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針對嚴重季節性流感的抗病毒治療

香港醫學會傳染病顧問委員會於二零一六年五月十八日召開會議，對季節性流感的臨床處理提出了以下建議：

1.      季節性流感可引致嚴重或甚至致命的疾病，尤其在容易產生併發症的高危群组中。

2.      嚴重或有潛在嚴重性流感的初步處理主要建基於臨床診斷。如在臨床上認為有需要，抗病毒藥物應盡早使用，無須等待化驗確診才開藥。

3.      神經氨酸酶抑制劑這類抗病毒治療方法能減低流感患病期和併發症。針對懷疑患上流感而需要入院、病情嚴重或不斷惡化、容易產生流感併發症的高危人士，包括小孩和孕婦，不論他們已接種疫苗與否，都應考慮使用上述治療。神經氨酸酶抑制劑擁有良好的安全記錄，但建議仍須監察可能出現的副作用。整體來說，預期效益大過小量可能出現的副作用機會。

4.      近年流感的檢測工具有了一些新發展，不過各類測試仍面對不同制肘，例如：化驗室的支援較難取得及相對費時，臨床快速測試一般敏感度較低，而流感病毒在體內出現的時間及位置亦可能影响所有測試的樣本採集。

5.      基於現有快速抗原檢測的敏感度有限，一個陰性的快速抗原檢測結果並不排除流感的可能性，尤其是在流感的高峰期。

6.      一些新發展的分子快速測試可較接近臨床使用，但相對標準的化驗室檢測，它們的敏感度一般仍較低。

二零一六年五月二十一日

編輯備忘：

香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。

PRESS

RELEASE

21 May 2016

Antiviral treatment for potentially severe influenza infection

The Hong Kong Medical Association Advisory Committee on Communicable Diseases convened a meeting on 18 May 2016 and made the following recommendations in relation to the clinical management of seasonal influenza.

1.       Seasonal influenza may cause severe or even life-threatening diseases, especially among individuals at risk for complications.

2.       The initial management of severe or potentially severe influenza infections remains largely clinical. If clinically indicated, empirical antiviral treatment should be started as soon as possible.  Laboratory confirmation of influenza virus infection is NOT necessary for the initiation of treatment.

3.       Antiviral treatment using neuraminidase inhibitors (NAI) has been shown to reduce the duration of illness and complications of influenza.  Empirical antiviral treatment should be considered for any patient with suspected influenza who is hospitalized, has severe or progressive illness, or is at high risk for complications from influenza, including children and pregnant women, irrespective of vaccination history. NAI has a good safety profile but monitoring of possible side effects is generally recommended.  The potential benefits generally outweigh the small risks of possible adverse effects for patients with severe influenza infections or at risk for major influenza complications.

4.       While there have been a number of innovations in diagnostic tools for influenza, they may still be subject to various limitations e.g. limited access or longer turnover time for laboratory-based tests, often lower sensitivity for point-of-care tests and intrinsic limitations (variable time profile / localization of virus expression) in specimen collection for both types of tests.

5.       The sensitivities of available rapid antigenic diagnostic tests for influenza are limited.  A negative rapid antigenic diagnostic test does NOT rule out influenza, especially during peak influenza periods.

6.       Although some rapid molecular tests have been developed for use nearer the bedside, they may still suffer from varying degrees of limitation in sensitivity as compared to the standard laboratory-based tests.

References

1. CDC guidelines.http://www.cdc.gov/flu/professionals/antivirals/antiviral- use-influenza.htm(Last accessed 20 May 2016)  
2. Public Health England Guidelines.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457735/PHE_guidance_antivirals_influenza_2015_to_2016.pdf
3. WHO guidelines for pharmacological management of pandemic influenza (H1N1) 2009 and other influenza viruses. 

http://www.who.int.eproxy2.lib.hku.hk/csr/resources/publications/swineflu/h1n1_guidelines_pharmaceutical_mngt.pdf

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Notes to editors:

The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts.  The foremost objective of the Association is to safeguard and promote public health.  The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world.  In fulfilling these goals, the association hopes to better serve the people of Hong Kong.