This American Family Physician review, published on 1 October, summarises influenza prevention, diagnosis and treatment for primary care.
Annual vaccination is recommended for everyone from six months of age without a contraindication, including in pregnancy. Point-of-care rapid testing in selected patients increases appropriate antiviral use and reduces antibiotic prescribing when positive, but a negative result does not exclude influenza.
Most patients do not need antivirals. They should be started as soon as possible in people who are hospitalised, severely or progressively ill, or at high risk of complications, and can be considered in symptomatic household contacts of high-risk people and in symptomatic health workers. Oseltamivir and baloxavir are the usual options. Benefit is greatest within 24 to 36 hours of onset and shortens symptoms by about 20 hours, with little or no evidence of fewer complications. In India, influenza peaks vary by region, with monsoon and winter seasons, so local surveillance matters more than a calendar.
- Offer influenza vaccine to every adult and child from six months, including pregnant women.
- Do not let a negative rapid test override a clear clinical picture during an outbreak.
- Start antivirals promptly in high-risk, severely ill or hospitalised patients without waiting for a test.
- Tell low-risk patients that antivirals shorten illness by about a day at best.
- Use a positive influenza test to avoid prescribing antibiotics for a viral illness.
Why it matters
The decision that matters most is who gets antivirals early, not whether everyone gets them.
Don't overread it
Antiviral benefit in low-risk patients is about 20 hours of symptoms, not fewer complications.
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