The Pharmaceutical Journal
Vol 271 No 7275 p668
15 November 2003

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Influenza season starts early this year

Signs that the influenza season has started are beginning to emerge.

In a letter sent to health professionals in England last week, Sir Liam Donaldson, chief medical officer, Department of Health, reports that influenza A viruses are being isolated from patients in both community and hospital settings. “After three relatively quiet years, influenza A is appearing somewhat earlier than normal,” he says.

The virus has been implicated in the deaths of several young children in England and Scotland during recent months, although the level of childhood deaths from respiratory illnesses is not unusually high for this time of year.

The number of people with influenza-type illness visiting their general practitioners is, however, on the increase. Those most affected are children and young adults and those living in the north and central parts of England.

Sir Liam urges health professionals to keep up the momentum of the national influenza vaccination campaign. He stresses the importance of immunising all those aged 65 years and over, as well as adults and children over six months who have conditions that put them at increased risk of serious influenza-related illness.

Most viruses analysed so far this season have been of a Fujian-like strain — a variant of the H3N2 (Panama) strain included in the current influenza vaccine. The Department of Health says the current vaccine shows cross reactivity to the Fujian-like strain and so should offer protection. Health professionals are also reminded that National Institute for Clinical Excellence guidance on the use of antiretrovirals comes into effect now that influenza A is circulating in the community (see Panel).

NICE guidance on the use of antiretrovirals Prevention When influenza A or B virus is circulating in the community, oseltamivir (Tamiflu) should be prescribed for the prevention of influenza to adults who belong to an at-risk group and have been in contact with someone with influenza-like symptoms if: • They have not been vaccinated against influenza this season • They have been vaccinated too recently to have gained good protection • They have been vaccinated, but the vaccine did not match the virus circulating in the community The guidance only applies to adults who can start taking oseltamivir within 48 hours of being in contact with the person with ’flu-like symptoms. It does not apply to otherwise healthy people under the age of 65 years. Treatment Zanamivir (Relenza) and oseltamivir are recommended for use in at-risk children and adults to treat influenza-like illness, providing they can start treatment within 48 hours of the onset of symptoms. NICE does not recommend amantadine for either the prevention or the treatment of influenza. Full guidance is available at www.nice.org.uk