Comment: A paper out in the British Medical Journal on the 10th August 2009 [1] raises some interesting questions about the benefit of treating children under the age of 12 with neuraminidase inhibitors. This paper looked at 4 RCT’s involving 1766 children of whom 1243 had confirmed seasonal influenza A. Plus three RCT’s for the potential benefits of prophylaxis in 863 children.
Their conclusion: Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.
Influenza A is a virus capable of rapid genetic mutations and when ‘stressed’ by anti-virals is susceptible to antigenic drift – where changes in proteins by genetic point mutation and selection occur easily. Plus as Seasonal Flu and H1N1 flu may combine in the same cell in the coming months the result may be antigenic shift and a brand new virus may appear in humans. Concerns are being raised that the limited benefit in terms of symptom reduction achieved from the treatment of seasonal influenza A may also be all that is seen in the current H1N1 (Swine Flu) and that the risk for increasing resistance to the now rapidly produced H1N1 (Swine Flu) vaccination may render that treatment clinically ineffective.
So what to do? In the current H1N1 pandemic, about 30% of cases in the United Kingdom have been in children aged under 10.[2] What does this study say:
- Antivirals (oseltamivir and zanamivir) shorten the median duration of influenza by 0.5 to 1.5 days and reduce transmission of influenza by just 8%
- Antiviral treatment does not have a clinically significant effect on reducing asthma exacerbation’s or on overall use of antibiotics, but oseltamivir is associated with an increased risk of vomiting
- The effects of antivirals on reducing the course of illness or preventing complications in children with the current influenza pandemic are not known but, based on current evidence, might be limited
Consider the use of Vit D3 in dose levels to increase Anti Microbial Peptides, maintain Hydration, include Colostrum to raise antibodies to aid elimination, and use the most clinically relevant methods to control fever. It may be of assistance to read the mechanisms of viral infection and elimination. Using suitable antiviral masks may also present a practical solution to risk management.
[1] Shun-Shin,M. Thompson,M. Heneghan,C. Harnden,A. Mant,D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ 2009;339:b3172 View Paper
[2] Health Protection Agency. HPA weekly national influenza report: week 27. 2009 July 1. www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1243928258754
