The Pharmaceutical Journal Vol 266 No 7152 p815-820
June 16, 2001

  RPM
  In-store pharmacies
  Pharmacy medicines
  Patient packs
  The Profession
  Future of pharmacy
  Coronary heart disease
  Influenza
  Checking technicians
  Dianette
  Paracetamol
  Monitored dosage systems
  Disillusioned youth
  Code of Ethics
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  Disposal of medicines
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  Onlooker
  The Journal

Influenza

Make specific antiviral therapy available

From Mr J. Dawson, MRPharmS

Your report (PJ, May 5, p629) of the recent meeting held at the Royal Society on “The origin and control of pandemic influenza”, highlighted some extremely pertinent points.

We would like to endorse Dr Douglas Fleming’s assertion that the best way to prepare for dealing with a pandemic is to gain expertise in treating annual outbreaks and epidemics. Indeed the experience in getting to grips with the foot and mouth epidemic illustrates the difficulties encountered when trying to implement control measures on an occasional basis. Rolling out the Department of Health’s amantadine reserves during a pandemic will be greatly facilitated if the medical community develops an expertise, annually, in specifically diagnosing influenza and treating it with specific antiviral therapy.

Regarding the use of the rapid near-patient diagnostic tests which can specifically diagnose influenza from other respiratory infections, Dr Fleming raised another valid point concerning the logistical difficulties of employing such a test within GPs’ surgeries during an influenza outbreak. Similarly, the Department of Health recognised the logistical problems associated with treating influenza in GPs’ surgeries when, in implementing the National Institute for Clinical Excellence’s Relenza guidance last winter, it authorised patient group directions (PGDs) to enable nurses and pharmacists to prescribe the drug. The community pharmacist, with appropriate training, is in the obvious place from which to control an influenza outbreak. Patients can gain access as soon as symptoms begin and it is in these circumstances that antiviral therapy is strikingly effective.

Although Dr Joe Collier stated at the meeting that the symptoms of influenza could be treated with paracetamol and a cough suppressant, I believe the time has come to organise the availability of specific antiviral therapy during the annual influenza outbreaks. The influenza virus causes rapid and extensive lysis of the cells lining the respiratory tract, causing marked debilitation and opening up the way for secondary bacterial infections. During the winter of 1999/2000 in England and Wales, there were over 15,000 excess deaths directly attributable to influenza.1 Furthermore it is not just the at-risk population that is affected. In a study examining UK patient records from 1991 to 1996, it was found that approximately half of all influenza complications had occurred in the otherwise healthy population.² This situation will not improve until we start dealing with the causative agent.

References

1. Goddard NL, Joseph CA, Zambon M, Nunn M, Fleming D, Watson JM. Influenza surveillance in England and Wales: October 1999 to May 2000. Commun. Dis Public Health 2000;3:261-266.

2. Meier C, Napalkov P, Jefferson T, Wegmuller Y. Drug utilization patterns for influenza and influenza related complications in primary care in the UK. Options for the Control of Influenza IV. Hersonissos, Crete, 2000. W22-3.

John Dawson
Managing Director, Alliance Pharmaceuticals Ltd

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