Medical personnel, including clinical treatment, public health and health quarantine personnel;

Seniors aged 60 and older;

People with one or more chronic diseases;

Vulnerable groups and employees in places such as nursing homes, long-term care institutions, welfare homes, etc.;

Pregnant woman;

Children 6-59 months old;

Family members and caregivers of infants under 6 months of age;

People in key places such as childcare institutions, primary and secondary schools, and supervision venues.

The most common complications

Causes primary viral pneumonia. Some influenza patients may be infected with bacteria, other viruses, atypical pathogens, fungi, etc.

When combined with Staphylococcus aureus, Streptococcus pneumoniae or Invasive Aspergillus pulmonary infection, the condition is severe and the mortality rate is high.

Encephalitis, encephalopathy, myelitis, Guillain-Barre Syndrome, etc.

There are more children than adults, and acute necrotizing encephalopathy is even more dangerous.

The main ones are myocarditis and pericarditis. It can be seen that myocardial markers, electrocardiograms, heart ultrasound and other abnormalities can occur, and in severe cases, heart failure may occur.

After influenza virus infection, the risk of hospitalization and death related to myocardial infarction, ischemic heart disease is significantly increased.

Myalgia, myocardium, serum creatine kinase, myoglobin increase, and in severe cases, acute renal injury can lead to.

White blood cell count is generally not high or lower

The lymphocyte count in severe cases was significantly reduced.

Aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatinine, etc. may increase

Elevated creatine kinase in a few cases;

Some cases have electrolyte disorders such as hypokalemia

Blood lactate can be elevated in shock cases.

Severe cases may have aerobic partial pressure, blood oxygen saturation, oxygenation index, and acid-base imbalance.

The number of cells and proteins involved in the central nervous system can be normal or increased;

Acute necrotizing encephalopathy is characterized by approximately normal cell count and increased protein.

Nasopharyngeal swabs or pharyngeal swabs were collected for antigen testing, which was quick and easy, but the sensitivity was lower than that of nucleic acid testing. A positive antigen test supports diagnosis, and negative cannot rule out influenza.

Nasopharyngeal swabs, pharyngeal swabs, tracheal extracts, sputum or alveolar lavage fluid were collected for nucleic acid testing. It has high sensitivity and specificity, and can distinguish virus types and subtypes.

​Influenza virus can be isolated from respiratory specimens.

Even if the clinical manifestations are atypical, especially those with high-risk factors for severe influenza or hospitalized patients, the possibility of influenza is still necessary to consider and etiological testing should be performed.

For hospitalized patients with suspected viral pneumonia, in addition to testing for common respiratory pathogens, influenza virus testing is also required.

Comply with any of the following

Comply with any of the following

Respiratory failure and mechanical ventilation is required;

shock;

Acute necrotizing encephalopathy;

ICU monitoring treatment is required for combined with other organ failure.

The underlying diseases have significantly worsened, such as: chronic obstructive pulmonary disease, diabetes, chronic cardiac insufficiency, chronic renal insufficiency, cirrhosis, etc.

-Compare diagnostic criteria for severe or critical influenza.

During the flu epidemic season, influenza-like cases with severe/critical influenza-like high-risk factors should be subject to antiviral treatment as soon as possible, and antiviral treatment within 48 hours of onset benefit the most. Based on the current situation of the epidemic of multiple pathogens, it is recommended to undergo etiological examinations in time to guide treatment before antiviral treatment.

Patients with severe/critical high-risk factors and severe/critical patients with influenza virus pathogenesis should still be treated with antiviral treatment if influenza virus etiology is positive.

Antiviral treatment is recommended for patients with influenza who are at risk of transmission to high-risk groups.

The course of treatment can be appropriately extended for severe/critical patients based on the etiology results.

It is not recommended to use antiviral drugs with the same mechanism of action and increase drug dosage in combination.

Neuraminidase inhibitors

RNA polymerase inhibitor

Hemagglutinin inhibitors

On the basis of the above treatments, actively prevent and treat complications, treat underlying diseases, prevent and treat combined or secondary infections; promptly provide organ functional support.

Hypoxemia or ARDS is the main manifestation of severe and critical patients, and requires close monitoring and timely treatment.

1. Routine oxygen therapy

2. Transnasal high flow oxygen therapy (HFNC) or non-invasive ventilation (NIV)

3. Invasive mechanical ventilation

4. Extracorporeal membrane oxygenation (ECMO)

Severe/critical patients may be combined with sepsis and shock, perform fluid resuscitation based on hemodynamic evaluation, use vasoactive drugs reasonably, and closely monitor the patient's blood pressure, heart rate, urine volume and changes in arterial blood lactate.

Influenza virus infection can cause myocardial injury or myocarditis, and can aggravate congestive heart failure and coronary artery disease through various mechanisms. Therefore, for severe/critical patients, myocardial injury markers and electrocardiogram changes should be monitored, and echocardiography should be improved.

Severe/critical patients may have acute renal injury and should actively look for causes such as low perfusion and medication. While actively correcting the cause, pay attention to maintaining the balance of water, electrolytes, and acid-base.

Indications for continuous renal replacement therapy (CRRT) include: hyperkalemia; severe acidosis; pulmonary edema ineffective diuretics or excessive water load.

There is no special treatment for influenza-related encephalitis/encephalopathy, and symptomatic treatments such as controlling cerebral edema and epilepsy seizures;

Reference for the treatment of acute necrotizing encephalopathy "Diagnosis and Treatment Plan for Children with Acute Necrotizing encephalopathy (2023 Edition)"

Acute disseminated encephalomyelitis and transverse myelitis can be treated with glucocorticoids and/or gamma globulin;

Garcine and/or plasma replacement can be used for Guilan-Barre syndrome.

Routine glucocorticoid therapy is not recommended.

In patients with refractory sepsis shock, the use of hydrocortisone may be considered after weighing the risk/benefit.

Reasonable nutritional support and timely rehabilitation treatment should also be carried out.

Influenza is a type of "exoinfection disease" in traditional Chinese medicine. It can be further subdivided into diseases such as typhoid fever and spring temperature according to the infected influenza virus subtype, influenza epidemic season, and epidemic area.

Most patients with mild symptoms can be treated according to the initial clinical manifestations. Once the evil toxin enters the internal organs and turns into severe diseases, heat toxins are the core pathogenesis. Patients often lack qi and yin during the recovery period.

According to the severity and typing, this treatment plan is applicable to all populations, including pregnant women, children and patients with various underlying diseases. This treatment plan is applicable to different regions.

We must adhere to the principle of "adapting to the conditions" according to the time, place and person.

Wind and hot invaders

Wind and cold surface

Cold on the surface and hot on the inside

Heat and poison attack the lungs

Toxic heat congestion

Toxic heat is inwardly trapped, internally closed and externally removed

Both Qi and Yin are weak, and the positive energy has not returned