Rationing: No Tamiflu for Otherwise Healthy People With Swine Flu, WHO Says
August 21, 2009Healthy people who catch swine flu do not need antivirals like Tamiflu, but the young, the old and the pregnant surely do, the World Health Organization declared Friday in new advice to doctors.
The U.N. health agency said people who are otherwise healthy with mild to moderate cases of swine flu or regular flu don't need the popular drug, calling the medical evidence for giving it to those people "low quality."
But people thought to be at risk for complications from swine flu -- children less than five years old, pregnant women, people over age 65 and those with other health problems like heart disease, HIV or diabetes -- should definitely get the drug, WHO said.
WHO also recommended that all patients, including children, who have severe or worsening cases of swine flu, with breathing difficulties, chest pain or severe weakness, should get Tamiflu immediately, perhaps in higher doses than now used.
The advice contradicts some current government policies, such as those in England, whose health agency liberally hands out Tamiflu to healthy people with swine flu. Since the British set up a national flu service in July to deal with the surge of swine flu cases, Tamiflu has been available to anyone suspected of having the disease, including healthy people.
At its summer peak, British authorities guessed there were about 110,000 new cases of swine flu, also known as H1N1, every week. The number of new cases dropped last week to about 11,000, but the fall/winter flu season has not yet begun.
Boasting that Britain had the world's largest supply of Tamiflu, enough to cover 80 percent of its nearly 61 million people, Health Minister Andy Burnham promised the drug would be available to anyone who needed it.
Britons who call the national flu line can get Tamiflu without ever seeing a doctor -- it is given out by call center operators who have no medical training. Scotland, Northern Ireland and Wales decided not to participate in the swine flu phone line.
On its swine flu Web site, the Department of Health says "the government has decided to offer the antivirals Tamiflu or Relenza to everyone confirmed with swine flu."
To stop people fraudulently getting Tamiflu, the web site says "the government is relying on the public to use the system responsibly."
Some experts have criticized that approach, warning that blanketing the population with Tamiflu increases the chances of resistant strains emerging.
Flu expert Hugh Pennington of the University of Aberdeen called the strategy "a very big experiment" and said England's approach was out of step with the rest of the world. The U.S. Centers for Disease Control and Prevention, for instance, says antivirals must be prescribed by a health care professional.
Pennington called for the national flu line to be dismantled because Tamiflu should be used more sparingly.
"This approach increases the likelihood of a resistant strain and that is not a risk worth running," Pennington said.
Officials have already found widespread drug resistance in seasonal strains of H1N1 flu and worry that might also crop up with swine flu. So far, only a handful of Tamiflu-resistant swine flu strains have been found.
WHO said most patients infected with swine flu worldwide recover within a week without any medical treatment. Still, about 40 percent of the severe swine flu cases are occurring in previously healthy children and adults, usually under 50 years of age.
WHO has estimated that as many as 2 billion people could become infected over the next two years with swine flu -- nearly one-third of the world's population.
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