Review of the use of neuraminidase inhibitors for prophylaxis of influenza.

Influenza causes significant morbidity and mortality particularly in vulnerable population groups. Although vaccination is recommended as the primary method of preventing influenza, antiviral drugs may play a complementary role. The National Institute for Clinical Effectiveness (NICE) has recently published guidance on the use of anti-viral drugs in the treatment of influenza, and further guidance on their use for prophylaxis is expected later in the year. In anticipation of this guidance this paper reviews the evidence for the effectiveness of the prophylactic use of neuraminidase inhibitors. Results of this review show that neuraminidase inhibitors are effective in preventing laboratory-confirmed clinical influenza in healthy adults, both when used as post-exposure prophylaxis for close and household contacts, and as seasonal prophylaxis in the wider community. Direct evidence in the elderly and institutions is too limited to draw firm conclusions about their effectiveness in that setting. However it seems probable that neuraminidase inhibitors would also be effective in these groups.

Hostile Hartlepool and genteel Guildford: hostility and health in 10 English towns.

Research from the USA suggests that cities with high mortality rates have high levels of hostility. Our aim was to replicate this research in English towns. A telephone questionnaire, based on the Cook-Medley hostility scale, was administered to random samples of adults in 10 English towns: five with high standardized mortality ratios (SMR) and five with low SMRs. The point estimate for the age-sex-weighted mean hostility score of high SMR towns was higher than that of low SMR towns (mean difference 0.2). However, the 95% confidence interval on the estimate included no difference between the two groups (-0.3-0.8). Our study does not confirm beyond doubt the findings of earlier research in the USA.