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Flu levels trigger NICE guidance

Influenza levels are on the rise and the National Institute for Health and Clinical Excellence’s guidance on the use of antiviral drugs for the prophylaxis of flu should now be followed in England and Wales, the Department of Health has stated.

The guidance by NICE only applies when there are high enough levels of flu in the community. Weekly research conducted by the Royal College of General Practitioners suggests that the number of people with influenza-like illness in England and Wales increased from 16.5 per 100,000 in week 48 of 2008 to 27.6 per 100,000 in week 49 (which started on 1 December 2008).

This falls just below the threshold of “normal seasonal flu” activity of 30 consultations per 100,000 people. However, in central England and among 15- to 44-year-olds, levels are higher than the 30 per 100,000 threshold, lying at 37.5 and 32.1, respectively.

Calls to NHS Direct about colds, flu, coughs and fever have risen 306 per cent since September.

Most influenza A viruses currently circulating in England are sensitive to oseltamivir, states the Health Protection Agency. Viruses resistant to oseltamivir have been detected in the Avon area, where local guidelines are in place, and advice should be sought from the local health protection unit.

According to NICE guidance, oseltamivir and zanamivir should now be prescribed for the post-exposure prevention (PDF 61.2K) of influenza if the person is in an “at-risk” group and has been exposed to an influenza-like illness and has not been effectively protected by vaccination.

They must be able to start prophylaxis according to the timescale specified in the drugs marketing authorisation (within 36 hours of contact for zanamivir and within 48 hours of contact for oseltamivir).

NICE guidance for the treatment (PDF 150K) of flu says that adults should take oseltamivir or zanamivir within 48 hours of the onset of symptoms. Oseltamivir is recommended for the treatment of children aged one and over, zanamivir is recommended for children aged five years and over. The guidance is currently under review and updated guidance is due in February 2009.

Provisional data from the HPA suggests that for England, in week 49 of 2008, 71.4 per cent of those over 65 years and 43.4 per cent of those under 65 years and considered at risk had received a flu vaccination.

The Royal Pharmaceutical Society’s head of practice, Heidi Wright, is advising pharmacists to read NICE’s guidance on prevention. She added: “As the figures for those receiving flu immunisations are fairly low, especially in the under-65 at risk groups, we would encourage primary care trusts to consider commissioning immunisation services from their local community pharmacies.”

NHS Direct has launched a new symptom checker on its website to help patients decide what action they should take for their symptoms. These include self-care, speaking to a pharmacist or GP or visiting an accident and emergency department. The system may also offer a call back to the patient, from an NHS Direct nurse advisor, depending on what information patients enter.

Citation: The Pharmaceutical Journal URI: 10043598

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