Elderly should be low priority for antivirals, says scientist

Elderly people with swine flu should be treated as the lowest priority for antiviral drugs in a bid to preserve stocks for the younger population, according to new research.

The controversial view was published yesterday by an Italian scientist who claimed that distributing drugs such as Tamiflu to those over 65 has little effect on the spread of the infection or on mortality rates.

Age Concern said last night that older people were at high risk of complications if infected with swine flu and should receive antiviral treatment.
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However, halting the prescription of the drugs for the over 65s could be the most effective way to save lives and prevent illness, the report by Stefano Merler, of the Bruno Kessler Foundation, an Italian research organisation found.

The research was carried out to establish the most effective way to distribute antivirals after it emerged that Italy has only enough Tamiflu to prescribe 12% of the population, around half of the supply recommended by the World Health Organisation.

Scotland has enough of the drug to cover 50% of the population, it was confirmed last night.

Mr Merler looked to the 1918-1919 flu pandemic, which claimed between 20 million and 40 million lives and was most lethal to those in their 30s, to offer a comparison to today’s infection.

When looking at the use of antivirals during the peak of the outbreak, Mr Merler found that the mortality rate among adults of working age who were given the drugs dropped by up to 40%.

When the drugs were given to the elderly, classed as those over 65, the death rate fell by a maximum of 2.8%.

Mr Merler said: “Although a policy of age-specific prioritisation of antiviral use will be controversial ethically, it may be the most effective use of stockpiled therapies. This is of particular importance for countries where the amount stockpiled is well below the WHO’s suggested level.

“Our work demonstrates that even in countries where the antiviral stockpile is not sufficient to treat 25% of the population, the minimum level suggested by the WHO, it is possible to reduce morbidity by prioritising the use of antivirals by age.”

Mr Merler’s suggested approach is the reverse of the policy adopted during outbreaks of normal seasonal flu, when priority is given to the over-65s.

Dr Rowland Kao, senior lecturer in animal production and public health at the University of Glasgow, said that Mr Merler’s research should be considered.

“It might be worth thinking about if this group is not producing a lot of the virus and are not at severe risk from the infection,” he said.

A spokeswoman for the Scottish Government said that distribution of Tamiflu was purely a clinical decision and that no-one was excluded from being supplied.

A spokesman for Help the Aged said that the Italian-based research was not relevant to the UK given the healthy stock of antivirals.

He added: “Although older people seem at present less likely to catch the virus, they are more likely to have other long-standing health problems which could place them at higher risk once infected.”

Meanwhile, The family of Saltcoats woman Sharon Pentleton remains by her bedside in a Stockholm hospital after the pregnant 26 year old was flown to Sweden for treatment after suffering a rare reaction to swine flu.

A spokeswoman for NHS Ayrshire and Arran said last night that Ms Pentleton remains in a critical but stable condition.

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