206.3 🩺 內科專科考前版

206.3.0.1 1⃣ Empirical Oseltamivir in Hospitalized Flu

  • Start within hours of suspicion
  • Even > 48 hr onset benefit shown in hospitalized
  • Continue 5+ days (longer if immunocompromise + severe)
  • Adjust dose for renal impairment

206.3.0.2 2⃣ Post-Influenza Bacterial Pneumonia

  • 1-2 wk after acute flu
  • S. aureus PVL+ necrotizing pneumonia — high mortality young healthy
  • Cover with vancomycin + ceftriaxone empirically if suspected
  • CXR + cultures

206.3.0.3 3⃣ Flu Vaccine + Egg Allergy

  • 2024 ACIP: routine flu vaccination of egg-allergic (no precautions needed)
  • Egg allergy not contraindication
  • RIV (Flublok) egg-free if preferred
  • Severe egg allergy: observe 30 min post-vaccination

206.3.0.4 4⃣ Pregnancy + Flu

  • Increased severity (3rd trimester)
  • Vaccinate during pregnancy (any trimester)
  • Maternal Ab transplacental protection × 6 mo postpartum
  • Empirical oseltamivir for suspected flu in pregnancy

206.3.0.5 5⃣ H5N1 Workup Suspected Cases

  • Travel / occupational history (dairy farm, poultry)
  • Conjunctivitis + URI / pneumonia
  • Multiplex respiratory PCR
  • BSL-3 lab for confirmation
  • Isolation
  • Public Health notification

206.3.0.6 6⃣ Pediatric IAE (Influenza-Associated Encephalopathy)

  • Japanese term, severe necrotizing encephalopathy
  • 急 onset coma in pediatric flu
  • High mortality + sequelae
  • Treatment: ICU, IVIG, steroid
  • Surveillance + early recognition

206.3.0.7 7⃣ 健保 / Taiwan

  • 公費 flu vaccine for ≥ 65 yr, chronic disease, healthcare workers, school children
  • 自費 LAIV nasal
  • 健保 oseltamivir, baloxavir limited indication (severe + high-risk)
  • 通報 H5N1 + suspected pandemic strains
  • 盧醫垫 hint: 老 + 糖 + 慢病 → push flu vaccine annual, very effective severe disease reduction

206.3.0.8 8⃣ Baloxavir vs Oseltamivir

  • Baloxavir: single dose, convenient
  • Oseltamivir: 5-day course, more data
  • Baloxavir resistance emerges in 5-10% post-treatment
  • Cost: baloxavir higher
  • 倧倚 institutions use oseltamivir first

206.3.0.9 9⃣ ECMO for Severe Flu ARDS

  • Selective center capability
  • 2009 H1N1 pandemic experience built protocols
  • Survival benefit shown in observational data
  • Reserved for refractory severe ARDS

206.3.0.10 10. Universal Pan-Influenza Vaccine

  • Long-pursued goal
  • Targets conserved HA stem region
  • mRNA-1010 Moderna + others in trials
  • Quadrivalent + universal candidates
  • Would eliminate annual reformulation need