Renal Patients and Swine Flu

Following a request by the NKF for the Department of Health to issue specific advice for renal patients in respect of swine flu, the initial advice given was “that it is essential that renal patients inform any person prescribing or providing a vaccine or other medicine in relation to swine flu, that they alert the prescriber/provider to the fact that they are a renal patient”.

The NKF believe that this is very important whether the patient is on Dialysis or Transplanted as it may be that vaccines or drugs normally given are not suitable for renal patients and that alternatives would be better or safer.

We have now received the following more detailed response:

“I have been asked to reply to your recent question regarding the use of antivirals for renal patients on dialysis and on immunosuppressants. In 2007, widespread consultation including the Renal Specialty Committee of the Royal College of Physicians (Chairperson Lawrence Goldberg) occurred on the use of antivirals in this group of patients. It is safe for them to have antivirals. I am informed that the dosage regimens/recommendations were part of the National Policy for Antiviral Treatment approved by the Dept of Health.

“I attach the up to date summary advice from the Health Protection Agency Website which should be known to all those caring for Adults and Children with renal disease. You will note that the advice states that the preferential antiviral should be zanamavir (relenza) which is inhaled. Not included in the summary advice is that those on immunosuppression can have antiviral treatment.

“If you know of clinicians who are unaware of the policy for Renal patients or require further information I would be grateful if you could let me know.”

NKF Question

Does this mean that they are useable by Transplanted Patients?

“Yes it does. Other groups of patients, not only those with transplants, are on immunosuppressants and the expert advice for all those on immunosuppressants who are an at risk group because of their immunosuppression alone is that they can have antivirals.

“I do not want to muddy the waters too much. However it is possible that some renal patients may be given oral Tamiflu (oseltamavir) rather than inhaled zanamavir. There is an agreed dose regimen depending on the creatinine clearance and also for those on dialysis. For those with a functioning transplant again oseltamavir could be used. There may be a local circumstances when inhaled zanamavir is not available but I would think it would be highly unlikely. However I felt that you should be aware that there is clear agreed guidance on the use of oseltamavir for renal patients should the necessity arise.

“Finally again for information I have consulted my Paediatric colleague this morning about the treatment of children with renal disease. The treatment guidance has been prepared by the British Association of Paediatric Nephrologists (BAPN) and is in the process of official/final ratification by the BAPN and the Royal College of Child Health this week. This is the final signing off , if any treatment is required in the meantime it will be given.”

NKF Question

Will the vaccine be safe for kidney patients?

“There are two main types of vaccine, live and inactivated.

“Immunosuppressed individuals should not be given live vaccines as live vaccines can, in some situations, cause severe or fatal infections in immunosuppressed individuals due to extensive replication of the vaccine strain. Examples of a live vaccine include MMR and BCG. However, both seasonal influenza and swine flu vaccines are inactivated vaccines and therefore can be offered to immunosuppressed individuals.

“As you can see flu vaccination is safe for those who are immunosuppressed.”

Dr Colin Hardisty,

Consultant Clinical Advisor in Pandemic Flu Planning

Click here to read the summary advice.

Click here for the latest information and guidance from the Department of Health website.

Click here to read the Evolving guidelines for the management of patients with Influenza A (H1N1) from the Renal Association Clinical Affairs Board.

Click here to read about the Vaccination programme on the DH website.

National Pandemic Flu Service

Website: www.direct.gov.uk/pandemicflu

Tel: 0800 1 513 100

Textphone: 0800 1 513 200

Swine Flu Information from the Department of Health

SWINE FLU AND KIDNEY PROBLEMS: KNOW THE RISKS - (PDF, 63 KB added 26 November 2009)
SWINE FLU AND PREGNANCY: How to protect yourself and your baby - (PDF, 93 KB added 18 November 2009)
SWINE FLU VACCINATION: what you need to know - (PDF, 437 KB added 30 October 2009)
Pandemic Flu News October 2009 - (PDF, 344 KB added 12 October 2009)
Guidance on sickness certification in response to the swine flu pandemic - (PDF, 38kB added 1 October 2009)
DH response to EMEA announcement on pandemic vaccine - (PDF, 54kB added 25 September 2009)
Critical care strategy: Managing the H1N1 flu pandemic — September 2009 - (PDF, 326kB added 10 September 2009)
3 September 2009: UK Planning Assumptions - (PDF, 83kB added 3 September 2009)
20 August 2009: Advice concerning organ donation and H1N1 - (PDF link to DH website, 56kB linked 21 August 2009)
Department of Health’s Press release PANDEMIC VACCINE PRIORITY FOR MOST AT RISK - (PDF, 122kB added 17 August 2009)
Department of Health’s response to study in BMJ on under 12s and Tamiflu - (PDF, 48kB updated 17 August 2009)
Important Information about treatment for Swine Flu (PDF, 47kB added 6 August 2009)
Health Secretary Andy Burnham’s comments on latest pandemic plans - (PDF, 41kB added 30 July 2009)
Department of Health’s response to article in Lancet about Swine Flu and Pregnancy - (PDF, 43kB added 29 July 2009)
National Pandemic Flu Service goes live 23^rd July 2009 - (PDF, 50kB added 23 July 2009)
Statement to Parliament from health Secretary Andy Burnham on Swine Flu 20^th July 2009 - (PDF, 55kB added 21 July 2009)
Chief Medical officer’s Advice to Pregnant Women 20^th July 2009 - (PDF, 43kB added 21 July 2009)
Prescribing guidance for antivirals - (PDF, 161kB added 6 July 2009)
New Approach as Pandemic enters “treatment phase” — Swine Flu Pandemic — Top Lines - (PDF, 27kB added 2 July 2009)
Statement to Parliament from health Secretary Andy Burnham on Swine Flu 2^nd July 2009 - (PDF, 62kB added 2 July 2009)
Statement from health Secretary Andy Burnham on Swine Flu Death 29^th June 2009 - (PDF, 38kB added 29 June 2009)
Transcripts of Press Briefing, 11:13 am 25^th June 2009 - (PDF, 96kB added 25 June 2009)
Agreements secured for pre-pandemic vaccine for the UK - (added 15 May 2009)
Pandemic Flu News May 2009 - (PDF, 270 KB added 12 May 2009)
First step towards Swine Flu vaccine prototype achieved - (added 8 May 2009)
Flu Pandemic Guidelines, October 2007 - (PDF,233 kB added 11 May 2009)

D of H Updates on Swine Flu

The Department of Health issues regular information on the situation regarding Swine Flu in the UK. Click the links below to read these updates.

Pandemic Update from theMonth, issue 30 (PDF, 47kB)
Pandemic Flu News issue 25, February 2010 (PDF, 242kB)
Chief Medical Officer’s Swine Flu Update 4^th February 2010 (PDF, 92kB)
Swine Flu Update — National Pandemic Flu Service to end 11^th February — 1^st February 2010 (PDF, 58kB)
Chief Medical Officer’s Fortnightly Bulletin 21^st January 2010 (PDF, 97kB)
Final Weekly Swine Flu Update 14^th January 2010 (PDF, 46kB)
Pandemic Flu News issue 24, 20^th December 2009 (PDF, 304kB)
Weekly Swine Flu Update 17^th December 2009 (PDF, 44kB)
Weekly Swine Flu Update 3^rd December 2009 (PDF, 46kB)
Pandemic Update from NHS theMonth 1^st December 2009 (PDF, 65kB)
Flu update for third sector parties 1^st December 2009 (PDF, 60kB)
Swine Flu Media Briefing 26^th November 2009 (PDF, 73kB)
Weekly Swine Flu Update 26^th November 2009 (PDF, 44kB)
Swine Flu Update 26^thd November 2009 from NHS theweek (PDF, 37kB)
Swine Flu Media Briefing 19^th November 2009 (PDF, 77kB)
Swine Flu Update 12^th November 2009 (PDF, 45kB)
Swine Flu Update 5^th November 2009 (PDF, 44kB)
Swine Flu Update 29^th October 2009 (PDF, 44kB)
Swine Flu Update 22^nd October 2009 from NHS theweek (PDF, 51kB)
Weekly Swine Flu Update 22^nd October 2009 (PDF, 45kB)
Weekly Swine Flu Update 15^th October 2009 (PDF, 44kB)
Weekly Swine Flu Update 8^th October 2009 (PDF, 39kB)
Weekly Swine Flu Update 1^st October 2009 (PDF, 45kB)
Swine Flu Update 1^st October 2009 from NHS theweek (PDF, 39kB)
Swine Flu Update 24^th September 2009 from NHS theweek (PDF, 41kB)
Swine Flu Update 17^th September 2009 from NHS theweek (PDF, 41kB)
Swine Flu Update 3^rd September 2009 from NHS theweek (PDF, 64kB)
Pandemic Update 28^th August 2009 from NHS themonth (PDF, 64kB)
Update 27^th August 2009 from NHS theweek (PDF, 38kB)
Update 20^th August 2009 from NHS theweek (PDF, 39kB)
Weekly Briefing 6^th August 2009 (PDF, 1.41MB)
Weekly Briefing 30^th July 2009 (PDF, 261kB)
Weekly Briefing 23^rd July 2009 (PDF, 1.4MB)
1^st July at 3pm (PDF, 43kB)
30^th June at 3pm (PDF, 43kB)
29^th June at 3pm (PDF, 43kB)
26^th June at 3pm (PDF, 42kB)
25^th June at 6pm (PDF, 72kB)
25^th June at 3pm (PDF, 43kB)
24^th June at 3pm (PDF, 43kB)
23^rd June at 3pm (PDF, 42kB)
22^nd June at 3pm (PDF, 42kB)
17^th June at 3pm (PDF, 42kB)
16^th June at 3pm (PDF, 41kB)
15^th June at 3pm (PDF, 41kB)
12^th June at 3pm (PDF, 41kB)
11^th June at 3pm (PDF, 41kB)
10^th June at 3pm (PDF, 42kB)
9^th June at 3pm (PDF, 43kB)
5^th June at 3pm (PDF, 42kB)
4^th June at 3pm (PDF, 42kB)
3^rd June at 3pm (PDF, 41kB)
2^nd June at 3pm (PDF, 44kB)
29^th May at 3pm (PDF, 39kB)
28^th May at 3pm (PDF, 41kB)
27^th May at 3pm (PDF, 42kB)
21^st May at 3pm (PDF, 42kB)
20^th May at 3:30pm (PDF, 41kB)
19^th May at 3:30pm (PDF, 41kB)
14^th May at 2pm (PDF, 41kB)
12^th May at 3pm (PDF, 41kB)
11^th May at 3pm (PDF, 41kB)
8^th May at 6pm (PDF, 67kB)
8^th May at 3:30pm (PDF, 40kB)
7^th May (PDF, 51kB)
6^th May (PDF, 42kB)
5^th May (PDF, 44kB)
3^rd May at 3 pm (PDF, 40kB)
2^nd May at 3 pm (PDF, 41kB)
2^nd May at 12 noon (PDF, 58kB)
1^st May at 12 noon (PDF, 35kB)
30^th April (PDF, 31kB)

Further information is available from NHS Choices.

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