Authors' objectives:

To provide guidance on the use of oseltamivir and amantadine for the prophylaxis of influenza.

Authors' recommendations: Guidance: This guidance has been prepared in the expectation that vaccination against influenza is undertaken in accordance with national guidelines. Vaccination is the most effective way of preventing illness from influenza, and the drugs described in this guidance are not a substitute for vaccination. This guidance does not cover the circumstances of a pandemic, impending pandemic, or a widespread epidemic of a new strain of influenza to which there is little or no community resistance. This guidance pertains only to circumstances where it is known that either influenza A or influenza B is circulating in the community (see Section 1.7). 1.1 Oseltamivir is recommended for the post-exposure prophylaxis of influenza in at-risk people aged 13 years or older who are not effectively protected by vaccination and who have been exposed to someone with influenza-like illness (ILI) and are able to begin prophylaxis within 48 hours of exposure. People who are not effectively protected by vaccination include those who have not been vaccinated since the previous influenza season, or for whom: - vaccination is contraindicated, or has yet to take effect - vaccination has been carried out but the vaccine is not well matched to the strain of influenza virus circulating. (The Department of Health and the Welsh Assembly Government, acting on information from the Health Protection Agency, issue advice nationally each year on whether the vaccine and the circulating influenza virus are well matched.) Exposure to ILI is defined as being in close contact with someone who lives in the same home environment as a person who has been suffering from symptoms of ILI. 1.2 At-risk people are defined, for the purpose of this guidance, as those who are in at least one of the following groups. People who: - have chronic respiratory disease (including asthma and chronic obstructive pulmonary disease) - have significant cardiovascular disease (excluding people with hypertension only) - have chronic renal disease - are immunocompromised - have diabetes mellitus - are aged 65 years or older. 1.3 Oseltamivir is recommended for the post-exposure prophylaxis of influenza in at-risk people, aged 13 years and older and who can begin prophylaxis within 48 hours, whether or not they have been vaccinated, if they live in a residential care establishment where a resident or staff member has ILI. For the purposes of this guidance, a residential care establishment is defined as a place where the at-risk person resides in the long term in order to be provided with continuing care alongside a number of other individuals. 1.4 Oseltamivir is not recommended for post-exposure prophylaxis in healthy people up to age 65 years. 1.5 Oseltamivir is not recommended for the seasonal prophylaxis of influenza. 1.6 Amantadine is not recommended for either post-exposure or seasonal prophylaxis of influenza. 1.7 Community-based virological surveillance schemes should be used to determine when influenza virus is circulating in the community. Such schemes, including those organised by the Royal College of General Practitioners and the Health Protection Agency, should ensure that the onset of the circulation of influenza virus (A or B) within a defined area is identified as rapidly as possible. In Appendix D, definitions and numerical values of threshold levels for different categories of influenza activity are given.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nice.org.uk/cat.asp?c=86770

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)