Prevention and various treatments for influenza

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WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.C.L. BAUDAINS OF ST CLEMENT

ANSWER TO BE TABLED ON TUESDAY 4th DECEMBER 2007

Question

1. In view ofrecent media coverage relating to influenza preventionandtreatment that somemay have found confusing would the Minister clarify the situation byinformingmemberswhether –

( i) T a m iflu and Relenza are antivirals, not vaccines, and need to be taken within 48 hours of the start of

the illness to be of any use?

( i i) T a m iflu and Relenza are primarily for use against Influenza type A and B, and whether their

efficacy against avian flu has been quantified?

( ii i) a vaccine to protect against avian flu is currently available?

2. Given that drugswhich fight the influenza virus, such as Tamiflu and Relenza, need to be taken at the onset of symptoms in ordertobe effective, would the MinisteragreetoimplementDr.Laver's (the flu vaccine co- founder) adviceandmaketheanti-virals available overthecounter' in the eventof a majoroutbreak locally, thereby saving valuable time otherwise lost whilst patients wait for a doctor's appointment to get a prescription?

Answer

It strikes me that there may be some confusion in the minds of the lay public about the three different types of flu which have been topical in recent times: seasonal flu, avian flu and pandemic flu. I have added definitions at the end of this answer for ease of reference.

1. (i) I can confirm that Tamiflu and Relenza are antiviral drugs and notvaccines.Thesedrugsmust be taken within 48hours of the onsetof flu symptomsif they are to have an effect.TheMedical Officer of Health, Dr Geller, has advised me that for antiviral drugs to be optimally effective, for treating pandemic flu, she would like toseepatientstakingTamiflu within hoursand the sooner the better.

( ii ) Avian influenza is a type A influenza virus (H5N1). Tamiflu and Relenza are considered effective if

given early. They reduce the severity of the illness and can prevent death in this, the most severe form of flu ever seen in man. We have stockpiled Tamiflu for use against pandemic flu which is likely to be a variant of the H5N1 avian flu virus.

( ii i) A human vaccine has been manufactured which protects against avian flu. The potential of this vaccine

to save lives, however, is that it is predicted to offer some protection against any H5 variety of flu. The World Health Organisation is currently on pandemic alert as bird flu has passed into humans and they predict it is only a matter of time before this H5N1 virus variety can pass between people easily through coughs, sneezes and secretions, thus causing a worldwide flu pandemic.

2. Dr. Lavermade his comments in the lightof a seasonal flu outbreak in Australia. OurstockofTamiflu is largely reserved for treating the more severe - pandemic flu. There remain someconcernsabout inappropriate use and side effects if available over the counter. I would alsobeconcernedaboutdrug resistance and therefore that the drugscouldbecomeless effective for when we really need them: in a pandemic.

NB In answering the above questions, I have restricted my answers to the role of Tamiflu in the event of a flu pandemic. There are three types of flu that people frequently refer to. Each of these have different implications for individuals, populations and health care planning -

1. Seasonal Flu - we see this every winter. It can cause varying degrees of illness in either a few individuals or in large numbersdependingon the year.Currentlywe help to protect ourselves against this with the annualseason-specific influenza jab for people over65 and those with a chronic health problem.
2. Avian Flu - this is a flu that affects birds. There are manydifferenttypesbutatthemoment people usually use this term to refer to theH5NI strain that is affecting birdsaround the worldand that canbe highly pathogenic to poultry. It is rarely transmitted to man with just some300 cases notedinthelast 10 years. Howeverwhenmanacquires this infection he develops a severe illness and this iswhatmakes this type of flu a matterof particular concern.
3. Pandemic Flu -this is a severe flu due to a new virus to whichnoonehasimmunity and whichcan spread rapidly from person to person-hence the termpandemic - anepidemic that effects the whole world. Therehave been three pandemicsin the last 100 years in 1918,1957and1968.We are therefore due another oneatanytime. While wecannotbe certain which viral strain will cause this pandemic, H5N1avian flu looks likely. Experts predict that if it isanH5N1 derived strain that it will cause a more severe illness and higherdeath rate than that seen during the lastthreepandemics.