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The AMMI Canada Guidelines document ‘The use of antiviral drugs for influenza: A foundation document for practitioners’, published in the Autumn 2013 issue of the Journal, outlines the recommendations for the use of antiviral drugs to treat influenza. This article, which represents the first of two updates to these guidelines published in the current issue of the Journal, aims to inform health care professionals of the increased risk for influenza in long-term care facilities due to a documented mismatch between the components chosen for this season’s vaccine and currently circulating influenza strains. Adjusted recommendations for the use of antiviral drugs for influenza in long-term care facilities for this season are provided.

Infectious mononucleosis is caused by Epstein-Barr virus and can lead to complications, including hepatitis and hematological abnormalities, in a subset of patients. The authors of this article assessed measures of illness severity as well as viral load at presentation and six weeks later among a cohort of individuals, INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses. OBJECTIVES: To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM). METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden. RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks. CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV-related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity.

The most recent revision of the American Heart Association guidelines on infective endocarditis prophylaxis occurred in 2007. These revisions were based on the fact that current data have brought into question the benefit of previous recommendations for infective endocarditis prophylaxis. It was noted that the bacteremia that occurs following dental procedures represents only a fraction of the episodes of bacteremia that occur with activities of daily living (such as chewing, brushing teeth and other oral hygiene measures). The target groups and the procedures for which prophylaxis is reasonable have been significantly reduced in number. The focus is now on patients who are most likely to have adverse outcomes from infectious endocarditis. The present article is targeted at practicing Canadian physicians and provides the rationale for the current recommendations. In addition to a summary of the indications for prophylaxis, information is provided on the conditions for which prophylaxis is not recommended.

The present article addresses the use of antiviral drugs in the management of seasonal influenza illness for the 2012/2013 season. It updates the previous document published in 2011 (1). Noteworthy guidance updates since 2011 include the following: Seasonal influenza in 2012/2013 is predicted to be caused by two human influenza A and one influenza B strain, all of which are anticipated to remain generally susceptible to oseltamivir.The predicted strains are A/California/7/2009 (H1N1) pdm09-like, A/Victoria/361/2011 (H3N2)-like and B/Wisconsin/1/2010-like (Yamagata lineage). All are included in the seasonal influenza vaccine and are susceptible to oseltamivir.Swine-variant H3N2v, which has rarely caused infection in humans exposed to infected swine within the past year in the United States, is susceptible to oseltamivir. It is not included in the current seasonal influenza vaccine.It is still considered that initiation of antiviral therapy more than 36 h to 48 h after onset of symptoms is beneficial in patients hospitalized with complicated influenza and severe illness.Oseltamivir continues to be recommended for the treatment of influenza in pregnant women.The use of antiviral drugs among measures to control outbreaks of influenza in closed facilities such as correctional institutions is now included in the present document.Le présent article porte sur l’utilisation d’antiviraux pour prendre en charge l’influenza pendant la saison 2012–2013. Il met à jour le document publié en 2011 (1). Les conseils qui méritent d’être soulignés depuis 2011 s’établissent comme suit : On prévoit qu’en 2012–2013, l’influenza saisonnière sera causée par deux souches de l’influenza humaine A et une souche de l’influenza B, qui devraient demeurer généralement susceptibles à l’oseltamivir.Les souches prévues sont le virus analogue à A/California/7/2009 (H1N1)pdm09, le virus analogue à A/Victoria/361/2011 (H3N2) et le virus analogue à B/Wisconsin/1/2010 (lignée Yamagata). Toutes sont incluses dans le vaccin contre l’influenza saisonnière et sont susceptibles à l’oseltamivir.La variante porcine du virus H3N2 (H3N2v), qui a causé peu d’infections chez des humains exposés à des porcs depuis un an aux États-Unis, est susceptible à l’oseltamivir. Elle n’est pas incluse dans le vaccin actuel contre l’influenza saisonnière.On considère encore que l’amorce des antiviraux plus de 36 heures à 48 heures après l’apparition des symptômes est bénéfique aux patients hospitalisés en raison d’une influenza complexe et d’une maladie grave.L’oseltamivir continue d’être recommandé pour le traitement de l’influenza chez les femmes enceintes.Le recours à des antiviraux parmi les mesures de contrôle des éclosions d’influenza dans des établissements fermés, tels que les établissements de détention, fait désormais partie de ce document.