More urgent H1N1 treatment needed for at-risk groups with flu symptoms, UN warns

12 November 2009

Immediate H1N1 antiviral treatment for people in at-risk groups with flu symptoms is vital for saving lives, according to updated United Nations guidelines released today, calling for greater urgency than earlier recommendations.

But otherwise-healthy people with only mild illness should not receive antivirals nor should they be used as a preventive measure for such people.

At-risk groups include pregnant women, children under two, and people with underlying conditions such as respiratory problems. Others who have persistent or rapidly worsening symptoms such as difficulty breathing and a high fever lasting beyond three days should also be treated with antivirals, and people who have already developed pneumonia should be given both antivirals and antibiotics to combat bacterial infections.

“These medicines, antivirals and antibiotics, if used in a timely manner, can help save lives,” UN World Health Organization (WHO) global influenza officer Nikki Shindo told a news conference in Geneva. “We have heard that doctors involved in caring for very sick patients in intensive care units regretted that the patients arrived too late and even the most sophisticated medical procedures could not save their lives.

“We asked what could have been done differently to avoid the tragic outcomes. All of them answered, without exception, that things may have been very different if they had been treated with an antiviral drug earlier,” she added, stressing that people not in the at-risk groups and with only a typical cold need not take antivirals.

The pandemic virus can cause severe pneumonia even in healthy young people, though rather minor in proportion, and the virus can take life within a week. “The window of opportunity is very narrow to reverse the progression of the disease,” Dr. Shindo warned. “The medicine needs to be administered before the virus destroys the lungs.

“In the initial guidance, we took a more conservative approach because we had almost no experience with regard to the effectiveness of the antiviral medicine in this disease, and also we were aware that access to the influenza medicine was very limited. Now, we have gained knowledge in effectiveness, safety of the medicine and we have also contributed to the global availability of the medicine.”

Noting that WHO is supporting developing countries to face an upsurge in cases, Dr. Shindo said States should decentralize the distribution of antivirals and ensure that general practitioners have access to these medicines so that patients do not need to visit a hospital to get them, leaving hospitals freer to treat the most severe cases.

WHO has a stockpile of antivirals to bolster supply in resource-poor countries. In May, at the beginning of the pandemic, it shipped antivirals to 72 countries, and more recently to Afghanistan, Mongolia, Belarus and Ukraine. Additional supplies will soon be sent to Azerbaijan and Kyrgyzstan.

 

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