INFLUENZA SEASON 2007/08 - USE OF ANTIVIRALS

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To:	Consultants in Communicable Disease Primary Care Trusts - Directors of Public Health Primary Care Trusts - Medical Directors Public Health Link
Cc (Groups):	Chairman - Professional Executive Committee of PCT NHS Trust Chief Executives NHS Trusts - Medical Directors (England) NHST/FT/001 - NHS FOUNDATION TRUSTS (ENGLAND) - CHIEF EXECUTIVE NHST/FT/007 - NHS FOUNDATION TRUSTS (ENGLAND) - MEDICAL DIRECTOR PCT Chief Executives SHA Chief Executives Territorial CMOs
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From:	Dr David Salisbury CB - Immunisation and communicable disease team - Department of Health
Date:	9 January 2008

Reference	CEM/CMO/2008/01
Category:	URGENT (cascade within 24 hours)

Title:	INFLUENZA SEASON 2007/08 - USE OF ANTIVIRALS

Broadcast Content:

All GENERAL PRACTITIONERS - please ensure this message is seen by all practice nurses and non-principals working in your practice
- Deputising services
- Project manager/Nurse lead in Walk in Centres
- Lead nurses in PCTs
- PCT Pharmaceutical Advisers to forward to community pharmacists
- Accident & Emergency Departments

To: Medical Directors of NHS Trusts to forward to:
- all relevant hospital doctors

To: CCDCs

Cc:
- Regional Directors of Public Health
- Directors of Public Health of Strategic Health Authorities
- UK CMOs
- Chairmen of Professional Executive Committee

Dear Colleague

Influenza Season 2007/08 – Use of Antivirals

The most recent surveillance data available to us indicates that the overall rate of influenza reports has exceeded the threshold at which the National Institute of Clinical Excellence (NICE) guidelines on the use of antiviral drugs are triggered. Much of the activity is of influenza type H1.

In line with the NICE guidance, the use of antiviral drugs for the prevention or treatment of influenza is now recommended.

A summary of the NICE guidance is given below for ease of reference.

The National Institute of Clinical Excellence (NICE) guidance on antiviral drugs

Guidance on the use of antiviral drugs for the prevention of influenza

Guidance on the use of antiviral drugs for the treatment of influenza

3. Further information

1. Guidance on the use of antiviral drugs for the prevention of influenza (prophylaxis)

NICE recommends that when influenza A or B virus is circulating in the community, oseltamivir should be prescribed for the prevention of influenza to those aged 13* years or older who fulfil the following criteria:

belong to an ‘at-risk’ group, and
have not had a flu jab this season, or who have had one within the last two weeks, 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.

*In 2006, Oseltamivir was licensed for prophylactic use in children aged one year and above. Until NICE issues further advice, it would be appropriate to use oseltamivir, dose adjusted for body weight, for prophylaxis in persons aged 1 – 13 years following the criteria given above.

Prescribers should also note a concomitant change to the licensed duration of post-exposure prophylaxis in children and adults which is now ten (10) days (as opposed to the previous seven (7)).

Oseltamivir should not be used for the prevention of influenza in otherwise healthy people under 65 years of age, even if they have been in contact with people with flu-like symptoms.

Amantadine should not be used for the prevention of influenza in either group.

Further guidance can be found from page 195 in the 2006 edition of the Green Book – Immunisation against infectious disease (www.dh.gov.uk/greenbook).

2. Guidance on the use of antiviral drugs for the treatment of influenza

Updated guidance on the on the use of amantadine, oseltamivir and zanamivir for the treatment of influenza was issued in February 2003.

Within their respective licensed indications, zanamivir and oseltamivir are recommended for the treatment of influenza in adults who present with influenza-like illness (oseltamivir for the treatment of at-risk children aged one year and over and zanamivir for the treatment of at-risk children aged five years and over) and who can start treatment within 48 hours of the onset of symptoms.

Amantadine is not recommended for the treatment of influenza.

3. Further information

For more detailed information on the NICE guidance refer to the NICE web-site (http://www.nice.org.uk/).

Influenza activity in England and Wales

Information on the GP consultation rates for influenza/influenza-like illness is collected by the Royal College of General Practitioners (RCGP). Weekly updates on the consultation rates are published on the RCGP web-site (http:www.rcgp.org.uk/bru/tabular-data.asp) weekly reports from the Health Protection Agency on current influenza activity can be found on the Health Protection Agency Website:

http://www.hpa.org.uk/infections/topics_az/influenza/seasonal/default.htm)

Yours sincerely

Professor D M SALISBURY CB FRCP FRCPCH FFPH
Director of Immunisation

This document has been authorised by the Department of Health: Gateway reference no: 9280

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