BBC BLOGS - Newsnight: Susan Watts

Archives for August 2009

More confusion over prescription of Tamiflu

Susan Watts | 17:58 UK time, Friday, 21 August 2009

Yet more Tamiflu confusion on Friday with new advice from the World Health Organisation (WHO) that otherwise healthy individuals will recover from swine flu without needing the anti-viral drug.

That does not fit neatly with the UK government's policy of giving the drug to anyone who meets the National Flu line's "phone-in" criteria. It also comes a day after we learned that only some 10% of callers are likely to be suffering from swine flu, yet 40% are receiving the drug - as I reported yesterday (link to yesterday's blog).

Ok, some people may have cheated the system, matching the criteria so they can store the drug for future use. But if Tamiflu is being taken unnecessarily it could matter to everyone, because this increases the chance of the H1N1 virus developing resistance.

The Department of Health (DoH) denies that today's advice from the WHO contradicts its own, saying: "We have consistently said that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them."

The problem is that telephone prescribing takes the GP or nurse out of the loop, so limiting the opportunity for a health professional to take a view that some patients will do just as well without antivirals.

The DoH says its approach is safer: "We believe a safety-first approach of offering antivirals, when required, to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects."

And that's the important bit - because we may only be looking at 11,000 cases in the last week, but if that rockets up again in the autumn or winter then the experiment with mass-prescribing of Tamiflu gets bigger.

And every day the experts are learning more about who is most at risk. So targeted prescribing should get easier. Up until yesterday, the UK had seen 59 deaths linked to swine flu. Today, both Wales and Northern Ireland reported their first swine-flu related deaths.

The Chief Medical Officer for England, Sir Liam Donaldson, has been investigating deaths and classifying these according to whether a patient had mild, moderate or severe underlying health conditions, or none at all. To date, just over a fifth of deaths linked to swine flu are in otherwise healthy people.

As you can see in this graphic provided by the CMO:

piechart2.gif

So it clearly remains hard for anyone to second-guess who among otherwise healthy patients ringing the flu line might go on to develop severe symptoms from this disease.

And as the DoH pointed out today: "WHO state that 40% of severe cases worldwide have been in previously healthy children and adults and that serious cases should be treated immediately. This emphasises the need not to become complacent about the mildness of the illness and the reasoning behind a precautionary policy."

The bottom line then is if you have any doubts about whether you need Tamiflu or not, avoid the flu line. Which is pretty much what the government is saying too.

"People with underlying health conditions, pregnant women, and parents with children under the age of one should speak to their GP if they have symptoms. If people have any doubts about taking antivirals they should contact their GP."

Swine flu: Where next? - update

Susan Watts | 16:59 UK time, Thursday, 20 August 2009

Back from my holidays this week, and a chance to catch up on the latest swine flu situation at the weekly briefing at the Department of Health this afternoon. It looks as if we're approaching the end of the "first wave" of pandemic flu in the UK, with an official best estimate today of 11,000 new cases in England in the last week. This is a fall from the estimated 25,000 cases in the previous week, and 30,000 in the week before that. A quick look at the graphs shows the rise and fall over the past few weeks of summer.

So what comes next? The Chief Medical Officer (CMO) for England, Sir Liam Donaldson, said it's "virtually impossible" to predict when the second wave might hit. He showed us the pattern in cases of previous pandemics. The pandemic of 1957- 58 saw a first wave peaking in late September/early October of 1957, and a second peak over Christmas and New Year of 1958. The pandemic of 1968-70 peaked first in early March 1969, then again over Christmas and New Year of 1970. "That's completely different to 1957-8, and nobody knows why," Sir Liam said.

Pandemic 2009 could look like either of those last two, he said, or do something entirely new of its own. He hopes we see no second wave until Christmas, because this would buy time in which to roll out the vaccine programme. And he clearly remains convinced there will be a second wave - whether sooner or later.

There's been some discussion while I've been away over the wisdom of giving antiviral drugs such as Tamiflu to otherwise healthy children who catch the H1N1 virus. One study suggested that side effects outweigh benefits, though this was based on seasonal flu not swine flu. And there was more to add to the "Tamiflu good-or-bad" debate from today's briefing. It emerged that on the basis of sample testing, officials estimate that only 10% of people reporting to their GPs and of those ringing the National Flu line actually have swine flu.

This has been higher, up to a maximum of 33% so the Health Protection Agency tells me. And they say that it's expected that the percentage would come down to about the 10% mark as we reach the end of a first pandemic wave. In fact it seems any rise in this number is a sign that a second wave has begun...so worth watching.

But if some 90% of those calling the National Flu line are likely to be swine flu free, it begs the question; how many callers are being prescribed Tamiflu when they don't actually need it? The Department of Health is getting back to me on that.

UPDATE:

I asked the Department of Health for numbers of callers being prescribed antivirals, and at the moment it seems to be just over 40%, down from close to 50% the week before. Here's what their spokesperson had to say:

"Use of the National Pandemic Flu Service has continued to fall. In the week ending 18 August, 108,555 assessments were completed and 45,986 courses of antivirals were collected. This compares to 192,007 assessments and 90,363 courses of antivirals collected during the week ending 11 August."

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