Based on epidemiological and community derived virological surveillance, influenza A is now circulating in the community. As a result, the Department of Health have issued the a statement, which includes guidance from the National Institute of Clinical Excellence (NICE) on the use of antiviral drugs for the prevention or treatment of influenza. This recommends that doctors should consider the prescription of the antiviral agents zanamivir and oseltamivir for suitable patients in all regions of England (1).

In the week ending 09 January 2005, the overall general practitioner (GP) consultation rate for influenza-like illness in England, reported by the weekly returns service of the Royal College of General Practitioners (RCGP) increased to 41/100,000 (based on a survey population of 572,164) with rates of 62, 39 and 30/100,000 in the RCGP northern, central, and southern regions of England respectively. This national rate crosses the new ‘baseline’ threshold of 30/100,000 that was introduced in October 2004 (2). An increase in the number of influenza A isolates of both (H3) and (H1) subtypes have been reported from all regions of England over recent weeks.

Recommendations on the prescription of the antiviral neuraminidase inhibitors, oseltamivir and zanamivir, apply when influenza is known to be circulating in the community. They are triggered when the Health Protection Agency (HPA) advises that influenza viruses are circulating, when the RCGP indicates that new GP consultation rates for influenza–like illness in England have risen above the baseline of 30/100,000, and when community based influenza surveillance schemes indicate that levels of influenza activity have risen above baseline levels.

Useful Links

• Department of Health guidance on the implementation of NICE guidance on the use of antiviral drugs for the prevention or treatment of influenza:
  <http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/FluGenera lInformation/FluGeneral/fs/
  en?CONTENT_ID=4002391&chk=Cje5ME>.
• Full Guidance on the use of zanamivir, oseltamivir and amantadine for the treatment of influenza. National Institute for Clinical Excellence (NICE): <http://www.nice.org.uk/pdf/58_Flu_fullguidance.pdf>.
• Full Guidance on the use of antiviral drugs for the prevention of influenza. National Institute for Clinical Excellence (NICE): <http://www.nice.org.uk/page.aspx?o=86770>.
  

1.	Department of Health. Guidance on the use of antiviral drugs for the prevention of influenza - NICE guidance notes on prescribing antiviral drugs. London : Department of Health, 2005. Available at: <http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/FluGeneralInformation/FluGeneral/fs/en? CONTENT_ID=4002391&chk=Cje5ME>.
2.	Goddard NL, Kyncl J, Watson JM. Appropriateness of thresholds currently used to describe influenza activity in England . Commun Dis Public Health 2003; 6 :238-45.