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Antivirals for Chemoprophylaxis ÎÎClinical judgment and advice from local authorities are important factors in making postexposure chemoprophylaxis decisions. Postexposure chemoprophylaxis should be used only when antivirals can be started within 48 hours of the most recent exposure. •  An emphasis on early treatment is an alternative to chemoprophylaxis in managing certain persons who have had a suspected exposure to influenza virus. ÎÎWhen influenza viruses are circulating in the community, chemoprophylaxis can be considered for high-risk persons during the 2 weeks postvaccination before an adequate immune response to inactivated vaccine develops (6 weeks for children who were not previously vaccinated and who require 2 doses of vaccine) (A-I). ÎÎAntiviral chemoprophylaxis is recommended for all residents (vaccinated and unvaccinated) in institutions such as nursing homes and chronic care facilities that are experiencing influenza outbreaks (A-I). ÎÎAntiviral chemoprophylaxis can be considered for persons at high risk of complications from influenza if influenza vaccine is not available due to shortage (A-I) or in situations where there is documented low influenza vaccine clinical effectiveness due to the circulation of influenza virus strains that are antigenically distant from the vaccine strains such that a substantial increase in vaccine failures is anticipated, as determined by federal, state, and local public health authorities (C-II). ÎÎAntiviral chemoprophylaxis should be considered for adults and children ≥1 year of age at high risk of complications from influenza: •  Who have not yet received influenza vaccine when influenza activity has already been detected in the community (B-II). •  For whom influenza vaccination is contraindicated, unavailable, or is expected to have low effectiveness (eg, persons who are significantly immunocompromised) (B-II). Continue chemoprophylaxis for the duration of time that influenza viruses are circulating within the community (B-III). ÎÎWhen antiviral chemoprophylaxis is deemed necessary, it should be initiated at the onset of sustained influenza community activity as determined by local public health authorities (B-II) or when an influenza outbreak is detected or strongly suspected in healthcare institutions (A-II). ÎÎThe strongest consideration for use of antiviral chemoprophylaxis should be given to those at the highest risk of influenza-associated complications. The risk of influenza-associated complications is not identical among all high-risk persons, and antiviral chemoprophylaxis is likely to have the greatest benefit among those at highest risk of influenza complications and death, such as hematopoietic stem cell transplant recipients (B-III). ÎÎWhen antiviral chemoprophylaxis is used within a household following diagnosis of influenza in 1 family member, chemoprophylaxis should be continued for 10 days (A-I). ÎÎChoice of antiviral: refer to "Antivirals for Treatment" section. 9

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