People at high risk from flu should talk with doctors now

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.

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 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.

“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.

“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.”

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.

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