A prospective study to examine the effectiveness and safety of antivirals against pandemic influenza

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Pandemic influenza could cause significant mortality in populations of Australia and the south-east Asian region. Currently, avian influenza A (H5N1) is a concern to public health agencies because of its extreme pathogenicity. At present this strain is not transmitted readily between humans. A number of drugs are available to treat influenza infection in humans and research has shown these to be effective in preventing significant mortality in the setting of seasonal influenza epidemics (specifically the influenza neuraminidase inhibitors _NIs). As a consequence public health agencies around the world have been stockpiling these drugs and developing sophisticated plans for their use if an influenza pandemic was announced. However, there are no data indicating that the neuraminidase inhibitors (NIs) are safe and effective when used to manage pandemic influenza. Neither are there any data to support the use of these drugs on a population basis. Genetic resistance to NIS has been described but it is not clear if this has any relevance to public health. Our research will clarify this issue. This project will develop a number of clinical trials that could be implemented rapidly should pandemic influenza ever be announced by health authorities in Australia-Singapore or Hong Kong. Patients with suspected influenza infection will be asked to provide informed consent prior to commencing NI therapy. Clinical information will then be collected for a period of approximately one month along with some blood samples and swabs from the throat and nasal passages. Data will be analysed as quickly as possible to help inform the continued use of NI therapy as a cornerstone of the public health agency response to pandemic influenza. In addition, the study team will prepare clinical trials to be conducted in essential workers who are likely to receive long-term NI preventive treatment as well as the immediate contacts of people with presumed influenza infection who are likely to receive short-term prophylaxis with NIs.