Clinical Signs and Symptoms Predicting Influenza Infection | Geriatrics | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Schoenbaum  SC Economic impact of influenza: the individual's perspective.  Am J Med. 1987;8226- 30Google ScholarCrossref
Monto  AS Influenza: quantifying morbidity and mortality.  Am J Med. 1987;8220- 25Google ScholarCrossref
Not Available, Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections: The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group.  Lancet. 1998;3521877- 1881[published erratum appears in Lancet.1999;353:504].Google ScholarCrossref
Cate  TR Clinical manifestations and consequences of influenza.  Am J Med. 1987;8215- 19Google ScholarCrossref
Monto  ASOhmit  SEMargulies  JRTalsma  A Medical practice-based influenza surveillance: viral prevalence and assessment of morbidity.  Am J Epidemiol. 1995;141502- 1506Google Scholar
Monto  AS Studies of the community and family: acute respiratory illness and infection.  Epidemiol Rev. 1994;16351- 373Google Scholar
Carrat  FTachet  AHousset  BValleron  AJRouzioux  C Influenza and influenza-like illness in general practice: drawing lessons for surveillance from a pilot study in Paris, France.  Br J Gen Pract. 1997;47217- 220Google Scholar
Long  CEHall  CBCunningham  CK  et al.  Influenza surveillance in community-dwelling elderly compared with children.  Arch Fam Med. 1997;6459- 465Google ScholarCrossref
Glezen  WP Influenza control—unfinished business.  JAMA. 1999;281944- 945Google ScholarCrossref
Mossad  SB Underused options for preventing and treating influenza.  Cleve Clin J Med. 1999;6619- 23Google ScholarCrossref
Hayden  FGTreanor  JJBetts  RFLobo  MEsinhart  JDHussey  EK Safety and efficacy of the neuraminidase inhibitor GG167 in experimental human influenza.  JAMA. 1996;275295- 299Google ScholarCrossref
Hayden  FGOsterhaus  ADTreanor  JJ  et al. GG167 Influenza Study Group, Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenza virus infections.  N Engl J Med. 1997;337874- 880Google ScholarCrossref
Dolin  RReichman  RCMadore  HPMaynard  RLinton  PNWebber-Jones  J A controlled trial of amantadine and rimantadine in the prophylaxis of influenza A infection.  N Engl J Med. 1982;307580- 584Google ScholarCrossref
Hayden  FGHay  AJ Emergence and transmission of influenza A viruses resistant to amantadine and rimantadine.  Curr Top Microbiol Immunol. 1992;176119- 130Google Scholar
Mast  EEHarmon  MWGravenstein  S  et al.  Emergence and possible transmission of amantadine-resistant viruses during nursing home outbreaks of influenza A (H3N2).  Am J Epidemiol. 1991;134988- 997Google Scholar
Hayden  FGTreanor  JJFritz  RS  et al.  Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza: randomized controlled trials for prevention and treatment.  JAMA. 1999;2821240- 1246Google ScholarCrossref
Sintchenko  VDwyer  DE The diagnosis and management of influenza: an update.  Aust Fam Physician. 1999;28313- 7Google Scholar
Piedra  PA Influenza virus pneumonia: pathogenesis, treatment, and prevention.  Semin Respir Infect. 1995;10216- 223Google Scholar
Claas  ECvan Milaan  AJSprenger  MJ  et al.  Prospective application of reverse transcriptase polymerase chain reaction for diagnosing influenza infections in respiratory samples from a children's hospital.  J Clin Microbiol. 1993;312218- 2221Google Scholar
Grandien  MPettersson  CAGardner  PSLinde  AStanton  A Rapid viral diagnosis of acute respiratory infections: comparison of enzyme-linked immunosorbent assay and the immunofluorescence technique for detection of viral antigens in nasopharyngeal secretions.  J Clin Microbiol. 1985;22757- 760Google Scholar
Monto  ASOhmit  SE The evolving epidemiology of influenza infection and disease. Brown  LEHampson  AWWebster  RG Options for the Control of Influenza III. Amsterdam, the Netherlands Elsevier Science BV1996;45- 49Google Scholar
Carrat  FTachet  ARouzioux  CHousset  BValleron  AJ Evaluation of clinical case definitions of influenza: detailed investigation of patients during the 1995-1996 epidemic in France.  Clin Infect Dis. 1999;28283- 290Google ScholarCrossref
Nicholson  KGKent  JHammersley  VCancio  E Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden.  BMJ. 1997;3151060- 1064Google ScholarCrossref
Wald  TGMiller  BAShult  PDrinka  PLanger  LGravenstein  S Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons?  J Am Geriatr Soc. 1995;43170- 174Google Scholar
Not Available, A Double-blind, Randomised, Placebo-Controlled, Parallel-Group, Multicentre Study to Investigate the Efficacy and Safety of Inhaled Plus Intranasal Zanamivir in the Treatment of Influenza A and B Viral Infections.  Greenford, England Glaxo Wellcome Research & Development1998;Study NAIB2007.
Monto  ASFleming  DMHenry  D  et al.  Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenza A and B virus infections.  J Infect Dis. 1999;180254- 261Google ScholarCrossref
Lalezari  JKlien  TStapleton  JElliott  MFlack  NKeene  O The efficacy and safety of inhaled zanamivir in the treatment of influenza in otherwise healthy and `high risk' individuals in North America [abstract].  J Antimicrob Chemother. 1999;4444Google Scholar
Makela  MJPauksens  KRostila  T  et al.  Clinical efficacy and safety of the orally inhaled neuraminidase inhibitor zanamivir in the treatment of influenza: a randomized, double-blind, placebo-controlled European study.  J Infect. 2000;4042- 48Google ScholarCrossref
Original Investigation
November 27, 2000

Clinical Signs and Symptoms Predicting Influenza Infection

Author Affiliations

From the Department of Epidemiology, University of Michigan, Ann Arbor (Dr Monto); Center for Geriatrics and Gerontology, East Virginia Medical School, Norfolk (Dr Gravenstein); and Infectious Diseases and Hepatitis, Glaxo Wellcome Inc, Research Triangle Park, NC (Drs Elliott, Colopy, and Schweinle). Dr Monto has received honoraria and research support from Glaxo Wellcome Inc and Hoffmann-LaRoche Inc. Dr Gravenstein is a consultant to Glaxo Wellcome Inc and Hoffmann-LaRoche Inc and has received research support from Glaxo Wellcome Inc. Drs Elliott, Colopy, and Schweinle are employees of Glaxo Wellcome Inc and may hold Glaxo Wellcome stock or stock options.

Arch Intern Med. 2000;160(21):3243-3247. doi:10.1001/archinte.160.21.3243

Background  New antiviral drugs are available for the treatment of influenza type A and type B infections. In clinical practice, antiviral use has rarely been guided by antecedent laboratory diagnosis. Defined clinical predictors of an influenza infection can help guide timely therapy and avoid unnecessary antibiotic use.

Objective  To examine which clinical signs and symptoms are most predictive of influenza infection in patients with influenzalike illness using a large data set derived from clinical trials of zanamivir.

Methods  This analysis is a retrospective, pooled analysis of baseline signs and symptoms from phase 2 and 3 clinical trial participants. It was conducted in mainly unvaccinated (mean age, 35 years) adults and adolescents who had influenzalike illness, defined as having fever or feverishness plus at least 2 of the following influenzalike symptoms: headache, myalgia, cough, or sore throat who underwent laboratory testing for influenza. Clinical signs and symptoms were evaluated in statistical models to identify those best predicting laboratory confirmation of influenza.

Results  Of 3744 subjects enrolled with baseline influenzalike symptoms, and included in this analysis, 2470 (66%) were confirmed to have influenza. Individuals with influenza were more likely to have cough (93% vs 80%), fever (68% vs 40%), cough and fever together (64% vs 33%), and/or nasal congestion (91% vs 81%) than those without influenza. The best multivariate predictors of influenza infections were cough and fever with a positive predictive value of 79% (P<.001). The positive predictive value rose with the increase in the temperature at the time of recruitment.

Conclusion  When influenza is circulating within the community, patients with an influenzalike illness who have both cough and fever within 48 hours of symptom onset are likely to have influenza and the administration of influenza antiviral therapy may be appropriate to consider.