KEY POINTS FOR PHARMACISTS: this winter flu season
Key points this winter flu season
This winter the new influenza virus, H1N1 influenza 09 (previously called human swine influenza), will continue spreading within the NSW population, alongside seasonal influenza, and other viruses seen each winter. The H1N1 influenza 09 virus produces a mild illness in most, a severe illness in some, and is a moderate illness overall. You may see an increase in people seeking your advice. Most people can be managed with symptomatic treatment only, however, some groups are at increased risk of complications due to the flu and should be encouraged to seek care from their doctor urgently so that they can be provided with anti-influenza medication.
What are the symptoms?
Both H1N1 influenza 09 and normal seasonal influenza can produce fever, chills, cough, sore throat, tiredness and muscle aches, Some people have also complained of vomiting and diarrhoea. Symptoms generally appear between two to four days after exposure.
Controlling the spread of infection
Pharmacists and Pharmacy staff should wash their hands after handling patients' prescriptions.
People who have developed influenza-like symptoms, who are not at high risk of complications, should be encouraged to stay home until they are well.
Everyone should be advised to take appropriate precautions: covering the mouth when coughing or sneezing, washing hands regularly, including after contact with soiled tissues or contact with nose or throat discharge, and avoiding close contact with sick people.
Seasonal Influenza Vaccine
The current seasonal vaccine is not expected to be effective against H1N1 influenza 09. However, it is effective in reducing susceptibility to other circulating influenza viruses and should continue to be recommended to the public.
Pharmaceutical Information
The H1N1 influenza 09 virus has proven susceptible to the neuraminidase inhibitors - oseltamivir (Tamiflu®) and zanamivir (Relenza®) but resistant to both amantadine and rimantadine.
Consumer Medicine Information (CMI) for Tamiflu® and Relenza® are available for download from the National Prescribing Service website: www.nps.org.au/search_by_medicine_name
Antiviral Treatment
Currently, 5 days of treatment with oseltamivir or zanamivir is being recommended for people at high risk of complications from H1N1 influenza 09. Oseltamivir and zanamivir, if given within 48 hours of symptom onset, can reduce the severity of symptoms and the time taken to recover.
NSW Health is distributing anti-influenza medications to general practices, Aboriginal Medical Services and selected community pharmacies to ensure early treatment for those from vulnerable groups at risk of severe disease, and others who have moderate or severe illness.
People at higher risk of severe illness include those who:
• are pregnant (particularly in the second or third trimesters)
• have chronic respiratory disease, including lung conditions, such as asthma or COPD
• are morbidly obese
• have chronic heart conditions (except simple hypertension)
• have chronic kidney or liver disease
• have blood disorders (including sickle cell disease)
• have neurological disorders (including intellectual and developmental disability, cerebral palsy, spinal cord injuries and other neuromuscular disorders)
• have metabolic disorders (such as diabetes mellitus)
• have weakened immune systems (immunosuppression - which may be caused by medications or viruses such as HIV)
• are of Aboriginal of Torres Strait Islander background (of any age)
Other people in the community may wish to receive treatment. Treatment will be available through private prescription for people who do not fall into one of the higher risk groups, or who do not already have moderate or severe illness.
Oseltamivir suspension may be in short supply. For children who require urgent treatment because they are in a higher risk group, or who have moderate or severe illness and are not from a high risk group, a limited supply of oseltamivir suspension will be available through designated community and public hospital pharmacies.
Antiviral Chemoprophylaxis
Currently, post-exposure prophylaxis with oseltamivir or zanamivir is being recommended only for people at extremely high risk of complications from infection with H1N1 Influenza 09 when there is illness in their household. This should be prescribed on the advice of the doctor managing the ill household member.
Inventory Management
It is expected that demand for anti-influenza medications and personal protective equipment (PPE) such as surgical masks will remain at a high level this winter. Consideration should be given to maintaining a high level of stock of these items.
For more information
Call the Australian Government Department of Health and Ageing swine influenza information hotline 1802007
Related links
- NSW Health HIN1 influenza 09 websitewww.emergency.health.nsw.gov.au/swineflu/index.asp
- Australian Government Department of Health and Ageing - Health Emergency website http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/home-1
Published by NSW Health - 29 June 2009