Tamiflu policy was 'indefensible'

Welford Primary School in Birmingham was among places affected

Senior public health doctors in Birmingham have criticised the policy of giving tamiflu to patients without swine flu as "indefensible".

Jacky Chambers at Heart of Birmingham NHS Primary Care Trust, said the policy applied by the Health Protection Agency (HPA) was "inconsistent and confused".

The policy appeared to be politically driven, the doctor said in an open letter to the British Medical Journal.

The HPA said it was especially cautious initially when information was limited.

However, Dr Chambers, the trust's director of public health, said the policy had been ineffective and not based on any credible evidence.

She said in Birmingham decisions over children receiving prophylaxis (anti-viral drugs for preventative means) had "varied between the whole school, no school and single classes".

She wrote in some cases tamiflu had been given to "pupils sitting within one metre" of someone with the virus and in others to pupils "listed on the school register as having medical conditions (which include those who wear glasses)."

'Potential harm'

Dr Chambers wrote: "Mass prophylaxis of healthy people with antiviral drugs is an irrational, indefensible and ineffective response".

She also wrote such policies may promote "bad hygiene practices" because children treated with tamiflu appeared to have later developed swine flu symptoms and returned to school still unwell.

Our initial approach had to be highly precautionary. It would have been irresponsible for it to have been otherwise HPA spokeswoman

Dr Chambers added: "The time has come for the public health community to return to some basic principles for managing this pandemic and minimising potential harm."

She said these principles included early and rapid treatment of high-risk patients and and educating people about how to prevent the virus's spread.

Birmingham public health consultant Andrew Rouse added his concerns on the use of tamiflu saying that consent was not always clearly obtained.

He said: "I do not know but suspect that 10% of recipients will get nausea, vomiting, diarrhoea, abdominal pain and headaches.

He added that small numbers of people could develop conditions such as hepatitis and allergic reactions.

'Limited data'

Welford Primary School in Handsworth shut in May with nearly 200 people connected to the school diagnosed with the virus. Other schools in the region have also been affected.

Last month Birmingham became the first place in the UK to move to the "treatment phase" after health officials said the virus could no longer be contained in the city.

And on Thursday, the "containment phase" was abandoned across the UK and with it the mass provision of tamiflu.

The HPA said it had to be cautious in its initial assessment of the swine flu threat.

"HPA's response was influenced by limited data coming out of Mexico and the US, where it seemed to have caused a disproportionate number of deaths and was very infectious in schools," a spokeswoman said.

"Our initial approach had to be highly precautionary. It would have been irresponsible for it to have been otherwise."

She said individual risk assessments in schools had always considered a number of issues and aimed to limit illness in children, delay swine flu's wider spread and give the HPA time to find out more about the virus.