GPs can now prescribe antivirals for patients with symptoms of flu, after surveillance data showed a rise in cases.
A letter to the NHS from the chief medical offer said influenza activity was increasing across all levels of care and is expected to rise further in coming weeks.
The most notable changes include a ‘significant increase’ in influenza positivity in samples sent for laboratory surveillance.
In additions there has been an uptick in acute respiratory infection outbreaks and a ‘marked increase’ in those with influenza reported, mainly in care homes the letter sent on the 3 December said.
It means that as per NICE guidance prescribers in primary care can now give oseltamivir and zanamivir for those in clinical at-risk groups and anyone at risk of severe illness or complications from flu if not treated.
Patients must start taking the antivirals within 48 hours of onset of symptoms.
For children five years or older, zanamivir must be given with 36 hours of symptoms starting, the guidance added.
‘Clinical diagnosis of influenza may be challenging given its similarity in presentation to other respiratory viral infections including Covid-19,’ the letter states.
‘This situation complicates recommendations for antiviral use based on clinical-epidemiological evidence alone.
‘As such, where available, virological testing should be increasingly considered to guide case management and outbreak response.’
And it reminded health and social care workers to have their flu vaccine now that ‘we are in influenza season’.
The latest figures published by the UK Health Security Agency for the week up to the 28 November showed GP consultations for influenza like illness in sentinel practices had increased from 3.7 per 100,000 patients to 4.5 per 100,000 in a week.
Emergency department attendances and hospital admission had also seen a rise, the figures showed.
Updated data on NHS staff vaccine uptake is expected later this month but public health officials recently warned that only 24% of NHS workers had received a flu vaccine and 14% had had a Covid vaccine.
GPs have a slightly higher uptake than other healthcare professionals, but it was still only 42% for flu and 23.6% for Covid.
Data so far on vaccine uptake shows 34.8% of the under 65s in a clinical risk group have been vaccinated along with 31.1% of pregnant women.
To date 70.3% of the over 65s have taken up the offer of a flu jab, the GP data shows.
The figures cannot be compared to the same time last year because most patients only became eligible in October rather than September after the Joint Committee on Vaccination and Immunisation advised a later start to the campaign.
There had been some confusion among practices after the omission of GPs and frontline staff eligibility for autumn Covid boosters in the Green Book.
For primary school-aged children who can have the vaccine at school or through their GP, national uptake is 30% and for secondary school-aged children it is 17.4% – the highest on record at this time in the season, UKHSA said.
“In hospitalised patients with severe influenza, oseltamivir and peramivir might reduce duration of hospitalisation compared with standard care or placebo, although the certainty of evidence is low. The effects of all antivirals on mortality and other important patient outcomes are very uncertain due to scarce data from randomised controlled trials.”
Lancet 24 Aug 2024 Ya Gao et Al.
Not clear that the drugs help.
Meanwhile the NHS apparently cannot afford to provide GLP-1 drugs that do definitely help. And lots of other stuff.
Cochrane review: “Our findings confirm that both oseltamivir and zanamivir reduce the time to symptomatic improvement in adults (but not asthmatic children) with influenza‐like illness. The size of this effect is small, approximately half a day. It is unclear whether this is superior to treatment with commonly used antipyretic medications. However, we did not find any credible evidence that either oseltamivir or zanamivir reduce the risk of complications of influenza, particularly pneumonia, nor reduce risk of hospitalisation or death.” And “When used as prophylactic agents to prevent the occurrence of influenza in individuals or families, our findings again suggest a minimal effect on prevention.” “The small benefits we noted in symptomatic improvement and the lack of credible evidence for an effect on serious complications needs to be balanced with the adverse effects found with these drugs in meta‐analyses, especially diabetic/hyperglycaemic, renal and neuropsychiatric effects”