Antiviral treatment for avian influenza
Antivirals have demonstrated effectiveness in the treatment of avian influenza virus infections in humans, lowering severity and the risk of death. In August 2017, ECDC published an opinion on the use of antivirals to treat avian influenza, ‘Expert opinion on neuraminidase inhibitors for the prevention and treatment of influenza - review of recent systematic reviews and meta-analyses’.
The use of antivirals pre- and post-exposure should be considered for people exposed to avian influenza A(H5N1), particularly those not wearing a PPE or with a PPE breach, and in suspected cases of avian influenza infection, according to national guidelines of countries. Antiviral pre- or- post-exposure prophylaxis has been the measure of choice for exposed people in the context of infected birds or mammals.
Antivirals remain a treatment option in the absence of antimicrobial resistance to this type of treatment.
Available antivirals
Neuraminidase inhibitors (NAIs) and M2 inhibitors (adamantanes) are authorised for use as treatment of infected patients, in the situation of an influenza pandemic.
The following NAIs have been authorised in the EU for the treatment of influenza:
In addition, cap-dependent endonuclease inhibitor Xofluza (baloxavir marboxil) has also been authorised in the EU for the treatment of influenza.
M2 inhibitors (adamantanes) are amantadine and rimantadine, for which seasonal influenza viruses of type A have developed resistance. They are also not effective against type B viruses, and are thus not currently recommended for seasonal influenza virus infections.
However, avian influenza viruses A(H5N1) are susceptible to M2 blockers, so these antivirals remain a treatment option for avian influenza infections in humans.
More details about antiviral medicines for pandemic influenza are available on the website of the European Medicines Agency (EMA).