University of Iowa research could strengthen flu-season recommendations

Study will help determine when flu sufferers can return to school or work

By this time next winter, the federal government aims to have better recommendations about when seasonal flu sufferers should return to school or work thanks to an international study that includes the University of Iowa.

The research, funded by the National Institutes of Health, is looking specifically at the effectiveness of Tamiflu, a brand of the antiviral drug Oseltamivir commonly prescribed to treat influenza. The medication has been approved for use for about a decade, after initial studies saw symptoms improve after 24 hours, said Patricia Winokur, UI professor of internal medicine and infectious diseases.

But little research has been done on how Tamiflu affects spread of the illness, prompting a follow-up study using the latest technologies involving molecular testing, Winokur said.

“We are trying to fill in the gaps of what we know of how Tamiflu affects disease symptoms as well as viral shedding,” she said. “This is going to help us better understand how to use Tamiflu to prevent spread of the flu to other people.”

The study requires otherwise healthy individuals ages 18 to 64 with flu-like symptoms to volunteer within the first 48 hours of feeling sick. Half of the study participants will receive Tamiflu and half will get a placebo, and everyone will be asked to keep a journal of their symptoms.

UI researchers will collect nasal swabs and vital signs to determine how long the virus is contagious. Participants will be followed for 28 days – most heavily during the first week – and they’ll be compensated for their time and effort, Winokur said.

The research actually began last year and involved about 30 institutions, including sites in Thailand and U.S. naval laboratories. But because last year’s flu season was so quiet, the project was extended, Winokur said.

This season is better suited for the study, she said, because it’s been very active, with flu reports increasing across the nation and state. Flu activity in Eastern and Central Iowa has been particularly heavy, the Iowa Department of Public Health reported on Tuesday, announcing the state’s first pediatric flu-related death.

Iowa also has seen several probable flu-related deaths in adults this season, and public health officials say the region’s flu activity level soon could be upgraded from “regional” to “widespread.”

But even with the spike in flu cases, Winokur said, people willing to participate in the Tamiflu study can be hard to come by.

“Finding them in the first 48 hours is the trick,” she said. “Most people feel really bad and would prefer to just go home. But we have had some brave souls who decided science is worth it.”

So far, including both last season and this season, the UI has enrolled 11 people for the study. But Winokur said she expects to have enough data by March or April to report meaningful results.

Findings could become public in the late summer or early fall – just in time for another flu season and another round of recommendations about how to squash its spread.

“We are trying to understand the right set of instructions to use for schools and hospitals when dealing with workers and kids who have gotten sick,” Winokur said. “Right now we have these guesstimates about waiting 24 hours after fever has abated.”

The study and the new technologies involved, while primarily focused on Tamiflu, are expected to strengthen general recommendations about how long the flu is contagious – regardless of whether a patient is taking an antiviral drug.

“We are going to have better data than we have ever had,” Winokur said.

Influenza is a contagious viral infection affecting the nose, throat, chest and lungs. Symptoms include fever, headache, fatigue, cough, sore throat, runny or stuff nose, aches, and nausea or vomiting.

Individuals who have had symptoms for less than 48 hours and are willing to participate in the UI study can call 319-356-4848.


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