The Rational Clinical Examination
David L. Simel, Drummond Rennie
Influenza
Stephanie A. Call, Mark A. Vollenweider, Carlton A. Hornung, David L. Simel, W. Paul McKinney
Two agents, zanamivir and oseltamivir (for either type A or type B strains), are currently...
Topics Discussed:
diagnostic process, influenza, influenza virus vaccine
Excerpt:
"Ten percent to 20% of US residents contract influenza
annually, accounting for an average of 36 000 deaths throughout
the past decade1 and 133 900 pneumonia and influenza
hospitalizations per year from 1979 to 2001.2 Given
its propensity for antigenic drifts and shifts, influenza has the
capability to cause periodic epidemics and global pandemics. A shortfall
in production of vaccine because of problems at one manufacturer's
facilities (http://www.hhs.gov/news/press/2004pres/20041005.html; accessed March 28, 2008) created
the potential for increased morbidity and mortality in the 2004-2005
influenza season. The effect on society during major outbreaks is
substantial in terms of both direct medical costs and indirect costs
associated with illness, including missed workdays and reduced productivity.3 In
2003, there were concerns about early season reports of influenza-related
severe illnesses and deaths in the United States.4 The
fixed number of doses of vaccine (approximately 83 million) and
the increased demand for its use in 2003 led to a redistribution of
vaccine to clinicians caring for individuals with the greatest immediate
need.4 This situation was compounded by a vaccine
that may have had reduced effectiveness because of a suboptimal antigenic
match. Early in the 2004-2005 season, one of the manufacturers of
the trivalent inactivated vaccine did not provide vaccine to the United
States; consequently, the available vaccine for the nation was only
about half that projected for the year.5 Under
these circumstances, early diagnosis and intervention were even
more critical...."
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