January 16, 2013
Dear Kitsap County Providers,
Happy New Year. I’d like to share five brief points about flu with you.
1. Testing at the state lab has confirmed most of the virus circulating this year is influenza A (H3N2).
The H3N2 strain is typically associated with more severe flu seasons.
It’s still too early to predict how
severe it will be, but so far we are beginning to get reports of higher than expected hospitalization rates,
especially in people 65 and older.
2. We are not currently asking providers to col ect any more samples for the state lab. However,
laboratory-confirmed influenza associated deaths are reportable and give us an estimate of local

3. I recommend aggressive use of anti-virals not only for your high-risk patients but also for low-risk
patients who report symptoms more severe than they usual y experience.
For your convenience I’ve
inserted the dosing chart for antivirals at the end of this message. I would also like to remind you that
antiviral resistance to oseltamivir and zanamivir among circulating influenza viruses is currently low.
4. Later today, the Health District is issuing a media release with our customary flu guidance to the
general public, in which we additional y recommend that the people I described above cal their
healthcare provider promptly to discuss use of antiviral medications if indicated.
We realize this may
result in increased calls and/or appointments, and wanted to give you a heads-up.
5. Vaccine availability:
Adult―We have surveyed area pharmacies and it appears at this time Kitsap has an adequate supply
of adult vaccine. Vaccine supplies are being used as quickly as they are received, so patients may
report temporary shortages but our pharmacies and most clinics are able to resupply vaccine.
Pediatric―Orders for children's vaccine (<19 yrs of age) are placed through the Kitsap Public Health
District to the Washington State Department of Health Immunization Program; there is no shortage of vaccine for children and can be ordered at any time. Call us at 360-337-5235 to replenish your supply or to become a Vaccine For Children provider. I respect your time and will send additional information only if I believe it would support your clinical practice or help with your patient communications. As always, I welcome your feedback and questions. Recommended Dosage and Duration of Treatment or
Chemoprophylaxis for Influenza Antiviral Medications
If <1 yr old, the dose is 3 mg/kg/dose twice daily
(Dose varies by child's weight) If ≥1 yr old and weigh 15 kg or less,
the dose is 30 mg twice a day.
75 mg twice
If ≥1 yr old and weigh >15 to 23 kg, the dose is 45 mg twice a day.
If ≥1 yr old and weigh >23 to 40 kg, the dose is 60 mg twice a day.
If ≥1 yr old and weigh more than 40 kg, the dose is 75 mg twice a
(Not FDA approved for use in children <1 yr old) If child is <3
months old, chemoprophylactic use is not recommended unless (Tamiflu®)
situation is judged critical due to limited data on use in this age (Not FDA approved for children <1 yr, but use in children ≥3
months and <1 yr old was approved under EUA during the 2009
75 mg once
H1N1 pandemic) If child ≥3 months and <1 yr old, dose is 3
mg/kg/dose once per day.
(Dose varies by child's weight) If ≥1 yr old, and weigh 15 kg or less,
the dose is 30 mg once a day.
If ≥1 yr old and weigh >15 to 23 kg, the dose is 45 mg once a day.
If ≥1 yr old and weigh >23 to 40 kg, the dose is 60 mg once a day.
If ≥1 yr old and weigh more than 40 kg, the dose is 75 mg once a
10 mg (2 inhalations) twice daily
(Not FDA approved for use in children <7 yrs old)
twice daily
10 mg (2 inhalations) once daily
(Not FDA approved for use in children <5 yrs old)
once daily


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