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Influensa

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Akut luftvägsinfektion som orsakas av influensavirus A eller B, huvudsakligen aerosol smitta.
Förekomst:
Säsongsepidemier, incidens varierar från år till år.
Symtom:
Hastigt insjuknande, hög feber, frossa, muskelsmärtor, irritation i näsa och svalg, hosta, eventuellt kräkningar (särskilt hos barn)
Kliniska fynd:
Feber, rodnad i svalget och nedsatt allmäntillstånd.
Diagnostik:
Typisk klinisk bild under epidemier, eventuellt CRP. I vissa fall provtagning för influensa (PCR), om det påverkar den kliniska handläggningen.
Behandling:
Förebyggande behandling med vaccin årligen till riskgrupper inklusive alla >65 år och gravida. Antiviral behandling till alla i riskgrupp (oavsett vaccinationsstatus), vid risk för svår influensa, vid tecken på svår influensa eller som postexpositionsprofylax.
  1. Nicholson KG, Wood JM, Zambon M. Influenza. Lancet 2003; 362: 1733-45. PubMed  
  2. Hayward AC, Fragaszy EB, Bermingham A, et al. Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study. Lancet Respiratory Medicine 2014. doi: 10.1016/S2213-2600(14)70034-7. DOI  
  3. Jefferson T. How to deal with influenza?. BMJ 2004; 329: 634-5. PubMed  
  4. World Health Organization. Fifty-Sixth World Health Assembly. Prevention and control of influenza pandemics and annual epidemics (agenda item 14.14). Geneva: WHO, 26 May 2003.
  5. Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2017 Dec 13. PMID: 29248255.
  6. Turner D, Wailoo A, Nicholson K, Cooper N, Sutton A, Abrams K. Systematic review and economic decision modeling for the prevention and treatment of influenza A and B. http://www.nice.org.uk/pdf/ influenzaassrep.pdf (accessed Oct 15, 2003).
  7. Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med 2005; 353: 1363-73. PubMed  
  8. Jefferson T, Jones MA, Doshi P, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD008965. DOI: 10.1002/14651858.CD008965.pub4. DOI  
  9. Dugas AF, Valsamakis A, Atreya MR, et al. Clinical diagnosis of influenza in the ED. Am J Emerg Med 2015 Jun; 33:770. PMID: 25827595 PubMed  
  10. Merckx J, Wali R, Schiller I, et al. Diagnostic Accuracy of Novel and Traditional Rapid Tests for Influenza Infection Compared With Reverse Transcriptase Polymerase Chain Reaction: A Systematic Review and Meta-analysis. Ann Intern Med 2017. pmid:28869986 PubMed  
  11. Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza. Clin Infect Dis 2018. pmid:30566567 PubMed  
  12. Läkemedelsverket. Behandlingsrekommendation: Behandling och profylax vid influensa. Uppsala, juni 2022. lakemedelsverket.se  
  13. Dobson J, Whitley RJ, Pocock S, et al. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015 May 2;385(9979):1729-37 . pmid:25640810 PubMed  
  14. Louie JK, Lampiris H. Treating Influenza With Neuraminidase Inhibitors: What Is the Evidence? JAMA Intern Med. 2015 Dec;175(12):1899-900. PubMed  
  15. Butler CC, van der Velden AW, Bongard E, et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet. 2019. PMID: 31839279 PubMed  
  16. Heneghan CJ, Onakpoya I, Joes MA, et al. Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data. Health Technol Assess 2016. PMID: 27246259 PubMed  
  17. Jefferson T, Jones M, Doshi P, et al. Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014 Apr 9;348:g2545. doi: 10.1136/bmj.g2545. DOI  
  18. Jefferson T1, Jones MA, Doshi P, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014 Apr 10;4:CD008965. DOI: 10.1002/14651858.CD008965.pub4. DOI  
  19. Hanula R, Bortolussi-Courval E, Mendel A, et al. Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza A Systematic Review and Meta-analysis. JAMA Intern Med 2023. pmid:37306992 PubMed  
  20. Graner S, Smith T, Beau en pike-Michel C, et al. Neuraminidase inhibitors during pregnancy and risk of adverse neonatal outcomes and congenital malformations: population based European register study. BMJ 2017; 356: j629.. doi:10.1136/bmj.j629 DOI  
  21. Hung IFN, To KKW, Chan JFW, et al. Efficacy of clarithromycin-naproxen-oseltamivir combination in the treatment of patients hospitalized for influenza A(H3N2) infection: An open-label randomized, controlled, phase IIb/III trial. Chest 2017 May; 151: 1069. pmid:27884765 PubMed  
  22. Jefferson T, Del Mar C, Dooley L, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2009; 339: b3675. BMJ (DOI)  
  23. Behandling av och profylax mot influensa med antivirala medel - uppdaterad rekommendation. Läkemedelsverket 2011. www.lakemedelsverket.se  
  24. Rekommendationer om influensavaccination till riskgrupper. Folkhälsomyndigheten 2020. www.folkhalsomyndigheten.se  
  25. Scuffham PA, West PA. Economic evaluation of strategies for the control and management of influenza in Europe. Vaccine 2002;20: 2562-78. PubMed  
  26. Cates CJ, Jefferson TO, Bara AI, Rowe BH. Vaccines for preventing influenza in people with asthma (Cochrane Review): In. The Cochrane Library; Issue 4, 2000. Oxford Update Software. The Cochrane Library  
  27. Luftvägsinfektioner i öppen vård. Strama/Janusinfo Stockholms Länd Landsting. Hämtad 2017-10-24. www.janusinfo.se  
  28. Estabragh ZR, Mamas MA. The cardiovascular manifestations of influenza: a systematic review. Int J Cardiol. 2013 Sep 10;167(6):2397-403. doi: 10.1016/j.ijcard.2013.01.274.
  29. Folkhälsomyndigheten. Sammanfattande rapport för säsongen 2017-2018. (2018-07-06) hämtad 2019-01-29. www.folkhalsomyndigheten.se  
  30. Influensarapport. Folkhälsomyndigheten 2020. www.folkhalsomyndigheten.se  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas