thank you for the concise and informative resource guide. Don’t we all yearn for the days when patients with myalgias and fever were typically diagnosed with influenza and sent on their merry way? Believe it or not, there are some interns who may go their entire first winter as physicians without diagnosing influenza.
A large part of our jobs as emergency medicine physicians is reassurance. Patients want to know they are okay, but they always want something to make them feel better faster, which is true for influenza as well as coronavirus. And while most young, healthy patients do not need treatment for influenza, another consideration is time lost from work, even though symptom duration is really only decreased by one day. However, for some individuals, those one to two days of work may be essential, in which case, a prescription should be considered if the patient presents within 48 hours of symptom onset. For all other healthy adults, I discuss the side effects of the medication. Evidence from a Cochrane Review published in 2014 suggests that in healthy adults, the risks of side effects including nausea, vomiting, headaches and psychiatric symptoms likely outweighs any benefit, which again, does NOT include decreased hospitalizations rates or complications. I usually frame it as “yes, your flu symptoms may get better about 16 hours sooner, but you may also have nausea, vomiting and headaches.” Most people, in my experience, will then pass on a prescription for Tamiflu.
Screening for chronic medical conditions, pregnancy, high risk household members is essential in knowing which patients require treatment. High level athletes is another patient population where treatment may be considered to allow them to get back to training faster but also to minimize spread to the rest of the team.
Visits for influenza are also a great time to discuss vaccination with patients, especially during the current pandemic. Emphasis should be placed on how vaccines prevent life threatening complications from influenza and diminish symptom severity. This is a perfect time for vaccine education to hopefully prevent future pandemics.
References
Jefferson T et al. Oseltamivir for Influenza in Adults and Children: Systematic Review of Clinical Study Reports and Summary of Regulatory Comments. BMJ 2014. PMID: 24811411.
Gabrielle Ahlzadeh, MD
Clinical Assistant Professor of Emergency Medicine
University of Southern California
How To Cite This Post:
[Peer-Reviewed, Web Publication] Wedel, L. (2021, May 17). Seasonal Influenza. [NUEM Blog. Expert Commentary by Ahlzadeh, G]. Retrieved from http://www.nuemblog.com/blog/seasonal-influenza
