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Title: NICE Updates Guidance for the Prophylaxis of Influenza
URL: http://www.pslgroup.com/dg/22D732.htm
Doctor's Guide
September 24, 2008

London -- September 24, 2008 -- According to updated guidance by The National Institute for Clinical Excellence (NICE), oseltamivir and zanamivir are recommended to prevent influenza if all of the following apply: national surveillance has indicated that influenza virus is circulating; the person is in an at-risk group; the person has been in contact with someone with a flu-like illness and can start treatment within 36 hours (for zanamivir) or within 48 hours (for oseltamivir); the person has not been effectively protected by vaccination.

Oseltamivir and zanamivir are not recommended for seasonal prophylaxis of influenza. Amantadine is not recommended for the prophylaxis of influenza. NICE adds that its recommendations about oseltamivir and zanamivir should not reduce efforts to vaccinate those for whom it is recommended in national guidelines. The updated guidance does not cover widespread epidemics.

During localised outbreaks of influenza-like illness (outside the periods when national surveillance indicates that influenza virus is circulating generally in the community), oseltamivir and zanamivir may be used for postexposure prophylaxis in at-risk people living in long-term residential or nursing homes, whether or not they are vaccinated. However, this should be done only if there is a high level of certainty that the causative agent in a localised outbreak is influenza, usually based on virological evidence of infection with influenza in the index case or cases.

For the purposes of this guidance, NICE defines "at risk" as those who have 1 or more of the following: chronic respiratory disease (including asthma that requires continuous or repeated use of steroids or with previous exacerbations requiring hospital admission), chronic heart disease, chronic renal disease, chronic liver disease, chronic neurological disease, immunosuppression, and diabetes mellitus. People who are aged 65 years or older are also defined as at risk.

People who are not effectively protected by vaccination include: those who have not been vaccinated since the previous influenza season; those for whom vaccination is contraindicated, or in whom it has yet to take effect; and those who have been vaccinated with a vaccine that is not well matched (according to information from the Health Protection Agency) to the circulating strain of influenza virus.


SOURCE: National Institute for Clinical Excellence

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