Flu activity has increased in the community in recent weeks according to surveillance schemes monitored by the Health Protection Agency. As a result, the Agency has recommended to the Department of Health that antiviral drugs for flu should now be used according to guidance provided by the National Institute for Health and Clinical Excellence (NICE).

The Agency has examined a range of clinical, virological and epidemiological influenza surveillance schemes including:

- Cases of flu confirmed through the Agency's laboratories
- Calls to NHS Direct related to fever and cold/ flu
- Royal College of General Practitioners' data on consultation rates for flu-like illness
- The numbers of reported and confirmed flu-like illness outbreaks reported across the country

Together these schemes indicate that we are now entering a period when there is a substantial likelihood that people presenting with a flu-like illness are infected with flu virus. In other words, surveillance schemes indicate that flu virus is now circulating.

Dr Richard Pebody, a flu expert from the Health Protection Agency, said: "Since early December seasonal flu activity has started to increase to the normal levels seen most winters.

"Doctors in England have now been advised that the use of antiviral drugs for the prevention or treatment of flu in patients who are at higher risk of developing complications from the infection is now recommended.

"For most people, flu is miserable, lasting a week or so, but not life threatening. For those in at-risk groups, however, such as the elderly and patients with heart problems, diabetes or lung, liver or renal diseases, or those who have weak immune systems, it can be far more dangerous and can lead to more serious illnesses."

Symptoms of seasonal flu include sudden onset of headache, fever, and symptoms such as cough, sore throat, aching muscles and joints.

Dr Pebody said: "If you do get flu this year, our advice is to stay at home, rest, drink plenty of fluids and use over-the-counter remedies if they make you feel more comfortable.

"Good hand and respiratory hygiene such as covering your nose and mouth with a tissue when you cough and sneeze, disposing of the tissue as soon as possible and cleaning your hands as soon you can are important actions that can help prevent the spread of germs and reduce the risk of transmission.

"Vaccination offers the best protection for those at high risk from seasonal influenza and these groups should have been vaccinated by now. Antiviral drugs are only effective if taken within 48 hours of the onset of symptoms and may help limit the impact of some symptoms and reduce the potential for serious complications. However, it is difficult to avoid infection if there is a lot of flu circulating."

Notes

1. Antivirals are drugs given to high risk patients who become ill with seasonal influenza. They are only effective if taken within 48 hours of onset and may help limit the impact of some symptoms and reduce the potential for serious complications. They are also used in some situations where it is important to help prevent people from getting influenza. The NICE guidance applies only when the number of people with flu reaches a high-enough level and there is good evidence that flu is 'circulating in the community'.

2. The Department of Health has now advised GPs to consider prescribing antiviral drugs where necessary in line with guidance issued from the National Institute for Health and Clinical Excellence (NICE). To see the current guidance please go to: nice which has full guidance on the use of antivirals. It does not recommend antivirals for the prevention of flu in otherwise healthy people under 65, even if they have been in close contact with someone with a flu-like illness.

3. The Health Protection Agency is using a variety of clinical, virological and epidemiological indicators to monitor flu activity in the UK. These include:

- NHS Direct calls
The proportion of cold/flu calls increased from 0.9% in week 48 to 1.2% in week 49 of 2008 (1.2% is the threshold for exceeding baseline levels). Fever calls in the 5-14 age group made up 8.1% of the total calls in week 48 increasing to 10.0% in week 49 of 2008 (9% is the threshold).

- Royal College of General Practitioners
The overall incidence rate of flu-like illness remains just below the baseline activity threshold at 16.5 per 100,000 in week 48 and 27.6 per 100,000 in week 49. The rate is exceeded in central England (37.5) and among 15-44 year olds (32.1).

NB: Thresholds used to define the level of flu activity are: 'baseline activity' ( 'normal seasonal activity' (30 - 200 consultations per week per 100,000 population) 'epidemicactivity'(>200 consultations per week per 100,000 population).

- Number of reported flu-like illness outbreaks this season
23 outbreaks reported as of 10th December across the country in various settings such as hospitals, schools and care homes (9/23 confirmed as flu with several awaiting confirmation).

4. Advice on flu is available from NHS Direct on 0845 4647 or nhsdirect.nhs or local GP surgery.

5. The Department of Health's flu immunisation programme for this winter recommends that all those aged 65 and over and other at-risk groups should be vaccinated. In addition it is recommended that health care workers be vaccinated. For further details see their website here.

6. Latest influenza data from the Health Protection Agency can be found here.

7. Further information on seasonal influenza can be found here.

Health Protection Agency