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Plans ramp up for Tamiflu deployment in aged care


Jolyon Attwooll


6/05/2022 4:36:07 PM

Influenza is returning and while it is too early to judge the seasonal severity, general practice will be fundamental to the preventive measures being put in place.

Tamiflu
A file photo of Tamiflu, the antiviral treatment that is being distributed to aged care facilities. (Image: AAP Photos)

Pre-placed supplies of Tamiflu (oseltamivir) are at the heart of plans to protect vulnerable elderly residents as influenza cases begin to return in greater numbers to Australia.
 
In a winter preparedness webinar aimed at the primary care sector this week, more details were shared on a policy of placing advance supplies in residential aged care facilities (RACFs) around the country ahead of an anticipated uptick in cases.
 
It is a move foreshadowed by the Department of Health (DoH) last month, with packages of the oral antiviral prescription drug already being distributed to many facilities.
 
The strategy follows a decision earlier this year to supply the oral antiviral COVID-19 treatment molnupiravir (sold as Lagevrio) to RACFs around the country prior to its release on the Pharmaceutical Benefits Scheme (PBS).
 
DoH official Chris Jeacle appeared at the webinar to give more detail on the distribution program, which will include RACFs, multi-purpose services, as well as National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) services.
 
‘This will be a one-off deployment to facilities and the preplacement of supplies is not intended to replace standard supply chains that are usually utilised by providers,’ Ms Jeacle said.
 
‘Rather, it’s to reduce the impacts of supply shortages within the private market and the delays in shipping that may result from increased demand during the winter period.’
 
Care homes are being asked to assess residents’ suitability for treatment in advance and to seek family consent where required. 
 
Meanwhile, Ms Jeacle said prescribers such as GPs will play an important role, given the short 48-hour window from the onset of symptoms to the recommended start of medication.
 
‘[Aged care facilities] should also ensure agreed arrangements with an authorised prescriber are in place for timely provision of prescriptions when needed,’ she said.
 
She also stated that there are no known contraindications between Tamiflu and molnupiravir, but directed clinicians to the treatments’ product information to help guide clinical decision making.
 
Unlike for COVID-19, there is no requirement for a positive influenza result to prescribe Tamiflu.
 
The webinar took place with the backdrop of a growing presence of influenza in Australia, following an unprecedented stretch where serious cases of influenza barely existed in the country.
 
The latest Australian Influenza Surveillance Report notes a sharp increase in influenza-like-illness since the beginning of March – although levels remain lower than they were pre-pandemic.
 
It reports that 2714 notifications have been made to the National Notifiable Diseases Surveillance System (NNDSS) in 2022, with 1636 (60%) in the fortnight leading up to its report on 2 May.
 
By way of comparison, in 2021 there had been 598 cases recorded up until 7 November (the last date for which statistics are available).
 
So far this year, there have been 49 hospital admissions due to influenza, including three to ICU.

Of the notified influenza cases so far this year, more than 98% have been influenza A.
 
‘There is no indication of the potential severity of the 2022 season at this time,’ it reports.
 
GP Dr Chris Moy, the vice president of the Australian Medical Association (AMA), welcomed the presence of Tamiflu pre-supplies in RACFs but queried the level of supply and how it would be deployed.
 
‘I think that’s great, but those supplies [are] going to run out in about two seconds if we don’t start thinking about who we really need to treat,’ he said.
 
‘Are we going to use it for prophylaxis in our outbreak? Or are we going to target certain individuals?’
 
Vaccination approach
Also contributing to the webinar, RACGP President Adjunct Professor Karen Price said it will be important to put preventive measures in place despite uncertainty about what the season will bring.
 
‘You’ve probably heard that there’s a concern that the flu may be worse this year, because of a naive population,’ she said. ‘It’s not certain, but we want to be protected.’
 
Professor Price also noted that the most affected cohorts so far have been among young people aged 15–24, as well as younger children under the age of 10.
 
‘It is worthwhile promoting those private flu shots if we can,’ she said.
 
In fact, the Australian Health Protection Principal Committee (AHPPC) is placing a particular emphasis on the promotion of vaccination for the six-month to 5-year age group due to the low level of transmission in Australia during their lifetime so far.
 
GPs have also been reminded that it is possible to co-administer winter doses of COVID-19 vaccines at the same time as the influenza vaccines.
 
Dr Lucas de Toca, the DoH’s First Assistant Secretary for the COVID-19 Primary Care Response, noted that Australian Technical Advisory Group on Immunisation (ATAGI) guidelines were revised late last year and now include no restrictions for co-administration.
 
‘If someone’s coming in for the flu vaccination, and they’re eligible for the winter dose of COVID vaccine, it’s a great opportunity to opportunistically provide that co-administration,’ he said.
 
Dr de Toca also said that while COVID-19 vaccine suitability assessment items must be bulk billed, they can be co-claimed with other services including for the administration of a flu vaccine.
 
The AHPPC has stated that influenza vaccination should not be delayed for the sake of co-administering it with the COVID-19 vaccine.
 
Influenza rates in Australia dropped to record lows following the start of the pandemic, with border closures and social distancing measures believed to have contributed to more than 12 months without any recorded fatalities.
 
However, respiratory disease experts have widely predicted that influenza will make a significant return to the country with the opening of international borders and eased social distancing restrictions.
 
The RACGP has promotional material, including posters, available for GPs to encourage patients to get the flu vaccine and to let them know they are providing vaccine. Download them from the RACGP website.
 
ATAGI advice on the administration of flu vaccines is available on the Department of Health website.
 
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A.Prof Christopher David Hogan   7/05/2022 5:32:49 AM

I dealt with 2 outbreaks of influenza in a nursing very efficiently by using Tamiflu.
I have used it since I was involved in the drug trials for it to be registered in Australia


Dr Ian   7/05/2022 7:54:22 AM

Even earlier administration of oral oseltamavir (Tamiflu) was claimed in a paper by FY Aoki in 2003 in the J Antimicobiological Chemotherapy to have better results than within 48 hours wherein administration in 12 hours reduced illness by 74.6 hours .
Prophylactic use of influenza antivirals in Nursing Homes if there is an outbreak has been recommended by the CDC USA.
Whether this would apply to anti Covid Antivirals considering 5000 patients have died of Covid this year has not been announced .


Dr Ian   9/05/2022 11:34:43 AM

Good to read this use of Tamiflu saved lives .