Abstract
Influenza remains a significant cause of worldwide morbidity and mortality. With the availability of new effective antivirals for the treatment of influenza, early diagnosis of the disease will become increasingly important for effective disease management.
Although investigators are generally in broad agreement about the symptoms of influenza, there are currently no agreed guidelines for the clinical diagnosis of influenza during annual outbreaks. This paper outlines the recommendations of a Working Party (comprising virologists and family practitioners) who met to construct criteria that could be used by primary healthcare professionals to aid early clinical diagnosis of influenza, i.e. before the development of any complications.
A virologically confirmable diagnosis of influenza is likely when an otherwise healthy adult presents, during a known local influenza outbreak, with rapid onset of the symptom complex of fever, feverishness or chills plus myalgia, cough or malaise. Guidelines for the diagnosis of influenza in children, in patients with chronic diseases and in the elderly require further refinement.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2000; 49(RR03): 1–38
Jefferson T, Meier CR, Wegmüller Y, et al. The impact of influenza on adults [poster]. 21st International Congress of Chemotherapy: 1999 Jul 4–7; Birmingham, UK
Fleming DM, Chakraverty P, Sadler C, et al. Combined clinical and virological surveillance of influenza winters of 1992 and 1993. BMJ 1995; 311: 290–1
Jefferson T, Demicheli V. Socioeconomics of influenza. In: Nicholson KG, Webster RG, Hay AJ, editors. Textbook of influenza. Oxford: Blackwell Science, 1998: 541–7
Levy E. French economic evaluations of influenza and influenza vaccination. Pharmacoeconomics 1996; 9 Suppl. 3: 62–6
Mullooly JP, Bennett MD, Hornbrook MC, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Ann Intern Med 1994; 121: 947–52
Nichol KL, Margolis KL, Wuorenma J, et al. The efficacy and cost-effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994; 331:778–84
De Jong JC, Beyer WEP, Palache AM, et al. The mismatch between the 1997/98 influenza vaccine and the major epidemic A (H3N2) virus strain caused an inadequate vaccine-induced antibody response to this strain in the elderly. J Med Virol 2000; 61: 94–9
Hayden FG, Gwaltney Jr JM, van de Castle RL, et al. Comparative toxicity of amantadine hydrochloride and rimantadine hydrochloride in healthy adults. Antimicrob Agents Chemother 1981; 19: 226–33
Hayden FG, Belshe RB, Clover RD, et al. Emergence and apparent transmission of rimantadine-resistant influenza A virus in families. N Engl J Med 1989; 321: 1696–702
Nicholson KG, Aoki FY, Osterhaus ADME, et al. Treatment of acute influenza: efficacy and safety of the oral neuraminidase inhibitor oseltamivir. Lancet 2000; 355: 1845–50
Hirsch A. Handbook of geographical and historical pathology. London: New Sydenham Society, 1883
Beveridge WIB. Influenza, the last great plague. London: Heinemann, 1977
Patterson KD. Pandemic influenza 1700–1900: a study in historical epidemiology. New Jersey: Rowan & Littlefield, 1987
Pyle GF. The diffusion of influenza: patterns and paradigms. New Jersey: Rowan & Littlefield, 1986
Stuart-Harris CH. Influenza and other virus infections of the respiratory tract. London: Edward Arnold & Co., 1953
Cate TR. Clinical manifestations and consequences of influenza. Am J Med 1987; 82 Suppl. 6A: 15–9
Govaert TM, Dinant GJ, Aretz K, et al. The predictive value of influenza symptomology in elderly people. Fam Pract 1998; 15: 16–22
Lina B, Valette M, Foray S, et al. Surveillance of community-acquired viral infections due to respiratory viruses in Rhone-Alpes (France) during winter 1994 to 1995. J Clin Microbiol 1996; 34: 3007–11
Nicholson KG. Human influenza. In: Nicholson KG, Webster RG, Hay AJ, editors. Textbook of influenza. Oxford: Blackwell Science, 1998: 219–64
Perlman PE, Ginn DR. Respiratory infections in ambulatory adults. Postgrad Med 1990; 87: 175–84
Jamieson WM, For the Combined Study Group. Some aspects of the recent epidemic of influenza in Dundee. BMJ 1958; Apr 19: 908–13
Kerr AA, Downham MAPS, McQuillan J, et al. Gastric ‘flu influenza B causing abdominal symptoms in children. Lancet 1975; I: 291–5
Nicholson KG. Clinical features of influenza. Semin Respir Infect 1992; 7: 26–37
Price DA, Postlethwaite RJ, Longson M. Influenzavirus A2 infections presenting with febrile convulsions and gastrointestinal symptoms in young children. Clin Pediatr 1976; 15: 361–7
Retailliau HF, Storch GA, Curtis AC, et al. The epidemiology of influenza B in a rural setting in 1977. Am J Epidemiol 1979; 109: 639–49
Taylor JL, Dwyer DM, Coffman T, et al. Nursing home outbreak of influenza A (H3N2): evaluation of vaccine efficacy and influenza case definitions. Infect Control Hosp Epidemiol 1992; 13: 93–7
Wald TG, Miller BA, Shult P, et al. Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons? J Am Geriatr Soc 1995; 43: 170–4
Carrat F, Tachet A, Rouzioux C, et al. Evaluation of clinical case definitions of influenza: detailed investigation of patients during the 1995–1996 epidemic in France. Clin Infect Dis 1999; 28: 283–90
Everett MT. The ‘flu-like illness. Practitioner 1977; 219: 699–711
Fleming DM, Ayres JG. Diagnosis and patterns of incidence of influenza, influenza-like illness and the common cold in general practice. J R Coll Gen Pract 1988; 38: 159–62
Monto A, Gravenstein S, Elliot M, et al. Clinical predictors of an acute influenza epidemic with laboratory confirmation. 39th Interscience Conference of Antimicrobial Agents and Chemotherapy: 1999 Sep 26–29; San Francisco
Nicholson KG, Kent J, Hammersley V, et al. Acute viral infections of upper respiratory tract in elderly people living in the community: comparative prospective, population based study of disease burden. BMJ 1997; 315: 1060–4
Hayden FG, Sperber SJ, Belshe RB, et al. Recovery of drug-resistant influenza A virus during therapeutic use of rimantadine. Antimicrob Agents Chemother 1991; 35: 1741–7
Hayden FG, Osterhaus ADME, Treanor JJ, et al. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. N Engl J Med 1997; 337: 874–80
The MIST Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet 1998; 352: 1877–81
Hayden FG, Treanor JT, Fritz RS, et al. Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza: randomized, controlled trials for prevention and treatment. JAMA 1999; 282: 1240–6
Arruda E, Pitkäranta A, Witek Jr TJ, et al. Frequency and natural history of rhinovirus infections in adults during autumn. J Clin Microbiol 1997; 35: 2864–8
Lachman B. Counseling the patient with cold/flu symptoms. Am Pharm 1987; NS27: 51–4
World Health Organization. Surveillance of acute viral respiratory infections in Europe: report of WHO symposium. Madrid: WHO Regional Office for Europe, 1980 Jun 2-6
Fleming DM, Cross KW. Respiratory syncitial virus or influenza? Lancet 1993; 342: 1507–10
Treanor JJ, Hayden FG, Vrooman PS, et al. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza. JAMA; 2000; 283: 1016–24
Webster RG. Immunity to influenza in the elderly. Vaccine 2000; 18: 1686–9
Acknowledgements
The Influenza Diagnosis Working Party: René Snacken, Brussels, Belgium; Albert Osterhaus, Rotterdam, The Netherlands; Andrew Rotheray, Falmouth, Cornwall, UK; Alan Middleton, Fowey, Cornwall, UK; Fabrizio Pregliasco, Milan, Italy; J. Vidal Tort, Barcelona, Spain; Alain El Sawy, St Martin d’hers, France; Loïc Boucher, Muis-Eugné, France; Jean-Marie Cohen, Paris, France; Jérôme Boussac, Carquefou, France; Rudolf Fuchs, Hermaringen, Germany; George Leo, Berlin, Germany; Otmar Carewicz, Dossenheim, Germany; Paul Whitsitt, Ontario, Canada. The Influenza Diagnosis Working Party is sponsored by an educational grant from F Hoffmann-La Roche Ltd.
Author information
Authors and Affiliations
Additional information
See Acknowledgements for members of the Working Party.
Rights and permissions
About this article
Cite this article
Snacken, R. Managing Influenza in Primary Care. Dis-Manage-Health-Outcomes 8, 79–85 (2000). https://doi.org/10.2165/00115677-200008020-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-200008020-00003