Zanamivir, influenza, and meningococcal disease

Editor—The zanamivir issue described by Yamey in his news article¹ and the whole subject of treating influenza have ramifications apart from the potential expense to the British taxpayer (who can easily turn into a patient).

I am keen on any development that might help to reduce the burden of disease in hospital wards. If I were asked to state which single condition will fill up my inpatient beds and send healthcare staff home ill most efficiently, I would always choose influenza. Although it is true that influenza is often a mild illness, its association with the development of potentially lethal sequelae is well recognised. It has been described as the best known model of bacterial-viral coinfection.² Influenza is a powerful predisposing factor for invasive meningococcal disease³ one of the few bacterial conditions still regularly killing otherwise normal healthy young people in the United Kingdom. Hubert et al have stated that when an epidemic of influenza-like syndrome is identified, medical practitioners should be informed of the likelihood of an increased incidence and severity of meningococcal disease.⁴ We cannot currently vaccinate against Neisseria meningitidis type B. Zanamivir has the potential to be useful here. This certainly needs further investigation.

Influenza epidemics result in increased hospital admission rates for bacterial pneumonia,² and I have come across many patients who have known the pain and misery of having to have chest drains inserted for the drainage of empyemas as a consequence of having suffered a bout of “not very serious” influenza.

The zanamivir issue merits a broader debate, which should not centre exclusively upon whether or not it will be a helpful agent for groups at high risk. At a recent meeting in Geneva, to mark the 50th anniversary of WHO influenza surveillance, the Director General, Gro Harlem Brundtland, said that, “time to react may be very short—from the first recognition of a new subtype and the onset of a full-blown pandemic, it may be too short to prepare a vaccine and to use it.”⁵

We have time to plan now but may not later. Like the little Dutch boy, we may need a finger to stick in the dyke to stop everyone drowning—perhaps zanamivir and similar drugs are that finger.