1. This guidance has
been prepared by the UK Department of Health and the National Assembly for
Wales in conjunction with NICE. It is being issued along with NICE's guidance
on the use of zanamivir (Relenza) for the treatment of influenza to provide
the NHS in England and Wales (particularly PCG/Ts & LHGs and their
related GP practices) with supplementary advice on implementation.
2. NICE recommends
zanamivir for the treatment of at-risk adults who present within 36 hours
of the onset of influenza like illness (ILI) when influenza is circulating
within the community and who are able to commence treatment within 48
hours of the onset of these symptoms. Other patients should continue to
be advised that the best way to treat flu is to stay at home, rest, take
symptomatic treatment if necessary and drink plenty of non-alcoholic fluids.
3. At-risk groups
are recommended to be immunized against influenza before every winter.
This should be the first line of defence against influenza for at-risk
patients. Improvements in the delivery of the immunization program
for the 2000/01 influenza season are expected to achieve a target uptake
of at least 60% in the 65 and over age group.
Potential impact on primary health care services
4. The accompanying
guidance from NICE properly acknowledges that the guidance is likely to
have an impact on primary health care services - principally, increased
activity, but also some additional drug costs. Their guidance sets out
an assessment of the potential impact.
5. NICE recommends
that the NHS develops plans to implement their guidance as part of integrated
winter planning arrangements. The remainder of this document explains
the arrangements being made nationally and sets out what might be done
locally. Arrangements for notifying when influenza is circulating are
explained. It is suggested that separate arrangements should be developed
to deal with the at-risk groups and those not falling within the recommendations
Information for the public
6. The leaflets What
should I do about flu? (England) and All you need to know about Flu (Wales)
are available from the Department of Health, PO Box 777, London SE1 6XH
and Public Health Division, National Assembly for Wales, (029) 20823336.
They give important advice to patients on how to judge whether they have
flu, and what they should do, depending on their age and underlying health.
Glaxo Wellcome also
have available posters and leaflets on flu and colds. These can be obtained
from the Glaxo Wellcome Customer Service Department - Telephone 0800 221
NHS Direct will advise
callers on what to do if they have an influenza like illness.
Guidance on "when
influenza is circulating"
7. NICE's guidance
does not apply until influenza is known to be circulating in the community.
This will be triggered across England and Wales when PHLS advises the
Administrations that they have identified the circulation of influenza
viruses and when the RCGP Weekly Returns Service monitoring data indicates
that new GP consultations for ILI have risen above the baseline level
of 50 consultations per 100,000 population per week. This information
will be cascaded through Regional Epidemiologists and flu coordinators
each Thursday. The information is available on the web at www.doh.gov.uk/flu/
8. HAs with their
LHGs, PCGs and PCTs will need to put in place suitable arrangements for
managing the supply of zanamivir to high risk patients as part of their
winter planning. Ensuring that there is timely, adequate and appropriate
information available to health professionals locally and patients will
be an important part of this.
9. Zanamivir, a prescription-only
medicine (POM), is available only on prescription from a doctor or supply
by health professionals (including pharmacists and nurses) on the direction
of a doctor. Depending upon local circumstances local arrangements may
need to incorporate a mixture of the following elements:
- Telephone triaging
by practice nurse or other health professional working to a protocol
and standard diagnostic questions
- Patient group
directions for direct supply by nurses and community pharmacists, including
those working from NHS Walk-in Centres (England only)
- NHS prescriptions
issued by GPs in the normal way following consultation or home visit
10. As with all prescribing
the final decision will fall to GPs in the exercise of their clinical
11. It is likely that
most patients developing flu symptoms will contact the GP surgery or out
of hours services by telephone in the first instance. Health professionals
working under a well drafted protocol with standard diagnostic questions
could recommend whether a prescription is appropriate and advise on arrangements
for collection. As an aid to this and for more general planning purposes
GP practices may wish to identify in advance their at risk population
for whom zanamivir might be appropriate from existing influenza immunization
registers. Local pharmacies may be prepared to offer a local delivery
service for dispensed prescriptions. A sample document, which has been
trialled by a PCT, is available here on the Vidyya
12. Glaxo Wellcome
can supply additional Patient Information Leaflets on zanamivir which
may be helpful, including in introducing Patient Group Directions. These
can be obtained from the Glaxo Wellcome Customer Service Department -
Telephone 0800 221 441. For further information on zanamivir you should
contact the Glaxo Wellcome Medical Information Department - Telephone
0800 371 891.
issued by GPs following consultation
13. Some at-risk patients
will present at the surgery or will be seen at home within 36 hours of
the onset of symptoms. Arrangements should be in place for these patients
to receive NHS prescriptions from the GP in the usual way. GPs may wish
to carry a small stock of zanamivir (so-called "black bag")
for immediate supply during OOH.