Beginning in March 2009 North America experienced an outbreak of a new strain of influenza A virus, designated influenza H1N1 2009, which represents a reassortment of swine, avian and human influenza viruses.1
On 11 June 2009, the World Health Organization (WHO) signalled that a global pandemic of novel influenza A/H1N1 (swine flu) was underway by raising the worldwide pandemic alert level to phase 6,2
the highest level.
In the UK, cases of influenza A/H1N1 have spread from hotspots where it first started to affect at times nearly every local community. The Department of Health reported on the 23 July 2009 that there had been approximately 100 000 new cases of H1N1 reported in the preceding week in England.3
While the majority of cases had been mild, there had been 840 hospitalisations and an estimated 26 deaths in England at this stage of the pandemic.4
Since then the case incidence has generally decreased with 9000 new cases per week estimated on the Health Protection Agency report of the 17 December 2009, with 203 swine flu related deaths since the pandemic started.4
The death toll of this, as any, pandemic depends not only on the virulence of the virus in question but also on the rapidity with which we are able to introduce effective preventative and therapeutic measures.5
During the current pandemic of swine influenza, neuraminidase inhibitors such as oseltamivir phosphate (Tamiflu) and zanamivir (Relenza) have been extensively used. In studies, oseltamivir has been found to be effective at reducing the duration and severity of illness6,7
and providing prophylaxis for close contacts of influenza infected persons against illness.8
In adults, the most commonly reported adverse drug reactions (ADRs) are moderate nausea and vomiting9
; however, recent reports suggest there may be more serious ADRs associated with the use of oseltamivir,10
including hepatitis, gastrointestinal bleeding and neuropsychiatric side effects.11–13
On 23 July 2009 the National Health Service (NHS) launched the National Pandemic Flu Service in order to deal with the increasing number of H1N1 cases in the UK. The service (through the telephone or internet) assesses the patient’s symptoms and, if required, provides an authorisation number which can be used to pick up antivirals from a local antiviral collection point.14
To receive antivirals, individuals do not need to see or speak to a doctor or other health professional and do not require a prescription. Medical leaders and charities have already given a warning that diagnosing all cases of flu remotely could lead to other serious infections and conditions being missed, or the ‘worried well’ applying for and receiving medication inappropriately.15
We present a case of acute pancreatitis that was diagnosed in a previously well patient who had received oseltamivir through the National Pandemic Flue Service. The patient was found to be negative for H1N1 on subsequent polymerase chain reaction (PCR). We discuss some of the issues surrounding current policies regarding the prevention and treatment of H1N1 in the UK.