Increased resistance of pneumococci to antimicrobial drugs may encourage more extensive use of pneumococcal polysaccharide vaccine.

Rimantadine hydrochloride (Flumadine - Forest), the alpha-methyl derivative of amantadine (Symmetrel, and others), was recently approved by the US Food and Drug Administration for prevention and treatment of influenza A virus infections in adults and for prevention of influenza in children.

Influenza is generally a self-limited illness, but pneumonia, respiratory failure, and death can occur, especially in persons at increased risk for influenza complications (see Table 1). Updated information on influenza activity and antiviral resistance is available from the CDC at cdc.gov/flu.

The 2017 adult immunization schedule approved by the CDC's Advisory Committee on Immunization Practices (ACIP) includes some new or revised recommendations.1 The complete schedule is available on the CDC's website (www.cdc.gov/vaccines/schedule). New recommendations for use of influenza vaccine during the 2016-2017 season were included in a previous issue of The Medical Letter.2 Updated recommendations for other vaccines are summarized below. Recommendations for routine use of vaccines in adults were reviewed in an earlier issue.3DK Kim et al. Advisory Committee on Immunization Practices...

Zanamivir, a neuraminidase inhibitor taken by inhalation, has been approved by the FDA for treatment of influenza. Oseltamivir phosphate, an oral neuraminidase inhibitor, will probably be approved soon.

The FDA has approved peramivir (Rapivab – BioCryst), an IV neuraminidase inhibitor administered as a single dose, for treatment of acute uncomplicated influenza in patients ≥18 years old who have had symptoms for no more than 2 days. Peramivir was available temporarily in the US during the 2009-2010 influenza season under an emergency use authorization for treatment of hospitalized patients. It has been available in some Asian countries since 2010. Peramivir is the third neuraminidase inhibitor to be approved in the US. Oseltamivir (Tamiflu), which is taken orally, and zanamivir...

Recent reports (D Kaye.Clin Infect Dis April 1, 2008;46:iii) indicate that 2 of the 3 components of this year's influenza vaccine (Med Lett Drugs Ther 2007;49:81), the influenza B and A/H3N2 antigens, do not matchup well with circulating strains. The B component is probably not protective. The A/H3N2 antigen in the vaccine probably provides some protection, particularly for high-risk patients. The third component, the A/H1N1 antigen, is protective against circulating A/H1N1 influenza viruses, but these viruses, unlike previous A/H1N1 strains, are developing some resistance to oseltamivir...

The FDA has licensed Capvaxive (PCV21; Merck), a 21-valent pneumococcal conjugate vaccine, for prevention of invasive pneumococcal disease (IPD) and pneumococcal pneumonia in adults. Four other pneumococcal vaccines are currently available in the US: Prevnar 20 (PCV20), Vaxneuvance (PCV15), and Prevnar 13 (PCV13) are conjugate vaccines licensed for use in persons ≥6 weeks old, and Pneumovax 23 (PPSV23) is a pneumococcal polysaccharide vaccine licensed for use in persons ≥2 years old (see Table 1).

The FDA has approved three office laboratory tests for diagnosis of influenza. These tests are of special interest now because the FDA recently also approved two new drugs for treatment of influenza that must be started--to be effective--less than 48 hours after the onset of symptoms.

Six vaccines are recommended for routine use in adults living in the USA (Guide for Adult Immunization, 2nd ed, Philadelphia:American College of Physicians, 1990). Immunization recommendations for travel outside the USA were published in The Medical Letter, volume 32, page 33, April 6, 1990.