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The best treatment for influenza infections in humans is prevention by vaccination. Work by several laboratories has produced vaccines. The first H1N1 vaccine released in early October 2009 was a nasal spray vaccine that was approved for use in healthy individuals ages 2-49. The injectable vaccine, made from killed H1N1, became available in the second week of Oct. 2009. This vaccine was approved for use in ages 6 months to the elderly, including pregnant females. Both of these vaccines were approved by the CDC only after they had conducted clinical trials to prove that the vaccines were safe and effective. A new influenza vaccine preparation is the intradermal (trivalent) vaccine is available; it works like the shot except the administration is less painful. It is approved for ages 18-64 years.
Almost all vaccines have some side effects. Common side effects of H1N1 vaccines (alone or in combination with other flu viral strains) are typical of flu vaccines used over many years and are as follows:
Flu shot: Soreness, redness, minor swelling at the shot site, muscle aches, low-grade fever, and nausea do not usually last more than about 24 hours.
Nasal spray: runny nose, low-grade fever, vomiting, headache, wheezing, cough, and sore throat
Intradermal shot: redness, swelling, pain, headache, muscle aches, fatigue
The flu shot (vaccine) is made from killed virus particles so a person cannot get the flu from a flu shot. However, the nasal spray vaccine contains live virus that have been altered to hinder its ability to replicate in human tissue. People with a suppressed immune system should not get vaccinated with the nasal spray. Also, most vaccines that contain flu viral particles are cultivated in eggs, so individuals with an allergy to eggs should not get the vaccine unless tested and advised by their doctor that they are cleared to obtain it. Like all vaccines, rare events may occur in some rare cases (for example, swelling, weakness, or shortness of breath). If any symptoms like these develop, the person should see a physician immediately.
Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are zanamivir (Relenza) and oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their guidelines that pregnant females can be treated with the two antiviral agents.
On Dec. 22, 2014, the FDA approved the first new anti-influenza drug (for H1N1 and other influenza virus types) in 15 years, peramivir injection (Rapivab). It is approved for use in the following settings:
Diarrhea, skin infections, hallucinations, and/or altered behavior may occur as side effects of this drug.
Adult patients for whom therapy with an intravenous (IV) medication is clinically appropriate, based upon one or more of the following reasons:
The patient is not responding to either oral or inhaled antiviral therapy, or
drug delivery by a route other than IV is not expected to be dependable or is not feasible, or
the physician decides that IV therapy is appropriate due to other circumstances.
Pediatric patients for whom an intravenous medication clinically appropriate because:
The patient is not responding to either oral or inhaled antiviral therapy, or
drug delivery by a route other than IV is not expected to be dependable or is not feasible.
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