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Influenza vaccination is recommended yearly Those at greatest risk for severe complications of influenza should have priority in vaccination programs: (1) Adults and children with chronic cardiopulmonary disease, including asthmatics (2) Residents, health care workers, and employees of longterm care facilities (3) Healthy adults 50 years of age or older (4) Adults and children who have required either regular medical follow-up or hospitalization in the last year for chronic metabolic disorders (including diabetes) or renal disease, those with hemoglobinopathies, and those receiving immunosuppressive drugs (5) Children and teenagers (age 6 months to 18 years) who are on long-term aspirin therapy and would be at increased risk for developing Reye s syndrome following influenza (6) Women who will become pregnant during the influenza season (7) Persons who are likely to

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Project, Free software and open source describe the same category of software, more or less, but say different things about the software, and about values The GNU Project continues to use the term free software , to express the idea that freedom, not just technology, is important (http://wwwfsforg/gnu/the-gnu-projecthtml) The open source movement shares many of the same ideas as the free software movement (availability of source code; the ability to freely copy, extend, and distribute a program), but it was founded on different principles and promotes different goals Eric Raymond and Bruce Perens, founders of the open source movement, were concerned that the philosophical ideology and emphasis on freedom promoted by the free software movement were turning off traditional businesses.

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transmit influenza to persons of high risk as defined above, such as in-home or out-of-home caregivers or household and close contacts of persons at high risk Certain high-risk groups of patients (the elderly, persons with AIDS, transplant patients) may have a poor antibody response to vaccine, but they should still be vaccinated Concern that vaccination of HIV-positive patients may result in a brief (2- to 4-week) period of increased HIV viremia and viral replication has been raised, but the clinical significance is unclear and should not preclude vaccination To prevent disease in high-risk patients, vaccination is advised for household members and health care providers who have contact with these high-risk patients Vaccination is recommended also for otherwise healthy adults who provide essential community services and for any individual who wishes to decrease the risk of becoming ill with influenza Local reactions (erythema and tenderness) at the site of injection are common, but fevers, chills, and malaise (which last in any case only 2 3 days) are rare Like measles, mumps, and yellow fever vaccines, influenza vaccine is prepared using embryonated chicken eggs, and persons with a history of anaphylaxis to eggs should not be vaccinated The risk of Guillain-Barr syndrome is not increased following vaccination Influenza vaccination may be associated with multiple false-positive serologic tests to HIV, HTLV-1, and hepatitis C, but it is self-limited, lasting 2 5 months A trivalent live attenuated influenza vaccine administered as a single-dose intranasal spray is as effective as inactivated vaccine in preventing disease in adults and may be more efficacious in children between 6 and 59 months of age, although it is not yet approved for this age group It is currently approved for use in otherwise healthy individuals between the ages of 5 and 49 years (the group studied in clinical trials) Because the risk of transmission of the live attenuated vaccine virus to immunocompromised individuals is unknown, it should NOT be used in household members of immunosuppressed individuals, health care workers, or others with close contact with immunosuppressed persons It is not recommended for those with reactive airway disease; chronic underlying metabolic, pulmonary, or cardiovascular diseases; children or adolescents receiving long-term aspirin therapy (because of the risk of Reye s syndrome); those with a history of Guillain-Barr syndrome; pregnant women; or those with a history of egg allergy Two neuraminidase inhibitors (zanamivir and oseltamivir) are available for prevention and therapy of influenza A and B The dose of oseltamivir is 75 mg/d for prophylaxis and 75 mg twice daily for 5 days for therapy Zanamivir is administered by inhaler (10 mg dose) and is given twice daily for therapy and once daily for prophylaxis The duration of prophylaxis depends on the clinical setting Amantadine and rimantadine should not be used for prophylaxis or treatment because of the high incidence of resistance of influenza A to these agents.

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