Swine Flu Treatment Update | Pandemic Preparedness

WHO says healthy children over five don’t need Tamiflu

New WHO guidelines for the pharmacological treatment of pandemic H1N1 recommend that healthy children with swine influenza not be given Tamiflu.
The medication, which continues to represent the mainstay of treatment for the illness, should be administered only if the sick child

• develops a severe form of swine flu;
• starts deteriorating;
• has an underlying medical condition, like asthma or diabetes; or
• is under the age of five.

Children who require treatment should be given Tamiflu immediately. Those with underlying conditions or under five years of age should be treated as soon as possible, even if they have mild symptoms.

Evidence-based recommendations

The WHO says the new guidelines, issued August 20, 2009, have been developed keeping in consideration the results of two studies that recently raised doubts about Tamiflu’s safety in children. The findings had been published early this month in the British Medical Journal by researchers of Oxford University, UK, led by Dr. Matthew Thompson.

Thompson’s team found that children on Tamiflu not only experience slight benefits–those who receive the drug recover up to one day earlier than those who don’t–one in 20 also suffer from side effects like vomiting, which may lead to potentially life-threatening conditions like dehydration. What’s more, treatment with Tamiflu seems ineffective in reducing the occurrence and/or severity of ear infections, asthma flare-ups or the need for antibiotics. In other words, say the researchers, the risks associated with Tamiflu outweigh the benefits; therefore, widespread use of the drug in children in unjustified and potentially harmful.

As the WHO points out, these findings “were considered by … its expert panel when developing the current guidelines and are fully reflected in the recommendations.”

Treat mild cases like ordinary seasonal flu

The advice, for clinicians and parents, is to give healthy children with swine flu, who are older than five paracetamol, as well as plenty of rest and fluids–just like for seasonal flu.

Be alert for worsening

However, as the vast majority of severe cases of swine flu develop in previously healthy individuals, it is important to monitor the child for signs of worsening, so that Tamiflu can be administered promptly.

“In children,” the WHO says, “danger signs include

• fast or difficult breathing;
• lack of alertness;
• difficulty in waking up; and
• little or no desire to play.”

Any of these signs may indicate that the child is progressing towards a more severe form of swine flu and needs hospital care. Call the doctor right away, as deterioration may occur very rapidly.

Know the side effects of Tamiflu

For children who need Tamiflu treatment, consider that some may experience side effects other than vomiting. Two studies conducted in England by researchers of the Health Protection Agency (HPA) found that more than 50 percent of a group of children aged 11 to 12, who were given Tamiflu had side effects, such as nausea, headache and stomach pains. Diarrhea and problems sleeping were also reported as well as poor concentration and nightmares.

References

Shun-Shin M., Thompson M., Heneghan C., Perera R., Harnden A. “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials,” British Medical Journal, August 10, 2009, 339:b3172. doi: 10.1136/bmj.b3172

World Health Organization (WHO). WHO guidelines for the pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. August 20, 2009. [Accessed 23.08.09].

World Health Organization (WHO). Recommended use of antivirals. Pandemic (H1N1) 2009. Briefing note 8. August 21, 2009. http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html. [Accessed 23.08.09].

By Lorena Tonarelli, MSc

Tamiflu Update | Pandemic Preparedness

Frontline defense against swine flu... but for how long?

There are now several confirmed cases of swine flu resistant to Tamiflu. Overall, more than ten have been reported, as of August 2009, in various countries, including Canada, China, Japan, Hong Kong, Denmark, Singapore and the US. Further spread could result in the medication becoming ineffective–a worrying scenario, given that Tamiflu is the most widely used medicine for the prevention and treatment of swine flu.

Dangers of stopping treatment

The growing concern over Tamiflu resistance is supported by evidence that, in the past two years, the seasonal flu H1N1 virus has changed into a form almost completely resistant to the drug. Why and how, exactly, this happened is unknown, but it is reasonable to expect that the same thing might occur with the swine flu H1N1 virus.

One suggested reason for resistance is patients not finishing their treatment course; a phenomenon also referred to as medication noncompliance.

The recommended treatment course for swine flu is two 75mg capsules a day for five days. When patients start taking Tamiflu, the first H1N1 strains to die are those highly susceptible to the medication, followed by those less susceptible – that is, the more resistant.

A whole treatment course ensures that both highly and less susceptible strains are killed. But, if patients stop taking Tamiflu, the less susceptible strains survive in the body, where they continue to replicate and may, potentially, originate a strain completely resistant to the drug.

Patients, who don’t finish their treatment course are about 20 percent of all those on Tamiflu, according to researchers at Imperial College London, UK. These patients could be the key agent for transmission of resistant forms of the virus, enabling them to rapidly spread through populations. The good news is there is no evidence, so far, indicating that Tamiflu-resistant strains of H1N1 can be transmitted from person to person.

A single-dose alternative?

A solution to the problem of compliance could be a treatment that is taken only once. A strong candidate, in this regard, is Laninamivir, a swine flu medication administered through inhaler, which, according to recent findings from clinical trials conducted in Asia, is also effective at treating seasonal and avian influenza.

Manufactured by the Australian pharmaceutical company Biota Holdings Limited, Laninamivir – like Tamiflu and the other medication used for swine flu, Relenza – belongs to a class of drugs called neuraminidase inhibitors, which act early in the virus’ replication cycle, “so effectively creating a ‘still birth’ of the new virus,” says the company’s chief executive, Peter Cook.

Laninamivir, which Cook expects to be licensed for marketing in Japan, Europe and the US by next year, could represent a significant improvement in the treatment of swine flu. Not only has it been shown, in studies, to be as effective as Tamiflu, it also has the advantage that, as a single-dose medication, it is easier and less costly to stockpile, and–most importantly–potentially crucial in preventing the virus from becoming resistant due to patients not finishing their treatment.

Widespread use not the best strategy

An important contributing factor to the development to Tamiflu-resistant strains of H1N1 is the mass use of the drug, which is given for prophylaxis (prevention) also to individuals with no symptoms of swine flu.

In the attempt to make it easier for the public to obtain the medication, and avoid placing further strain on already stretched healthcare services, some governments have implemented measures to ensure access to Tamiflu for everyone. For example, in the Netherlands, the drug is distributed for free to anyone with a physician’s prescription and, in the UK, it is sold over the counter in most any store.

But, experts urge caution. Widespread access to Tamiflu may not be the best strategy. Why? Because it speeds up the spread of resistant mutations, increasing the risk of the virus becoming resistant – globally. As a result, Tamiflu would become useless. And if this happens in the fall, when a more powerful strain of H1N1 is likely to circulate, the consequences could be disastrous.

Strategies have been put forward that could, potentially, help prevent the phenomenon of Tamiflu resistance from becoming global. These, according to findings in the journal BioMed Central Infectious Diseases, include not giving Tamiflu to people over 65 – the age group supposedly at least risk of swine flu.

However, mass Tamiflu use is causing another problem. People on the drug develop side effects for which they require medical attention. And this puts additional pressure on healthcare systems worldwide.

A study published this month in the British Medical Journal shows children are a category particularly at risk. The researchers, from Oxford University, say the side effects (mostly vomiting, which may lead to potentially life-threatening complications, like dehydration) are so severe and frequent that physicians should consider giving Tamiflu only to children with underlying health problems. Those with a mild form of the infection should be given paracetamol.

What’s the advice?

In summary, swine flu has been found resistant to Tamiflu in sporadic cases, which may indicate that the threat of a global resistance to the drug is real and that strategies – like improving the drug’s compliance and limiting its use to certain patient groups – to prevent, or delay, H1N1 from becoming completely resistant may be worth considering. However, currently most patients respond well to the drug.

So, what’s the advice? In a briefing note issued on August 21, the World Health Organization (WHO) says: “Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. [Thus] healthy patients with uncomplicated illness need not be treated with antivirals.”

However, “for patients who initially present with severe illness or whose condition begins to deteriorate WHO recommends treatment with oseltamivir [Tamiflu] as soon as possible. Studies show that early treatment, preferably within 48 hours after symptoms onset, is strongly associated with better clinical outcome. For [these patients] treatment should be provided even if started later.”

The same recommendation applies to all children younger than five years, pregnant women and individuals with pre-existing health problems. These, too, should be given Tamiflu as soon as possible.

Since approximately 40 percent of cases of progression to severe illness occur in previously healthy individuals – mostly adults younger than 50 and children – the WHO recommends that clinicians, caregivers, and the patients themselves be particularly alert for signs of deterioration of the infection (e.g., chest pain, confusion, difficult breathing, blue skin, low blood pressure, persistent high temperature, colored sputum) “and take urgent action, which should include treatment with oseltamivir.”

“In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.”


References

Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/h1n1flu [Accessed 08.18.2009].

Merler S., Ajelli M., Rizzo C. “Age-prioritized use of antivirals during an influenza pandemic,” BMC Infectious Diseases, July 28, 2009, 9:117.

Shun-Shin M., Thompson M., Heneghan C., Perera R., Harnden A. “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials,” British Medical Journal, August 10, 2009, 339:b3172. doi: 10.1136/bmj.b3172

World Health Organization (WHO). http://www.who.int/csr/disease/swineflu/en/. [Accessed 08.18.2009].

World Health Organization (WHO). Recommended use of antivirals. Pandemic (H1N1) 2009 briefing note 8. August 21, 2009. http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html. http://www.who.int/csr/disease/swineflu/en/. [Accessed 08.26.2009].

By Lorena Tonarelli, MSc

Pandemic Preparedness Affects Us All, Learn The Facts About Swine Flu

Influenza A ( H1N1) or swine flu may have been a term that was rarely heard until recently. Now it never seems to out of the news. The reason for this is simple, it is a new strain of an existing influenza virus that affects and kills humans. It is easily transmitted and as such poses a real threat, which is why the current swine flu pandemic level has been raised to its highest level, which means a global pandemic is underway. So what can be done, as an individual, to ensure you and your loved ones are able to deal with the eventuality of swine flu.

The governments of the world are already putting into action their respective swine flu pandemic planning scenarios, but there is much more the consumer can find out and do to help themselves, which is why an ingenious website has brought out an informative eBook which tells all. The eBook is available from www.thedeadlyflu.com.

The website has become a repository of information about swine flu. The global reaction has sparked panic in some countries and the pandemic preparedness plans have been put into action, with a variety of elements, some of which have included closing schools and amenities in which the general public congregate. The stage has now been elevated in some countries with containment no longer an option, the swine flu pandemic planning strategy is now to immunise and deal with the infected as quick as possible. In the northern hemisphere, a second more virulent wave is expected in autumn, with many hospitals and health authorities on high alert.

With so much information floating about it can be difficult to ascertain what the truth is and what is myth. The authoritive eBook from www.thedeadlyflu.com is an excellent resource whose aim is to provide detailed and informative advice on the subject of swine flu. The eBook offers salutary advice on a range of related items and ensures that the visitor is fully informed about the aspects of this new virus and the implications for them and their families. The website puts the global pandemic into context and provides relevant and pertinent information about the oncoming swine flu pandemic.

For anyone looking for effective information about the swine flu virus and what can be done about it, a visit to www.thedeadlyflu.com should be undertaken, where they will find useful and informative details which will ensure they are fully aware of the circumstances and details of this new deadly flu virus.

For further information visit http://www.thedeadlyflu.com

School Absenses Set To Rise Due To Swine Flu

Children are shortly due back into schools after the summer break and reports show that in the USA alone they can expect an increase of approximately 30% over the first few months of school absences due to Swine Flu.

The standard expected absence rate is as low as 6%, so 30% is quite scary. The presence of Swine Flu within our schools is unavoidable especially as children and teens between the ages of 15 and 19 are amongst the most susceptible to the fast spreading virus.

Pandemic Preparedness has never been more important especially when your children are involved.

Swine Flu Vaccine Effective After One Shot?

Reports have come in that a new vaccine has been produced by Chinese company Sinovac that allegidely is effective after only one dose. Their shares rose 10% in just one day after the news.

There are fears that the more conventional vaccines are to thin on the ground to administer to everybody as they generally need two shots. If Sinovacs vaccine proves OK then this will greatly stretch to a lot more people.

Testing is stuill underway so check back again for further updates. There are still no guarantees that this or any other vaccine will be effective when Swine Flu returns for its second wave so lets hope that scientists are working on something a little stronger????

For more information Click Here For general information on Swine Flu please visit our website and learn all you need to know about Pandemic Preparedness