Vaccination

Annual vaccination is essential in all those at risk of complications from influenza. Guidance may change from year to year. Check the Public Health England (PHE) website (seasonal influenza) for latest updates.

Patients under 13 years- follow Public Health England (PHE) Influenza Advice.

Treatment

Oseltamivir and zanamivir are not licensed for use unless influenza is circulating in the community. In England, the formal announcement is made by the Department of Health.

Treat 'at risk' patients, when influenza is circulating in the community ideally within 48 hours of onset (within 36 hours for zanamivir treatment in children) or in a care home, where influenza is likely. For otherwise healthy adults antivirals are not recommended.

At risk groups:

• Pregnancy (including up to two weeks post-partum)
• Age over 65 years
• Chronic respiratory disease (including COPD and asthma)
• Significant cardiovascular disease (not hypertension)
• Immunocompromised
• Diabetes mellitus
• Chronic neurological, renal or liver disease
• Morbid obesity (BMI 40 or greater)
• Children under 6 months of age.

See Public Health England (PHE) Influenza Advice regarding whether to use oseltamivir or inhaled zanamivir. In general use oseltamivir in all cases except in the severely immunocompromised where the predominate circulating strain is H1N1 or the infection is with an oseltamivir resistant strain.

Refer to individual SPCs before prescribing

See NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza (February 2009).

Prophylaxis

Oseltamivir and zanamivir are recommended, within their marketing authorisations, for the post-exposure prophylaxis of influenza if all of the NICE TA circumstances apply.

• See NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza (September 2008) for more information.

Oseltamivir and zanamivir are not recommended for routine prophylaxis of seasonal influenza; they may be given for post-exposure prophylaxis when the virus is circulating in the community.

Amantadine is not recommended for the prophylaxis of influenza.

Vaccination is the first-line intervention to prevent influenza and its complications. This guidance should not detract from efforts to ensure that all eligible people receive vaccination.

See 5.3.4 Influenza