Flu Information for Providers and Infection Control

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Annual influenza activity follows a winter seasonal pattern in the United States from October through May, with peak activity typically occurring in late December to early February.

The best way to prevent seasonal flu is to get vaccinated every year. CDC recommends annual influenza vaccination for everyone 6 months and older with any licensed, age-appropriate flu vaccine in the absence of any contradictions. For the 2024-25 season influenza season, CDC preferentially recommends that those 65 and older receive either a Fluzone High-Dose (HD-IIV, Sanofi), Flublock recombinant (RIV, Sanofi), or Fluad adjuvanted (aIIV, CSL Seqirus) influenza vaccine. The Advisory Committee on Immunization Practices (ACIP) concluded in June 2022 that these three vaccines are potentially more effective than standard dose, unadjuvanted flu vaccines. However, if none of these three products are available, then they should receive any age-appropriate influenza vaccine so as to not miss an opportunity to vaccinate against influenza.

Reporting Requirements

Contra Costa Public Health collects and analyzes both clinical and laboratory data throughout the year in an effort to help determine the timing and impact of influenza virus spread in the community. The information gathered is used for targeted outreach to health care partners and the community around disease prevention and control activities.

Report to Public Health (per Title 17, California Code of Regulations (CCR) §2500)

1. Laboratory-Confirmed influenza-related pediatric deaths (ages 0-17 years)

2. Acute Respiratory Outbreaks in both healthcare and congregate living settings, such as residential living facilities (retirement community, assisted living, board & care, skilled nursing facilities, rehabilitation centers, homeless and evacuation shelters, camps, jails, etc.) An outbreak is defined as:

One lab-confirmed influenza case in a healthcare or congregate living setting.
2 or more cases of new onset respiratory illness within 72 hours (3 days) in a healthcare or congregate living settings.

3. Suspicion for infection with a novel influenza strain (such as Avian Influenza/H5N1/HPAI).

How to Report

Clinical Management

Obtain an exposure history (within 10 days from symptom onset) for all patients in which influenza has been suspected. History should include:

Residence in a congregate living setting
Travel (dates and travel destination)
Close contact (same exposure) with similar symptoms or clinical diagnosis
Animal exposure (pigs and poultry. Animals that can be infected with variant influenza viruses)

Laboratory Testing

Laboratory testing with real-time reverse-transcription polymerase chain reaction (rRT-PCR) is the preferred testing method when there is strong clinical suspicion of influenza, even if the rapid test is negative.

Rapid influenza tests may vary in terms of sensitivity and specificity, when compared with rRT-PCR, with sensitivities ranging from 50-70%. This means that false positives are common when influenza prevalence is low and false negatives can occur when influenza prevalence is high.

Influenza testing by rRT-PCR is encouraged in the situations listed below:

A patient who is hospitalized or in the intensive care unit (ICU)
A patient who lives in a congregate living setting
A patient who has recently traveled (document travel dates and destination)
A patient who has recently been exposed to animals such as pigs or poultry (that can be infected with variant influenza viruses)

Specimen Collection Guides

Influenza Specimen Collection - Desk Guide (CDC)
Influenza Specimen Collection - Visual Guide (CDC)
If you suspect Novel Influenza Infection or Avian Influenza Infection, call the Communicable Disease Program at 925-313-6140 for testing guidance.

Treatment

Treat with antivirals prior to laboratory confirmation if suspicion for influenza is high or an outbreak has been confirmed.

Influenza Antiviral Medications: Summary for Clinicians (CDC)

The following groups of people are more likely to get serious flu-related complications if they get sick with flu and treatment should not be delayed prior to obtaining test results.

Children younger than 5 years (especially less than 2 years old)
Adults 65 years of age and older
Pregnant women (and women up to two weeks postpartum)
Residents of congregate living nursing homes and other long-term care facilities
American Indians and Alaska Natives
People who have underlying medical conditions, including:
- Asthma
- Neurological and neurodevelopmental conditions
- Chronic lung disease
- Heart disease
- Blood disorders
- Endocrine disorders
- Kidney disorders
- Liver disorders
- Metabolic disorders
- Weakened immune system due to disease or medication
- People younger than 19 years of age who are receiving long-term aspirin therapy
- People with obesity (body mass index [BMI] of 40 or more)