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October 4, 2006

Shift Shown in Influenza A Adamantane Resistance—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296(13):1585-1587. doi:10.1001/jama.296.13.1587-a

In Reply: Dr Shea's suggestion that NIs be withheld from persons with influenza who are at low risk for complications is thought-provoking. The utilitarian approach Dr Shea advises, ie, a collective refusal to mitigate morbidity in individuals solely for the good of society, is a vast departure from most other medical care in the United States. Thus, any recommendation to restrict NIs raises many logistical, legal, and outcome-based questions.

First, what is the cumulative cost to society (in terms of days lost from work and school) each year from withholding NIs among low-risk persons with influenza? Second, how would this cost compare with the theoretical benefit of preserving NI susceptibility among epidemic and pandemic influenza strains? No information is available to predict the clinical efficacy of NIs against a pandemic H5N1 strain, even if the virus is susceptible in vitro. It is also not known whether NI-resistant strains are capable of causing an epidemic. Thus far, transmission of NI-resistant strains appears to be extremely rare, and no outbreaks have been reported.1