Respiratory virus season: Strategies for successful navigation

Article Figures & Data

TABLE 1

Some representative influenza vaccines

Brand name (vaccine form)	Approved ages	Dose
Fluzone (inactivated, egg-based)	6–35 months	0.25 mL
Fluzone (inactivated, egg-based)	≥ 3 years	0.5 mL
Fluzone High-Dose (inactivated, egg-based)	≥ 65 years	0.5 mL
FluBlok (recombinant, egg-free)	≥ 18 years	0.5 mL
FluMist (live attenuated, egg-based)	2–49 years	0.1 mL in each nostril (0.2-mL prefilled single-use intranasal sprayer)
Fluad (inactivated adjuvanted, egg-based)	> 65 years	0.5 mL

TABLE 2

Respiratory syncytial virus vaccines

Brand name (vaccine form)	Approved ages^{^a}	Dose	Efficacy, %^{^b}	Side-effect rates, %
Arexvy (inactivated protein subunit, adjuvanted)¹⁵	≥ 75 years 60–74 years with high-risk factor	0.5 mL	Season 1: 94.1 Season 2: 84.6	Severe reactogenicity events 3.8 (vs 0.9 with placebo) Pain 60.9 Fatigue 33.6 Myalgia 28.9 Headache 27.2
Abrysvo (inactivated protein subunit, nonadjuvanted)^14,15	≥ 75 years 60–74 years with high-risk factor Pregnant at 32–36 weeks’ gestation	0.5 mL	Season 1: 88.9 Season 2: 78.6	Severe reactogenicity events 1.0% (vs 0.7% with placebo) Pain 10.5 Fatigue 15.5 Myalgia 10.1 Headache 12.8
mResvia (inactivated messenger RNA encoding the respiratory syncytial virus F glycoprotein)^13,16	≥ 75 years 60–74 years with high-risk factor	0.5 mL	Season 1: 80.9 Season 2: 61.1	Severe reactogenicity events 6.1 (vs 4.0 with placebo) Pain 55.9 Fatigue 30.8 Myalgia 25.6 Headache 26.7

↵^a This table does not include maternal indication data.
↵^b Efficacy in preventing symptomatic, laboratory-confirmed respiratory syncytial virus–associated lower respiratory tract disease with at least 3 lower respiratory signs.

TABLE 3

COVID-19 outpatient treatments

Treatments	Who^{^a}	When	How	Clinical considerations
Molnupiravir	Adults	Start as soon as possible; must begin within 5 days of symptom onset	Taken at home orally	Not recommended in pregnant or lactating women No renal or hepatic adjustment
Nirmatrelvir ritonavir	Adults; children ages 12 years and older	Start as soon as possible; must begin within 5 days of symptom onset	Taken at home orally	Renal dosing if estimated glomerular filtration rate is 30–59 mL/min, and not recommended if < 30 mL/min Review drug-drug interactions
Remdesivir	Adults and children	Start as soon as possible; must begin within 7 days of symptom onset	Intravenous infusions at a healthcare facility for 3 consecutive days	Consider stopping if patient develops alanine aminotransferase (ALT) elevation ≥ 10 times the upper limit of normal during treatment Discontinue if ALT elevation is accompanied by signs or symptoms of liver inflammation

↵^a Age ≥ 65 years and those with certain underlying medical conditions including: asthma, cancer (hematologic malignancy), cerebrovascular disease, chronic kidney disease (people receiving dialysis), chronic lung diseases (bronchiectasis, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary embolism, pulmonary hypertension), chronic liver diseases (cirrhosis, nonalcoholic fatty liver disease, alcoholic fatty liver disease, autoimmune hepatitis), cystic fibrosis, diabetes mellitus type 1 and 2, disabilities including Down syndrome, heart disease (heart failure, coronary artery disease, cardiomyopathies), human immunodeficiency virus, mental health conditions (mood disorders, schizophrenia), neurologic conditions (dementia), obesity, physical inactivity, recent or current pregnancy, primary immunodeficiencies, current or former smoking, transplantation, tuberculosis, and use of corticosteroids or immunosuppressive medications.
Information from references 20 and 21.

TABLE 4

Anti-influenza outpatient treatments

Treatments	Who	When	How	Clinical considerations
Influenza treatment: oseltamivir	Adults and children from birth	As soon as possible; ideally begin within 2 days of symptom onset	Taken at home orally	For persons at high risk ofcomplications,^{^a} initiate as soon as possible, even if > 2 days since symptom onset Renal dosing if creatinine clearance is < 60 mL/min
Influenza prevention after exposure^{^b}: oseltamivir	Adults and children from 3 months of age at very high risk for influenza complications^{^a}	Start as soon as possible after exposure	Taken at home orally	Prophylaxis and treatment dosing differ—refer to your institutional guideline Renal dosing if creatinine clearance is < 60 mL/min

↵^a Adults ≥ 65 years, people who are pregnant or post partum (within 2 weeks after delivery), residents of long-term care facilities, non-Hispanic Black persons, Hispanic or Latino persons, American Indians and Alaska natives, persons with body mass index ≥ 40 kg/m², and individuals with certain chronic medical conditions (eg, pulmonary, cardiovascular, endocrine [eg, diabetes mellitus], renal, hepatic, hematologic, metabolic, neurologic, human immunodeficiency virus, malignancy), or those receiving immunosuppressive medications.
↵^b Contact within the past 48 hours with a confirmed or suspected case.
Information from reference 22.