charles shepherd
Senior Member
- Messages
- 2,239
TREATMENT OF INFLUENZA THIS WINTER:
Below is some information on the use of antiviral medication to treat influenza
This has been sent to doctors by the UK Chief Medical Officer following the increased level of notification of cases of flu this winter
MEA information on the use of flu vaccination in relation to ME/CFS:
http://www.meassociation.org.uk/shop/management-leaflets/flu-vaccination/
Dr Charles Shepherd
Hon Medical Adviser, MEA
Letter from the CMO:
Richmond House
79 Whitehall
London SW1A 2NS
7 January 2016
Dear Colleague
INFLUENZA SEASON 2015/16 – USE OF ANTIVIRAL MEDICINES
The most recent surveillance data indicate that there has been a recent increase in influenza virus activity and that there is now a substantial likelihood that people presenting with an influenza-like illness are infected with an influenza virus.
GPs and other prescribers working in primary care may now prescribe at NHS expense, antiviral medicines for the prophylaxis and treatment of influenza, in accordance with NICE guidance and Schedule 2 to the National Health Service (General Medical Services Contracts) (Prescription of drugs etc) Regulations 2004), commonly known as the Grey List or Selected List Scheme (SLS).
You should consider prescribing antiviral medicines for patients if they are at risk of severe illness and/or complications from influenza if not treated, whether or not they are in a ‘clinical at risk group’. The use of antiviral medicines is supported by the National Institute for Health and Care Excellence (NICE). Their guidance on the use of antiviral medicines can be accessed at: http://guidance.nice.org.uk/TA168 for treatment, and http://guidance.nice.org.uk/TA158 for prophylaxis.
There is good evidence that antiviral medicines can be of benefit and that they reduce the risk of death in patients hospitalized with influenza. A recent widely reported Cochrane review of trials of influenza antivirals found only a small, but significant, clinical benefit in patients with mild illness in the community. There is evidence, however, from an observational study that early treatment of hospitalised patients with influenza can reduce mortality1. More recently, a report from the Academy of Medical Sciences and Wellcome Trust on the Use of neuraminidase inhibitors (NAIs) in influenza, supported the use of antiviral medicines in patients who are severely ill with influenza, and that the routine use of antivirals for patients with influenza may be advisable when influenza circulates more widely or causes more severe symptoms.
1 Muthuri et al, Lancet Respir Med 2014;2:395-404)
The Grey List
The “Grey List”, which is included within the Drug Tariff at Part XVIIIB, restricts prescribers working under a primary care contract to only prescribe antiviral medicines to specified people who are listed in the Drug Tariff. i.e. the clinical at risk groups, pregnant women, people over the age of 65 years and those people under 65 years of age who are not in `clinical at risk’ groups but are clinically assessed to be at risk of developing medical complications from influenza.
Clinicians in secondary care are not subject to the “Grey List” restrictions that apply in primary care to prescribing of antiviral medicines, They can therefore use their clinical judgment to prescribe antiviral medicines, including for those not in the 'clinical at risk' groups.
For clinicians treating hospitalised patients with suspected influenza, rapid laboratory confirmation with subtype identification is advised, to support patient management.
Advice for prescribers for endorsing prescriptions
Further information on the at-risk groups and patients who are eligible for treatment in primary care at NHS expense with either oseltamivir (Tamiflu) or zanamivir (Relenza) can be found in Part XVIIIB of the Drug Tariff (Drugs, Medicines and Other Substances that may be ordered only in certain circumstances is available at: http://www.ppa.org.uk/ppa/edt_intro.htm.
Primary care prescribers are reminded to endorse all prescriptions for oseltamivir (Tamiflu) and zanamivir (Relenza), with the reference “SLS”. Community pharmacies are only able to dispense oseltamivir and zanamivir at NHS expense, if the prescriber endorses the prescription with “SLS”.
Prescribing for children over the age of one year
Wherever possible, for children over the age of one year and for adults who are not able to swallow capsules, the appropriate strength of capsules should be prescribed. The contents of the capsules can be emptied and added to a suitable sugary diluent. As far as possible, oseltamivir (Tamiflu) suspension should be restricted for children under 1 year of age. This will support the continuity of supply of the liquid form of oseltamivir for this vulnerable age group.
MAXIMISING UPTAKE OF FLU VACCINATION, INCLUDING HEALTHCARE STAFF
The increase in flu activity also highlights the need to ensure maximum protection through vaccination. Please encourage as many people in the at risk qualifying groups those aged 65 and over, those under 65 in ‘at risk’ groups, pregnant women and children aged 2-4 and in primary school years 1 and 2 to get the flu vaccination.
It is also important that frontline healthcare workers, including GPs, nurses, pharmacists, and their teams, minimise the risk of transmitting flu by getting vaccinated themselves and observing strict infection control measures. This season 44.1% of healthcare workers have been vaccinated up to end of November 2015, please vaccinate yourself as this will help protect those in your care, as well as you and your family.
Yours sincerely
Professor Dame Sally C Davies
Chief Medical Officer
Below is some information on the use of antiviral medication to treat influenza
This has been sent to doctors by the UK Chief Medical Officer following the increased level of notification of cases of flu this winter
MEA information on the use of flu vaccination in relation to ME/CFS:
http://www.meassociation.org.uk/shop/management-leaflets/flu-vaccination/
Dr Charles Shepherd
Hon Medical Adviser, MEA
Letter from the CMO:
Richmond House
79 Whitehall
London SW1A 2NS
7 January 2016
Dear Colleague
INFLUENZA SEASON 2015/16 – USE OF ANTIVIRAL MEDICINES
The most recent surveillance data indicate that there has been a recent increase in influenza virus activity and that there is now a substantial likelihood that people presenting with an influenza-like illness are infected with an influenza virus.
GPs and other prescribers working in primary care may now prescribe at NHS expense, antiviral medicines for the prophylaxis and treatment of influenza, in accordance with NICE guidance and Schedule 2 to the National Health Service (General Medical Services Contracts) (Prescription of drugs etc) Regulations 2004), commonly known as the Grey List or Selected List Scheme (SLS).
You should consider prescribing antiviral medicines for patients if they are at risk of severe illness and/or complications from influenza if not treated, whether or not they are in a ‘clinical at risk group’. The use of antiviral medicines is supported by the National Institute for Health and Care Excellence (NICE). Their guidance on the use of antiviral medicines can be accessed at: http://guidance.nice.org.uk/TA168 for treatment, and http://guidance.nice.org.uk/TA158 for prophylaxis.
There is good evidence that antiviral medicines can be of benefit and that they reduce the risk of death in patients hospitalized with influenza. A recent widely reported Cochrane review of trials of influenza antivirals found only a small, but significant, clinical benefit in patients with mild illness in the community. There is evidence, however, from an observational study that early treatment of hospitalised patients with influenza can reduce mortality1. More recently, a report from the Academy of Medical Sciences and Wellcome Trust on the Use of neuraminidase inhibitors (NAIs) in influenza, supported the use of antiviral medicines in patients who are severely ill with influenza, and that the routine use of antivirals for patients with influenza may be advisable when influenza circulates more widely or causes more severe symptoms.
1 Muthuri et al, Lancet Respir Med 2014;2:395-404)
The Grey List
The “Grey List”, which is included within the Drug Tariff at Part XVIIIB, restricts prescribers working under a primary care contract to only prescribe antiviral medicines to specified people who are listed in the Drug Tariff. i.e. the clinical at risk groups, pregnant women, people over the age of 65 years and those people under 65 years of age who are not in `clinical at risk’ groups but are clinically assessed to be at risk of developing medical complications from influenza.
Clinicians in secondary care are not subject to the “Grey List” restrictions that apply in primary care to prescribing of antiviral medicines, They can therefore use their clinical judgment to prescribe antiviral medicines, including for those not in the 'clinical at risk' groups.
For clinicians treating hospitalised patients with suspected influenza, rapid laboratory confirmation with subtype identification is advised, to support patient management.
Advice for prescribers for endorsing prescriptions
Further information on the at-risk groups and patients who are eligible for treatment in primary care at NHS expense with either oseltamivir (Tamiflu) or zanamivir (Relenza) can be found in Part XVIIIB of the Drug Tariff (Drugs, Medicines and Other Substances that may be ordered only in certain circumstances is available at: http://www.ppa.org.uk/ppa/edt_intro.htm.
Primary care prescribers are reminded to endorse all prescriptions for oseltamivir (Tamiflu) and zanamivir (Relenza), with the reference “SLS”. Community pharmacies are only able to dispense oseltamivir and zanamivir at NHS expense, if the prescriber endorses the prescription with “SLS”.
Prescribing for children over the age of one year
Wherever possible, for children over the age of one year and for adults who are not able to swallow capsules, the appropriate strength of capsules should be prescribed. The contents of the capsules can be emptied and added to a suitable sugary diluent. As far as possible, oseltamivir (Tamiflu) suspension should be restricted for children under 1 year of age. This will support the continuity of supply of the liquid form of oseltamivir for this vulnerable age group.
MAXIMISING UPTAKE OF FLU VACCINATION, INCLUDING HEALTHCARE STAFF
The increase in flu activity also highlights the need to ensure maximum protection through vaccination. Please encourage as many people in the at risk qualifying groups those aged 65 and over, those under 65 in ‘at risk’ groups, pregnant women and children aged 2-4 and in primary school years 1 and 2 to get the flu vaccination.
It is also important that frontline healthcare workers, including GPs, nurses, pharmacists, and their teams, minimise the risk of transmitting flu by getting vaccinated themselves and observing strict infection control measures. This season 44.1% of healthcare workers have been vaccinated up to end of November 2015, please vaccinate yourself as this will help protect those in your care, as well as you and your family.
Yours sincerely
Professor Dame Sally C Davies
Chief Medical Officer