Immuno-compromised individuals in England should consider anti-flu drugs, says DoH

The Department of Health (DoH) has issued a statement which includes guidance from the National Institute of Clinical Excellence (NICE) on the use of antiviral drugs for the prevention or treatment of influenza. The Health Protection Agency (HPA) says that there is now ‘normal seasonal activity’ of influenza A circulating in England, and the DoH recommends that ‘at-risk’ individuals - e.g. those with suppressed immune systems due to HIV infection - who have not had a flu jab this season should consider taking the prescription of the antiviral agents zanamivir and oseltamivir to prevent or treat flu.

“Based on epidemiological and community based virological surveillance,” says the DoH statement, “influenza A is known to be circulating in the community. In line with NICE guidance, the use of antiviral drugs for the prevention or treatment of influenza is now recommended.”

Last week’s weekly returns of GP consultations for influenza-like illness to the Royal College of General Practitioners (RCGP) increased to 41 per 100,000 (based on a survey population of 572,164) with rates of 62, 39 and 30 per 100,000 in the RCGP northern, central, and southern regions of England respectively. This national rate crosses the ‘baseline’ threshold of 30 consultations per 100,000 that defines normal seasonal activity. An increase in the number of influenza A isolates of both (H3) and (H1) subtypes have been reported from all regions of England over recent weeks.

NICE recommends that when influenza A or B virus is circulating in the community, oseltamivir (Roche’s Tamiflu) should be prescribed for the prevention of influenza to adults who fulfil the following criteria:

Adults who

• belong to an ‘at-risk’ group, and
• have not had a flu jab this season, or who had one but too recently for it to have given good protection, or have had a flu jab but the vaccine does not match the virus circulating in the community, and
• have been in close contact with someone with flu-like symptoms, and
• can start taking oseltamivir within 48 hours of being in contact with the person with flu-like symptoms.

According to the HPA, the vaccine for this winter contains the influenza A (H3N2)-Fujian strain which has been the predominant circulating influenza strain since it emerged last winter.

Zanamivir (GSK’s Relenza) and oseltamivir are recommended for the treatment of influenza in 'at-risk' children or adults who present with influenza-like illness and who can start treatment within 48 hours of the onset of symptoms.

Dr John Watson, Head of the HPA’s Respiratory Diseases Department, says that "for the majority of people, flu is not life-threatening, however unpleasant it might be; symptoms can include headache, fever, cough, sore throat, aching muscles and joints. However it can be more dangerous for those in at-risk groups, such as the elderly and patients with heart problems, diabetes or asthma, or those who are immuno-compromised, who are at risk of developing complications from their influenza virus infection.”