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Managing Influenza

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Managing Influenza CAREMARK NOVEMBER 2004 Timely information and solutions for effective healthcare management Control (CDC) and Prevention Advisory Committee on Managing Immunization Practices (ACIP), those who are at high-risk for complications from the flu should get the vaccine every year, Influenza generally in October or November.1,2 Typically, anyone in these high-risk groups should receive the flu shot. However, Background there is a shortage of flu vaccine for the 2004-2005 flu season. nfluenza is a contagious illness that is caused by the Chiron Corporation is the manufacturer of Fluvirin® (inactivated influenza virus. It is more commonly known as the “flu”. influenza vaccine). Its license was suspended in the United The “flu season” usually begins in early October and can Kingdom where the vaccine is produced. Due to the suspension, last as late as May. It is estimated that 5 percent to 20 I Fluvirin was not distributed to the U.S. this season. This percent of people in the United States (U.S.) will become in- means that about one half of the expected supply of injectable fected with the flu each year. Every year, about 36,000 people flu vaccine in the U.S. will not be available. In response to the will die and more than 200,000 people will be hospitalized shortage, the CDC made changes in its recommendations due to complications of the flu.1,2 Reports have estimated on who should be considered most at risk from the flu. On that $4.6 billion per year is spent on flu-related direct medical October 5, 2004, the ACIP formally made interim vaccination costs.3 recommendations for the 2004-2005 flu season.5 These recom- Flu symptoms usually begin suddenly and include fever, mendations outlined the priority groups for vaccination. headache, tiredness, dry cough, sore throat, nasal congestion These priority groups are listed in Table 1.1,5 and body aches. Most people will recover in one to two weeks. But some people may develop serious complications such as Table 1. Priority Populations to Receive the Flu Vaccine for the 2004-2005 Flu Season1,5 pneumonia, bronchitis and sinus and ear infections.1 All children 6 to 23 months of age Prevention of Influenza: Healthy Habits Adults 65 years of age and older One of the best ways of preventing the flu is to have good Persons aged 2 to 64 years with underlying chronic health habits.1 These healthy habits include the following: medical conditions (such as asthma, diabetes or immunosuppression from medications • Avoid close contact when you or others are sick or human immunodeficiency virus [HIV]) • Stay at home when you are sick All women who will be pregnant during the influenza season • Cover your mouth and nose when sneezing or coughing Residents of nursing homes or other long-term • Wash your hands care facilities • Avoid touching your eyes, nose or mouth to avoid Children aged 6 months to 18 years on chronic spreading germs aspirin therapy The Flu Shot Health-care workers involved in direct patient care Out-of-home caregivers and household contacts of children Another way to prevent the flu is to get an influenza vaccine aged < 6 months or “flu shot” each fall. According to the Centers for Disease continued on reverse www.caremark.com People who should not get the flu shot are those who have a Caremark Clinical Initiatives severe allergy to eggs, have experienced a severe reaction Caremark offers multiple clinical programs to address influenza. from the flu shot, and those who have developed Guillain-Barré ™ syndrome after getting the flu shot, children less than 6 months • The Caremark SecureCare safety drug utilization programs of age and people who are sick with a fever. 1 detect potential duplication of antiviral drug therapy. • Caremark Utilization Management programs place quantity Other Preventative Options: Nasal Flu Vaccine limits and/or require prior authorization on antiviral drugs Although the flu shot is the best way to prevent the flu, there to ensure appropriate prescribing and duration of therapy. are other options available. FluMist™ (influenza virus vaccine • Caremark CarePatterns® disease management programs live, intranasal) is a nasally administered vaccine. It is used for provide to both plan participants and physicians with the prevention of influenza in healthy children and adults annual influenza vaccine education and reminders. five to 49 years of age.1,6 Together, these clinical programs help ensure appropriate use Because FluMist is a “live” vaccine, it should not be given to: of products in individuals predisposed to and suffering from influenza. • anyone with a weak immune system • anyone with a chronic medical condition that would make Notes: him or her more susceptible to influenza Drugs listed in bold are available on the Caremark Preferred • anyone with asthma or other respiratory conditions or Primary Drug Lists. • anyone who has an allergy to eggs. *Amantadine is available as a generic product. Potential side effects of FluMist include runny nose/congestion, sore throat, and cough.6 Because FluMist must be kept frozen and Relenza must be initiated within 48 hours of flu symptoms, these products Antiviral Drugs will not be available from the Caremark Mail Service phar- In addition to vaccines, oral antiviral drugs, such as Tamiflu® macies. (oseltamivir), Symmetrel® (amantadine*) and Flumadine® References: (rimantadine), are available by prescription. They can be used 1. Centers for Disease Control. Flu home page. Available at: to prevent influenza. These medicines are used for people http://www.cdc.gov/flu/. Accessed October 19, 2004. 2. Centers for Disease Control and Prevention. Prevention and control of influenza: who have had close contact with someone who has been recommendations of the Advisory Committee on Immunization Practices (ACIP). 1,2,7,9 MMWR. 2004;53(No. RR-6):1-40. infected or during a community outbreak. 3. Cox F, Khan Z, Schweinle JE et al. Cost associated with the treatment of influenza in a managed care setting. Medscape General Medicine [serial online]. Treatment of Influenza 2000;2(4). Available at: http://www.medscape.com/viewarticle/418843. Accessed October 20, 2004. Anyone with the flu should get plenty of rest and drink plenty 4. U.S. Food and Drug Administration web site. Center for Biologics Evaluation and Research. Available at http://www.fda.gov/cber/flu/flu2004.htm. of fluids. They can also take medicines to relieve symptoms.1,2 Accessed October 20, 2004. 5. U.S. Department of Health and Human Services. News Release. Available at In addition, there are medicines that can be taken to treat the http://www.dhhs.gov/news/press/2004pres/20041005b.html. flu. These medicines are Tamiflu, Relenza® (zanamivir), Accessed October 20, 2004. 6. FluMist package insert. Gaithersburg, MD: MedImmune Vaccines, Inc.; Symmetrel and Flumadine.1,2,7-10 When treating the flu, these 2004 September. 7. Tamiflu package insert. Nutley, NJ: Roche; 2004 June. medicines must be started within 48 hours after the first 8. Symmetrel package insert. Endo Pharmaceuticals; 2002 April.Available at: http://www.drugs.com/PDR/Symmetrel_Tablets.html. Accessed October 20, 2004. signs of flu symptoms, in order to be effective. The usual 9. Flumadine package insert. St. Louis, MO: Forest Pharmaceuticals, Inc.; 2000 course of treatment for influenza lasts five to 7 days, with September. Available at: http://www.fda.gov/cder/drug/antivirals/influenza/flumadine.htm. the exception of Symmetrel, which should be taken for at Accessed October 20, 2004. 10. Relenza package insert. Research Triangle Park, NC: GlaxoSmithKline; 2003 April. least 10 days. 7-10 The Caremark Clinical Update is provided as reference material and is based in part on information derived from third parties. Caremark does not assume any liability or responsibility for the accuracy or completeness of any third party material footnoted in this piece. Caremark Inc. does not operate the referenced Web sites. Caremark is not responsible for the avail- ability or reliability of the contents of those Web sites. Reference to any third party does not constitute or imply endorsement, sponsorship or recommendation by Caremark. www.caremark.com © 2004 Caremark Inc. All rights reserved..
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