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Number of flu cases high enough to bring in the antivirals

The overall rate of influenza reports has exceeded the threshold at which the National Institute for Health and Clinical Excellence (NICE) guidelines on the use of antiviral drugs are triggered, and so in line with NICE guidance, the use of antiviral drugs for the prevention and treatment of influenza is now recommended.

A letter from Dr Salisbury, the Director of Immunisation Policy, Monitoring and Surveillance at the Department of Health, has been sent to all GPs to inform them that the most recent influenza surveillance data available indicates it is time to offer Oseltamivir  to all patients at risk of flu or who have come into contact with someone with flu.

Much of the increase is from cases of influenza type A (H3) in the 15-44-year-old, and 45-64-year-old, age groups.

New guidance on the use of antiviral drugs for the prevention of influenza was announced in September 2003. 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 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.
  • Can start taking oseltamivir within 48 hours of being in contact with the person with flu-like symptoms.

On 31 January 2006, oseltamivir was licensed for prophylactic use in children aged one year and above. In the interim, until NICE completes its review, it would be appropriate to use oseltamivir for prophylaxis in persons aged 1 year above according to the other conditions laid out by NICE as summarised above.

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

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.

For more detailed information on the NICE guidance refer to the NICE website (