On 20 December 2017, the Scottish Chief Medical and Pharmaceutical Officers (CMO and CPO) issued a letter noting that recent surveillance information provided by Health Protection Scotland (HPS) was indicating a substantial likelihood that people presenting with an influenza-like illness would be infected with an influenza virus. Accordingly, antiviral drugs can currently be prescribed for the prevention or treatment of influenza in the community where clinically indicated/appropriate and in particular, in those who are presenting with severe infection/symptoms where it is evident their use might help reduce overall symptoms and mortality in hospitalised patients.
Notwithstanding the debate concerning the effectiveness of antivirals (which the letter details), the CMO/CPO’s advice was that:
- Any patient hospitalised with influenza should be given antivirals.
- Antiviral treatment should be considered for all patients in an at-risk category, including pregnant women and those over 65, and those severely immunocompromised. Antivirals should ideally be given within 48 hours of onset of symptoms.
- Normally healthy patients who present with flu like symptoms and who do not at the time require hospitalisation should not require antivirals unless there is a risk that they may develop more severe symptoms as a result of the infection or if the flu strain is particularly severe. Similarly, clinical judgement should be used in deciding whether to administer antiviral treatment to healthy children.
- There is a paucity of evidence from recent studies to inform a single approach for prophylaxis in care homes. These decisions must therefore be made on a case by-case basis using clinical judgement and take account of the severity of the outbreak.
- Should the strain of seasonal flu circulating in the community increase in virulence or show greater risk of complications and/or death, consideration should be given to prescribing antivirals more widely, both prophylactically and for those displaying symptoms.
Weekly information on the incidence and predominant strain of influenza circulating in Scotland can be found on the HPS website.