Clinical guidelines for influenza in children updated

According to the definition, influenza is an acute respiratory viral disease characterized by fever and symptoms of general intoxication, dominating over a moderate catarrhal syndrome in the upper respiratory tract.

Previously, the list of ICD-10 codes in the Kyrgyz Republic included only J10 (influenza caused by an identified seasonal influenza virus) and J11 (influenza, virus not identified). Now the list includes J9 (influenza caused by a specific identified influenza virus).

In addition, a new form of disease severity has been added to the document – hypertoxic. Mild, moderate and severe (toxic) – have remained unchanged. The Ministry of Health has also introduced a new section “Clinical picture of a disease or condition (group of diseases or conditions)”, in which, among other things, it has expanded the list of symptoms indicating a severe course of influenza. These include infectious-toxic (hypoxic) encephalopathy, acute respiratory distress syndrome, Gasser syndrome, Reye syndrome, myocarditis and Kiss syndrome, Waterhouse-Friderichsen syndrome, and DIC syndrome.

The block describing recommendations for laboratory diagnostics for different disease progressions has also been changed. For example, doctors are now recommended to conduct an express test for influenza A and B viruses, a molecular biological test for the influenza virus, for nucleic acids of SARS-CoV-2 viruses, parainfluenza, rhinoviruses, adenoviruses, respiratory syncytial viruses, coronaviruses 229E, OC43, NL63, HKUI, bocaviruses and metapneumoviruses. If hemorrhagic manifestations develop during the course of the disease, it is recommended to prescribe a coagulogram, and in severe cases of influenza, a study of the level of sodium, potassium and chlorides in the blood.

The recommendations for diagnostic tests included pulse oximetry if there is a suspicion of lower respiratory tract damage, an appointment (examination, consultation) with a cardiologist, neurologist, otolaryngologist, anesthesiologist-resuscitator (for timely transfer to the intensive care unit). Neurosonography was excluded from this list.

Given the course of the disease, treatment of influenza is recommended to be carried out with antiviral drugs of direct action (baloxavir marboxil), systemic action (Kagocel), and also ambroxol. Now the CR also contain information about which drugs are not recommended for treatment of influenza. For example, this is rimantadine. The commentary states that "resistance of most strains of the influenza virus to drugs of this group has been proven."

The section with other treatment methods used to contain physical methods of reducing temperature (undressing, wiping with water at room temperature), sanitizing the upper respiratory tract (removing mucus from the nose, rinsing the oropharynx), and aerating the room. Now, immunostimulants are recommended as other treatment, as well as Anaferon for children, Ergoferon.

In most cases, rehabilitation of patients who have had the flu is not required, however, if complications develop or concomitant diseases worsen, rehabilitation measures are prescribed by medical specialists in the appropriate field.

Recommendations for prevention and dispensary observation include vaccination, a single use of a direct-acting antiviral drug no later than 48 hours after contact, and other measures. The document also added risk factors for an unfavorable outcome of the disease. For example, children under 5 years of age (especially under 2 years of age), with diabetes, obesity, heart defects and inflammatory diseases are at risk.

In July 2025, Chief State Sanitary Doctor of the Russian Federation Anna Popova signed a decree on measures to prevent influenza, acute respiratory viral infections and COVID-19 in the 2025-2026 epidemic season. The document provides for a large-scale vaccination campaign covering up to 60% of the population of each region, including at least 75% of people at risk. The decree, like last year, regulates the preparation of medical institutions, the improvement of laboratory diagnostics and the organization of informing the population - key measures to reduce the incidence rate and minimize the risks of the spread of infections in the autumn-winter period. Particular attention is again paid to the elderly, children, health workers, as well as employees of organizations related to poultry farming, livestock farming and zoos.