Influenza in general practice: prevention, diagnosis and treatment

Influenza is the most prominent annually recurring respiratory infection general practitioners (GPs) encounter. GPs play a key role in the management of influenza prevention, diagnosis and treatment.;A systematic review of published systematic reviews and RCTs showed that the inactivated influenza vaccine proved to be effective in preventing laboratory-confirmed influenza among healthy adults and children. However, there is strikingly limited good-quality evidence of the effectiveness of influenza vaccination on complications such as pneumonia, hospitalisation and influenza-specific and overall mortality. Inconsistent results are found in studies among children younger than 6 years, individuals with COPD, institutionalised elderly, elderly with co-morbidities and healthcare workers in elderly homes.;Two out of three Flemish GPs vaccinated themselves against influenza in 1997 and 1998. A controlled trial for the first time showed that especially in young GPs influenza vaccination proved to be effective in preventing influenza during an epidemic. GPs' immunity was high in general and showed variations in consecutive years depending on changes in the circulating influenza virus type.;Two clinical prediction rules were defined and tested on clinical information and laboratorial results of 4597 flu patients, collected by 138 sentinel GPs during five consecutive winter periods. Outside an influenza epidemic, absence of cough and fever(>37,8°C) makes influenza 14 times less likely in flu patients. During an epidemic, presence of 'previous flu-like contacts', cough, 'expectoration on the first day of illness' and fever(>37,8°C) increases the likelihood for influenza threefold.;A systematic review of systematic reviews showed that the combination of diagnostic uncertainty, the risk for virus strain resistance, possible side effects and cost outreaches the small clinical benefits of neuraminidase inhibitors (oseltamivir or zanamivir), in the prophylaxis and treatment of healthy individuals. In the elderly or other at-risk groups no evidence was available for benefit of treatment on clinically relevant outcomes such as hospitalisation and mortality.;In conclusion, evidence on the prevention, diagnosis and treatment of influenza is essential, but missing for the prevention and treatment of clinically important complications in risk-groups, and for a prompt and accurate diagnosis and an early prognostic assessment. Especially young GPs benefit from an influenza vaccination.