Government's Tamiflu advice is wrong, says WHO

Only seriously ill and vulnerable patients should be prescribed antiviral drugs to help them to get over swine flu, the World Health Organisation said yesterday, in advice which conflicts with the decision taken by the British Government to prescribe Tamiflu to everyone with swine flu.

Most people will recover from swine flu within a week, just as they would from seasonal forms of influenza, the WHO said.

"Healthy patients with uncomplicated illness need not be treated with antivirals," the WHO concluded in guidance issued on the internet. "Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment."

Swine flu, now present in 177 countries, has been blamed for 1,799 deaths, and it is feared that over-use of Tamiflu will lead to the virus becoming resistant to it. The WHO has been formally notified of 12 cases where the H1N1 virus has already been found to have developed resistance after mutating.

The WHO issued its advice after a panel of international experts reviewed the effectiveness and safety of antivirals in tackling the pandemic.

It agreed, however, that antivirals are appropriate in cases where patients suffer a severe bout of swine flu or have an underlying medical condition. In these cases the drugs have proved effective at reducing the risk of pneumonia setting in.

The Department of Health responded to the WHO guidance by saying that the decision to offer Tamiflu remained right and sensible.

"We believe a safety-first approach of offering antivirals, when required, to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects," a spokesman said.

Andrew Lansley, the shadow Health Secretary, has backed the Government's approach, especially in the early stages of the outbreak when the severity of the disease was unclear.

He added: "In the light of this latest expert advice, it may be appropriate for GPs and the fluline to make clear to otherwise healthy patients that there may be little benefit in taking anti-virals. But I do not think it would be appropriate for us to not offer treatment to those who request it."

The number of courses of antivirals issued in England by the National Pandemic Flu Service has almost halved since the beginning of the month. In the seven days up to 18 August there were 45,986 courses prescribed, compared to 90,363 the previous week. Last week there were 11,000 new cases of swine flu reported, down from 25,000 the week before.

In its advice the WHO included pregnant women as one of the at-risk groups that should continue to receive antivirals.

"As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset," it said.

The WHO recommended that children under five be regarded as being a high-risk group and should therefore be treated with antivirals as soon as possible once symptoms began.

Children over five years, however, should only be given the drugs if their condition becomes serious or if they have an underlying health problem.

Earlier this month a team of researchers from Oxford University said children with mild symptoms should not be given the antiviral to combat swine flu and urged the Department of Health to urgently rethink its policy.

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