A systematic review of the use of oseltamivir for treatment of
influenza in children garnered significant media coverage in the UK (1).
Whilst the review was limited to trials of seasonal influenza treatment,
in the accompanying podcast one author said that it is ‘highly likely
[seasonal and pandemic strains] behave exactly the same’ (2). On the basis
that across two trials of oseltamivir treatment, 20 extra children vomited
compared to placebo groups, and despite acknowledging their analysis was
not sufficiently powerful to detect differences in complications of
influenza infection, the same author told ITN news that ‘in mild
[influenza] the benefits of treatment do not outweigh any harms’ (3). We
wanted to see whether media coverage has affected parents’ views on the
drug.
Between the 15th and 25th September 2009 we approached the parents of
276 children presenting for any reason to a Paediatric Emergency
Department in central London, and invited them to complete a survey on
their attitudes to oseltamivir (Tamiflu). 29 refused and were excluded
from analysis, and some didn’t finish the survey, mainly because they were
seen by medical staff prior to completion. The parents were mostly mothers
(66%), accompanying children with a median age of 4 years.
Words associated with Tamiflu were ‘Swine flu’ (176; 71%), ‘Worried’
(105; 43%), and ‘Side-effects’ (100; 40%). 41 (17%) associated it with
‘Safe’, and 58 (23%) with ‘Dangerous’. Parents were asked to choose which
(up to three) of a list of sentences about Tamiflu they most agreed with.
The most popular choices were ‘I am worried that Tamiflu would give my
child unpleasant side-effects’ (112; 45%), ‘I am worried that not enough
is known about Tamiflu’ (97; 39%), and ‘I am confused by what I’ve heard
about giving Tamiflu to children with swine flu’ (84; 34%).
Parents were almost five times more likely to want their children
treated with Tamiflu than not if the diagnosis had been made by their GP
(42% versus 9%), but this was reversed if the diagnosis was not made by a
doctor (23% versus 33%). In both scenarios many parents didn’t know
whether they would want their child treated or not (Figure).
When asked about swine flu vaccines in development, 84 (34%)
associated them with ‘Side effects’. However, parents were more than 8
times more likely to want their children vaccinated than not.
This data demonstrates significant public anxiety about the use of
oseltamivir for the treatment of influenza in children. Parental
reluctance to treat undermines the public health response to pandemic
influenza and in the context of the emergence of severe disease (4,5),
could be harmful.
Figure: Parental responses to two statements: ‘If my child’s GP
thought they had swine flu, I would want my child to take Tamiflu’ (number
shown in blue), and ‘If I thought my child had swine flu I would want them
to have Tamiflu even if we couldn’t get to see a doctor’ (red).
References:
1. 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.
4. Hackett S, Hill L, Patel J, Ratnaraja N, Ifeyinwa A, Farooqi M,
Nusgen U, Debenham P, Gandhi D, Makwana N, Smit E, Welch S. Clinical
characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet
2009; 374: 605.
5. Lister P, Reynolds F, Parslow R, Chan A, Cooper M, Plunkett A,
Riphagen S, Peters M. Swine-origin influenza virus H1N1, seasonal
influenza virus, and critical illness in children. Lancet 2009; 374: 605-
7.
Acknowledgements: KDJJ is grateful for support from the UK NIHR, and
an NIHR Comprehensive Biomedical Research Centre.
Competing interests:
None declared
Competing interests:
No competing interests
19 October 2009
Kelsey DJ Jones
Clinical Research Fellow
RWF Breakey, Jennifer N Clough, Harriet M Gunn, Seema Pattni, Ian K Maconochie, Rebecca Salter, and Gareth Tudor-Williams.
Centre for Respiratory Infection, Imperial College, London
Rapid Response:
Parental anxiety over oseltamivir
A systematic review of the use of oseltamivir for treatment of
influenza in children garnered significant media coverage in the UK (1).
Whilst the review was limited to trials of seasonal influenza treatment,
in the accompanying podcast one author said that it is ‘highly likely
[seasonal and pandemic strains] behave exactly the same’ (2). On the basis
that across two trials of oseltamivir treatment, 20 extra children vomited
compared to placebo groups, and despite acknowledging their analysis was
not sufficiently powerful to detect differences in complications of
influenza infection, the same author told ITN news that ‘in mild
[influenza] the benefits of treatment do not outweigh any harms’ (3). We
wanted to see whether media coverage has affected parents’ views on the
drug.
Between the 15th and 25th September 2009 we approached the parents of
276 children presenting for any reason to a Paediatric Emergency
Department in central London, and invited them to complete a survey on
their attitudes to oseltamivir (Tamiflu). 29 refused and were excluded
from analysis, and some didn’t finish the survey, mainly because they were
seen by medical staff prior to completion. The parents were mostly mothers
(66%), accompanying children with a median age of 4 years.
Words associated with Tamiflu were ‘Swine flu’ (176; 71%), ‘Worried’
(105; 43%), and ‘Side-effects’ (100; 40%). 41 (17%) associated it with
‘Safe’, and 58 (23%) with ‘Dangerous’. Parents were asked to choose which
(up to three) of a list of sentences about Tamiflu they most agreed with.
The most popular choices were ‘I am worried that Tamiflu would give my
child unpleasant side-effects’ (112; 45%), ‘I am worried that not enough
is known about Tamiflu’ (97; 39%), and ‘I am confused by what I’ve heard
about giving Tamiflu to children with swine flu’ (84; 34%).
Parents were almost five times more likely to want their children
treated with Tamiflu than not if the diagnosis had been made by their GP
(42% versus 9%), but this was reversed if the diagnosis was not made by a
doctor (23% versus 33%). In both scenarios many parents didn’t know
whether they would want their child treated or not (Figure).
When asked about swine flu vaccines in development, 84 (34%)
associated them with ‘Side effects’. However, parents were more than 8
times more likely to want their children vaccinated than not.
This data demonstrates significant public anxiety about the use of
oseltamivir for the treatment of influenza in children. Parental
reluctance to treat undermines the public health response to pandemic
influenza and in the context of the emergence of severe disease (4,5),
could be harmful.
Figure: Parental responses to two statements: ‘If my child’s GP
thought they had swine flu, I would want my child to take Tamiflu’ (number
shown in blue), and ‘If I thought my child had swine flu I would want them
to have Tamiflu even if we couldn’t get to see a doctor’ (red).
References:
1. 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.
2. http://podcasts.bmj.com/bmj/2009/08/14/a-pandemic-of-pandemic-
news/ (accessed 25th Sept 2009).
3. http://www.youtube.com/watch?v=QwcEKBYbXWU&feature=player_embedded
(accessed 25th Sept 2009).
4. Hackett S, Hill L, Patel J, Ratnaraja N, Ifeyinwa A, Farooqi M,
Nusgen U, Debenham P, Gandhi D, Makwana N, Smit E, Welch S. Clinical
characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet
2009; 374: 605.
5. Lister P, Reynolds F, Parslow R, Chan A, Cooper M, Plunkett A,
Riphagen S, Peters M. Swine-origin influenza virus H1N1, seasonal
influenza virus, and critical illness in children. Lancet 2009; 374: 605-
7.
Acknowledgements: KDJJ is grateful for support from the UK NIHR, and
an NIHR Comprehensive Biomedical Research Centre.
Competing interests:
None declared
Competing interests: No competing interests