CDC released updated recommendations for antiviral medications on December 7, 2009. Updates addresses use of intravenous peramivir; availability of renal dosing for peramivir; updated oseltamivir dosing instructions for children younger than 1 year of age based on weight; antiviral treatment and chemoprophylaxis considerations for patients vaccinated with 2009 H1N1 and seasonal influenza vaccines; guidance on early antiviral treatment for patients with progressive or severe influenza-like illness; and clarification of treatment considerations for patients with illness longer than 48 hours. Complete recommendations are available here: http://www.cdc.gov/h1n1flu/recommendations.htm

In summary, treatment with antiviral medication is recommended for:

• Persons with suspected or confirmed influenza and illness requiring hospitalization;
• Persons with suspected or confirmed influenza and progressive, severe, or complicated illness, regardless of previous health status; and/or
• Persons with suspected or confirmed influenza and patients at risk for severe disease, including: children younger than 2 years old; adults 65 years and older; pregnant women and women up to 2 weeks postpartum (regardless of how the pregnancy ended); persons with certain chronic medical conditions.
• Those medical conditions include: asthma, neurological and neuro-developmental conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle ), 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
• The following persons who are a close contact of a person with suspected or confirmed 2009 H1N1 influenza during the infectious period may be considered for antiviral chemoprophylaxis: persons at high risk for complications of influenza; healthcare workers and emergency medical personnel; and pregnant women.

State health departments are following CDC recommendations on antiviral priority groups and reminding providers to prescribe the medication without relying on test results to confirm diagnosis. Many states are earmarking their state SNS-supplied antiviral medications for people in priority groups who are uninsured or underinsured and therefore unable to purchase the medication when prescribed. (MOUs for dispensing antivirals exist online.) States are also identifying the state SNS-supplied stockpile for outbreak-control purposes and as a backup for healthcare organizations in case of a supply shortage. Although no states noted a current shortage, a couple of states mentioned a shortage as a possibility, especially if vaccine distribution is further delayed.