TORONTO — Pregnant women and people with chronic health conditions who
are at higher risk of getting severely ill if they catch swine flu should talk
with their doctors about setting up a way to get rapid access to antiviral drugs
if they get sick, public health authorities are suggesting.
Officials of the Public Health Agency of Canada and the U.S. Centers for Disease
Control say people who fall into high risk groups should explore the possibility
of having a prescription for Tamiflu or Relenza issued in advance but held by
the doctor.
If the person got sick with what seems like the pandemic virus, he or she could
call the doctor, describe the symptoms and arrange to have the prescription
transmitted to a pharmacy, filled and picked up, they said.
"We think it is important for these risk group patients to be counselled about
the signs and symptoms to be watching for and providers to think through how
they can really reach their patients quickly during a busy season in the months
ahead," Dr. Anne Schuchat, director of the CDC's national center for
immunization and respiratory diseases, said Tuesday.
"We do feel that prompt treatment is important and that the doctors' offices may
get relatively busy and it may be reasonable in some circumstances for a phone
conversation to be sufficient for a prescription to be filled."
Schuchat noted many of the people in the high risk groups already have regular
contact with their doctors and could use the opportunity of a scheduled
appointment to raise the issue.
Tamiflu (the brand name for oseltamivir) and Relenza (zanamivir) are
neuraminidase inhibitors, drugs that lessen and shorten the impact of a bout of
flu by blocking the virus's ability to replicate. For maximum effect they should
be taken within 48 hours of the onset of symptoms, though doctors do give them
to hospitalized flu patients outside of the 48-hour window.
Pregnant women are at higher risk of complications from any flu, and pandemic
flu viruses particularly hit them very hard. Since the new H1N1 virus emerged in
the spring there have been frequent reports of miscarriages, emergency
deliveries and deaths in pregnant women who have become infected.
And a high proportion of people who become gravely ill with swine flu - as high
as 90 per cent in some case studies - have chronic conditions or illnesses that
elevate their risk. Extreme obesity, asthma, heart disease, chronic pulmonary
obstructive disorder - these and other health conditions are disproportionately
common in the sickest of pandemic flu patients.
The head of the Public Health Agency of Canada has also suggested doctors and
high-risk patients lay the groundwork for rapid antiviral access.
"When you do have that regular visit, have a conversation about if I do get
influenza-like symptoms, you know, fever, headache, muscle aches, cough, etc.,
what should I do?" Dr. David Butler-Jones said last week at a news conference.
"And consider maybe having a prescription for Tamiflu or whatever ready so that
you don't have to book an appointment and maybe you just have to call the
doctor's office and say I have these symptoms, etc."
"You don't need to rush into your doctor now but if you have a regular
appointment it's an important question to ask."
That said, Butler-Jones said he doesn't support the idea of people filling
prescriptions before they get sick and keeping the drugs at home. That would
leave drugs in the hands of some people who won't get sick or won't need them,
he said.
Schuchat, who was announcing changes to the CDC's recommendations on flu
antiviral use, stressed that most people who catch this virus won't need
antiviral drugs to recover.
Source : The Canadian Press.
