“Ring” prophylaxis of close contacts with antivirals may be an effective strategy

Recent efforts have been directed towards preparing rapid effective responses to epidemics of smallpox and severe acute respiratory syndrome (SARS). We must now hasten the preparations for another inevitable threat—the next global influenza pandemic. Currently contingency plans are largely based on rapid vaccination of susceptible populations; other measures, such as treatment with antiviral drugs, serve only as adjuncts.1 In practice, however, technical constraints on vaccine production—foremost among these the time required to initiate mass vaccine production during a pandemic—will limit the effectiveness of this measure in the first stages of the pandemic.2 Recently a systematic review by Cooper et al addressed the effectiveness of neuraminidase inhibitors in the treatment and prevention of influenza.3 The authors concluded that the prophylactic use of these drugs can lead to a reduction of 70-90% in the risk of laboratory confirmed symptomatic flu, depending on the strategy adopted and the population studied. Neuraminidase inhibitors have also shown efficacy in preventing transmission of influenza in institutions and community settings.3 4 The availability of a highly effective supplement to vaccination opens to debate the appropriate role …