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ARTICLES: Pedro A. Piedra, Kathy L. Schulman, and William A. Blumentals Effects of Oseltamivir on Influenza-Related Complications in Children With Chronic Medical Conditions Pediatrics 2009; 124: 170-178 [Abstract] [Full text] [PDF]

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Indication of Oseltamivir in Children and Adolescents with Chronic Underling Diseases

Akihiko Saitoh, Shinya Kamiyama   (31 August 2009)

Indication of Oseltamivir in Children and Adolescents with Chronic Underling Diseases 31 August 2009
Akihiko Saitoh, MD National Center for Child Health and Development, Tokyo, Japan, Shinya Kamiyama Send letter to journal: Re: Indication of Oseltamivir in Children and Adolescents with Chronic Underling Diseases saitoh-aki{at}ncchd.go.jp Akihiko Saitoh, et al.	To the Editor- In the July 2009 issue of Pediatrics, Piedra et al.1) studied the efficacy of oseltamivir in children and adolescents with chronic underlying diseases and concluded that oseltamivir reduced risks of influenza-related complications and hospitalizations for children with chronic medical conditions. Preventing complications and hospitalizations for children with high risks is an extremely important issue during influenza season; however, we found a few limitations in the study. First, vaccination rates before influenza diagnosis were significantly different between oseltamivir treated group and no antiviral drug group (21.6% vs. 18.7%, P = 0.015). As we already know, the efficacy of influenza vaccination in healthy children is high up to 67 percent;2) and higher efficacy is expected in those with high risks; therefore, efficacy of oseltamivir is difficult to assess. Second, although clinical use of rapid diagnosis test for influenza is limited because of its low sensitivity,3) no antiviral drug group (17.6%) had a significant lower rate of influenza test compared to oseltamivir treated group (50.5%). Patients with other viral infections, which efficacy of oseltamivir is not expected, could be included in the no antiviral drug group. Finally, numbers needed to treat of respiratory illness other than pneumonia, otitis media/complications, and all-cause hospitalizations in 14 days after influenza diagnosis are 25, 48, and 143, respectively. These high numbers do not convince us that oseltamivir reduced influenza-related complications and hospitalizations. Oseltamivir is the most important antiviral medication to treat or prevent influenza and it has been most extensively stockpiled worldwide; however, the availability of oseltamivir will be limited in influenza pandemic situation. In addition, there is a serious concern that the overuse of oseltamivir could emerge resistant virus.4) Recent endemic of novel H1N1 influenza has been spreading worldwide and will spread further especially in northern hemisphere in 2009/2010 winter season. Little data are available regarding the efficacy of oseltamivir for novel H1N1 influenza, and the use of key medication should be monitored and used carefully to be prepared for situation which oseltamivir administration is absolutely necessary for children at the greatest risk or those who have severe or progressive clinical presentation.5) To prepare for future endemic of novel H1N1, or possible avian H5N1 influenza,6) indication of oseltamivir in children and adolescents with chronic underlining diseases needs to be carefully determined. Shinya Kamiyama, M.D. Akihiko Saitoh, M.D., Ph.D. Infectious Diseases National Center for Child Health and Development Tokyo, Japan References 1. Piedra PA, Schulman KL, Blumentals WA. Effects of oseltamivir on influenza-related complications in children with chronic medical conditions. Pediatrics. 2009;124:170-178. 2. Manzoli L, Schioppa F, Boccia A, Villari P. The efficacy of influenza vaccine for healthy children: a meta-analysis evaluating potential sources of variation in efficacy estimates including study quality. Pediatr Infect Dis J. 2007;26:97-106. 3. Uyeki TM, Prasad R, Vukotich C, et al. Low sensitivity of rapid diagnostic test for influenza. Clin Infect Dis. 2009;48:e89-92. 4. Monto AS. Antivirals and influenza: frequency of resistance. Pediatr Infect Dis J. 2008;27:S110-112. 5. World Health Organization. WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses. (Accessed at http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/index.html. on August 28, 2009) 6. Shun-Shin M, Thompson M, Heneghan C, Perera R, Harnden A, Mant D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ. 2009;339:b3172. Conflict of Interest: None declared