Frequently Asked Questions

Pandemic flu occurs when a novel, highly infectious and dangerous strain of the influenza virus appears which can easily be transmitted from human to human and spreads rapidly throughout the globe, usually in a series of waves.

In contrast to the ‘ordinary’ or ‘seasonal’ flu outbreaks which we see every winter, flu pandemics occur infrequently usually every few decades. There were three last century. The most serious of these so called “Spanish Flu” caused up to 40 million deaths worldwide.

Swine influenza is a respiratory disease of pigs caused by type A influenza viruses. Outbreaks of swine flu happen regularly in pigs. People do not normally get swine influenza, but human infections can and do occur.

The most common occurrence of swine flu is with people who are around/work with pigs but it is possible for swine influenza viruses to spread from person to person. Recently, cases of human infection with swine influenza A (H1N1) have been reported in 37 countries around the world, resulting in the world health organisation changing their pandemic alert status to phase 6.

It is important to be clear about the differences between avian, seasonal/epidemic and pandemic flu. Avian flu is a disease which mainly affects birds [e.g. H5n1]. Occasional cases of human transmission occur, with a very high [greater than 60%] mortality rate.

Swine influenza is caused by influenza viruses which are present in pigs. Sometimes, animals and humans can pass strains of influenza back and forth to one another, such as when humans become ill with avian or swine influenza, usually from direct contact with animals who are ill. Mixing of human and animal influenza viruses can lead to the development of altered viruses which have the ability to cause infection and spread in the human.

International effort will attempt to try to control a pandemic when it emerges. The World Health Organization has stockpiled supplies of antivirals which will be targeted to the infected area in order to try to slow or stop the spread.

This will be logistically very difficult if the disease starts in a rural part of South East Asia, the Middle East or Africa and efforts are likely to slow the spread of the disease rather than stop it.

Personal hygiene measures are likely to be very helpful, including frequent hand washing with soap and water, avoiding close contact with an infected person, using and disposing of tissues appropriately, cleaning of hard surfaces etc. The use of face masks may also be helpful with appropriate training.

The 1918 Spanish flu was called Blitzcattarh [lightning flu] in Germany at that time giving a vivid indication of the rapidity of onset of symptoms.

Past experience of pandemic flu suggests that the onset of symptoms is usually rapid, within an hour or two, with the onset of high fever, chills, muscle pains, headaches and prostration, as well as a variety of upper respiratory symptoms sore throat, cough, nasal congestion, and nose bleeds.

People infected with the current strain of the avian virus (h5n1) have shown everything from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to pneumonia, severe respiratory diseases and other life-threatening complications.

Symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.

Based on previous pandemics the incubation period is from one to three days with most infected persons becoming symptomatic within 24 to 48 hours of exposure.

Persons with symptoms of flu shed infectious virus particles for about five days. Children and those with impairment of the immune system may shed virus particles and consequently remain infectious for considerably longer.

People of all ages are susceptible to pandemic flu, but unlike episodic winter flu which causes more severe illness and morbidity in the very young and elderly, past experience demonstrates a high morbidity and mortality in fit healthy young adults contracting pandemic flu.

In 1918 thousands of previously fit and healthy young soldiers involved in the first world war died within days of contracting “Spanish flu”.

Medicines called antivirals can be used to treat influenza. They have been shown to be very helpful in the treatment of 'ordinary' flu, and it is likely that they will also be effective in the treatment of pandemic flu, but their effectiveness will not be known until the pandemic virus is circulating.

Antivirals do not stop the flu from developing but they do lessen the symptoms and reduce the length of time people are sick.

Antiviral drugs are medicines for the treatment (and sometimes also prevention) of certain viral infections and are likely to play an important role in treating pandemic flu. The current drugs used for influenza are called neuraminidase inhibitors and include Oseltamivir [Tamiflu].

They work by preventing the spread of virus particles in the body. Initially infective particles enter the respiratory tract and multiply in the cells lining the airways.

Antivirals prevent these new virus particles being released from the infected cells. These infected cells are then dealt with by the body's own immune system and in a significant number of cases the presence of infective particles will result in immunity against further infection with that particular strain of virus.

The active substance is Oseltamivir (75mg Oseltamivir in each hard adult capsule). Paediatric capsules contain 30mg and 45mg of Oseltamivir respectively.

The other (inactive) ingredients present in small amounts comprise the capsule contents mainly starch based fillers the capsule shell: containing mainly gelatine, as well as colouring dyes and printing inks.

The full list of ingredients is included in the product leaflet included with the medication which you are advised to read before taking the medication.

No. Antiviral drugs are taken to alleviate or prevent the effects of pandemic influenza, whereas influenza vaccine is given to boost the body’s natural immune system by using an inactivated preparation of the actual pandemic virus to produce immunity.

The virus which causes pandemic flu will be new and a vaccine to protect against it cannot be made until the virus has been identified.

Before a pandemic starts it is difficult, if not impossible, to predict what strain will cause it and even then, predictions may prove wrong, or the predicted virus may have changed enough for a pre-prepared vaccine to be ineffective.

It is expected to take around six months to produce an effective pandemic vaccine in sufficient quantities for the majority of the population.

It is unlikely therefore that vaccination will have any effective role during the first wave of a pandemic, which is expected to last around fifteen weeks.

Treatment with antiviral drugs can be expected to shorten the duration of the disease, alleviate symptoms and reduce complications and serious illness.

If taken for prevention [prophylaxis] of pandemic flu they may prevent illness but still lead to useful levels of immunity against further infection with the same virus.

Current antiviral drugs are very safe and generally well tolerated. The main side effect is nausea and vomiting, usually with the first dose.

This can be helped by taking the antiviral with food. Rarely there are serious skin and liver complications, and very rarely in teenagers there have been reports of attempted suicides in young persons during treatment with antivirals for influenza.

There is however at present no proven causative link to antiviral drugs in these cases. It is advisable however to monitor young persons closely during treatment and seek medical advice if you have any concerns.

The only absolute contraindication to Oseltamivir (Tamiflu) is previous allergic reaction to either the active ingredient Oseltamivir or any of the inactive ingredients.

The following patients should speak to their medical advisers, before taking any antiviral medication: patients who are pregnant, possibly pregnant or breast feeding, patients with advanced renal (kidney) disease, patients on immunosuppressive treatment or chemotherapy, patients with diseases of their immune system.

Oseltamivir is licensed for children over one year of age. Children under the age of thirteen or any children suffering from chronic disease should not be given antivirals without discussing this with a doctor.

When should I take antiviral medication?

Antiviral medication should only be taken when both the following conditions have been met:

• an influenza pandemic has been declared and you have been notified that pandemic influenza is circulating in the community. This notification will be both by local and national media as well as the company’s communications network
  
• in the case of adults and children over 13 years old, antiviral medication should be taken as soon as symptoms of flu develop and in all cases within 36 hours of symptoms developing. In the case of children under 13 years old who become unwell during a flu pandemic, it is important that medical advice is sought before commencing antiviral treatment as children with influenza often have atypical symptoms making it more difficult to diagnose and also because the dose for children is dependent on weight.

There are three formulations of Oseltamivir adult capsules 75mg strength and two strengths of paediatric (children’s) capsules 30mg and 45mg. Adults and children over 13 years old are normally able to take the normal adult dose of one 75mg capsule twice daily for treatment.

Children’s doses for treatment are calculated on the child’s weight in kilograms as follows to be taken for five days:

Under 15 kilograms - 30mg twice daily
Between 15 and 23 kilograms - 45mg twice daily
Between 23 and 40 kilograms - 60mg twice daily
Over 40 kilograms - 75mg twice daily

If you have any doubt as to the correct dose especially in children, consult your medical adviser.

For treatment it is important that the medication is started as soon as symptoms develop and must in any case be started within 36 hours of symptoms developing.

Evidence shows that the earlier treatment is started the better the outcome in the severity of the illness, the duration of the illness and the likelihood of complications

A liquid form of Oseltamivir [Tamiflu] supplied in a powder for reconstitution into a liquid is licensed for use but is no longer being manufactured and has been replaced by two strengths of paediatric capsule 30mg and 45mg.

During situations when commercially manufactured Tamiflu oral suspension is not readily available, adults, adolescents or children who are unable to swallow capsules may receive appropriate doses of Tamiflu by opening capsules and pouring the contents of the capsules into a suitable, small amount (1 teaspoon maximum) of sweetened food product such as regular or sugar-free chocolate, syrup, honey (only for children two years and older), light brown or table sugar dissolved in water, dessert toppings, sweetened condensed milk, apple sauce or yoghurt to mask the bitter taste.

The mixture should be stirred and the entire contents given to the patient. The mixture must be swallowed immediately after its preparation.

Please follow these instructions to ensure proper dosing.

1. Determine the number of capsules that are needed to prepare a mixture with this procedure: *children weighing more than 40kg may receive medication with the adult dosage of Tamiflu 75mg capsules twice daily for 5 days for treatment or once daily for prevention

2. Check that you are using the correct dose according to the table above. Hold the capsule(s) over a small bowl, carefully pull the capsule(s) open and pour the powder into the bowl

3. Add a suitable, small amount (1 teaspoon maximum) of sweetened food product (to mask the bitter taste) to the bowl and mix well

4. Stir the mixture and give the entire contents of the bowl to the patient. The mixture must be swallowed immediately after its preparation. If there is some mixture left inside the bowl, rinse the bowl with a small amount of water and have the patient drink this remaining mixture. Repeat this procedure every time you need to take the medicine.

There is some limited evidence of resistance to Tamiflu (Oseltamivir). At present, the experience is that these drugs do work and that they should work against a pandemic strain of the flu virus.

Recent evidence from public health experts in Europe at the start of the 2007/8 flu season suggest that there is currently a circulating winter flu virus, particularly in Norway, which is showing significant laboratory resistance to Oseltamivir [Tamiflu]. The significance of this as far as the efficacy of Oseltamivir [Tamiflu] in pandemic influenza is not known at present.

The situation will continue to be monitored and this site updated if appropriate. In the meantime the expert advice remains that Oseltamivir should work against a novel pandemic strain of the influenza virus.

Oseltamivir (Tamiflu) can be taken with paracetamol, ibuprofen or acetylsalicylic acid (aspirin). Tamiflu is not expected to alter the effect of any other medicines apart from a very small number of medicines with a narrow spectrum of activity which may be affected by taking Oseltamivir. These include chlorpropamide and methotrexate.

If you have any concerns about taking Oseltamivir [Tamiflu] with these or any other medicines please discuss this with your medical adviser prior to starting treatment with Oseltamivir [Tamiflu].

Tamiflu is a prescription only medicine and it can only be obtained once a doctor has written a prescription in your name.

To ensure that it is appropriate for you to take Tamiflu, we need to obtain certain medical information about you and that is why we ask you to complete the medical questionnaire.

We make this process as simple as possible by asking only four of the most relevant questions – these questions relate specifically to Tamiflu.

If you indicate ‘yes’ to any of the questions, you will be contacted by one of our experienced nurses, who will take more details and then pass your information on to our medical team. They will assess your application and, if appropriate, write out your prescription.

The information you give is used to enable us to make a medical decision and all information is treated confidentially – we will never disclose any of your information to third parties (please see our privacy policy for further details).

Your medical information is viewed only by our nursing staff and then, if necessary, our medical team.

All the information you provide is sent via a secure link, which is protected by data encryption software. It is stored on a remote secure server for 5 years after the date of issue of your prescription, as required by the data protection act.

Hypersensitivity (allergy) to the active ingredient Oseltamivir is a contraindication to treatment. The capsules also contain inactive substances (excipients) comprising the capsule core, capsule shell, and capsule printing ink.

A full list of excipients is included in the product information leaflet and you are advised to study this if you have any concerns.

Adults with severe renal impairment may require dose adjustment. Tamiflu is not recommended for dialysis patients. There is insufficient data available for children with renal impairment to make a recommendation for dosage.

Patients with severe renal disease should discuss this with their medical advisers before taking antiviral medication.

If you are pregnant, possibly pregnant or breast feeding during a declared pandemic alert phase, you are advised to contact your general practitioner for advice before taking any antiviral medication. (UK Department of Health advice).

There is currently no adequate data for the use of Oseltamivir in pregnancy or breast feeding women. Oseltamivir should not be used in pregnancy unless the potential benefit to the mother justifies the potential risk to the foetus.

It is not currently known whether Oseltamivir or its active ingredients are excreted in human milk. Oseltamivir should only be used during breast feeding if the potential benefits for the mother justifies the potential risk for the breast fed infant.

Anti-viral medication is a very effective way of reducing the spread of influenza. There are much more simple measures that can be taken which reduce the spread of influenza.

The most basic of these measures is effective hand and respiratory hygiene. You can reduce the risk of catching or spreading influenza during a pandemic by:

• when you cough or sneeze, cover your mouth and nose with a tissue.
  
• throw away used, dirty tissues immediately.
  
• wash your hands frequently with soap and water – this is a very effective way of reducing the spread of the virus from your hands to your face or to other people, as the flu virus can survive for hours on inanimate objects, such as door handles, money and car-keys.
  

For further information, please visit www.hpa.org.uk

You can pay by using the following credit or debit cards. We do not accept cheques or cash for online orders.

Orders are subject to 15% vat where applicable.

Your medication will be dispatched within 7 days of your successful screening by IPL's medical team.

You can monitor the progress of your order by signing into the Login area on our home page.

Your medication is sent by the Royal Mail's recorded delivery service and a signature is required on delivery. If you are not available to sign for your medication, the Royal Mail will leave a card for you, explaining that an attempt at delivery was made and that you have seven days to collect your parcel from your local sorting office.

If you do not collect it within seven days, your medication will be returned to our pharmacy. In this case, we will contact you to arrange redelivery. This will incur a further delivery charge.

If you have any medical questions, please click on the 'Live Help' icon, which will put you through to one of our qualified nurses who will be able to advise you.

If you have any questions please e-mail admin@influenzaprotection.co.uk