In view of the dangers posed by flu toward public health, some developed countries represented by the US, England, Australia, Japan and WHO issued guidelines between 2007 to 2009, providing a lot of useful information on the diagnosis, treatment and medical prevention of flu, as well as the usage of anti-viral drugs and management of public facilities upon flu outbreak (4-8). These guidelines provide beneficial information for the global prevention and control of flu, and each guideline has its own focus, such as time effectiveness. WHO issued a guideline called “medical treatment guide on new armor flu and other flu viruses in 2009” promptly after the outbreak of the new armor flu, which provided clinicians with directions on the usage of anti-viral drugs for treatment and prevention. The guideline issued by the US was comprehensive, detailed and highly pertinent, and covered the diagnosis of flu, treatment, prevention and disease control. The guidelines issued by WHO, England and Japan focused on providing clinicians with instructions for the use of anti-flu virus medicine for treatment and prevention (4,5,7). The guideline issued by the Australian monitoring network of infectious diseases mainly focused on disease control, and provided directions for the Australian public health institutions, hostel organizations and their staff to prevent widespread outbreak in hostel facilities during a flu epidemic (8).

According to the 2011 guideline for flu prevention and control in China (9), it is obvious that practitioners and researchers in the area of respiratory medicine in China have learned much from the advanced experience and research results of foreign countries. They have also realized that the guidelines from foreign countries may not be entirely suitable for China. This is because China, being a nation with the largest population in the world, needs a diagnostic guideline which both complies with global standards and also considers the practical situation in China. For example, in terms of public safeguard against flu, the expense on the storage of neuraminidase inhibitor accounts for only 0.11% of the total medical expenditure in developed countries, but can be as high as 12.9% in the developing nations (10). Up till now, China is still the biggest developing nation in the world. Considering the financial support and drug manufacturing capacity in China, it may not be practical for China to rely solely on oseltamivir to fight against human avian flu and any other flu pandemic which may occur in the future. In addition, the overseas guidelines mainly focus on the situations in developed countries but there are major differences between China and those developed countries with regard to politics, economy, hygiene and education conditions. With the exception of a few developed areas, many developing regions in the western China fall way behind the requirements set out in the overseas guidelines. Therefore, the guidelines proposed by developed countries may not be entirely applicable. Finally, China has its own unique experience and characteristics in flu treatment, such as the rescue of seriously ill flu patients. The extraordinary high cure rate and treatment with traditional Chinese medicine in China during the SARS outbreak was globally impressive and China also has successful experience in the emergency rescue of multiple organ dysfunction syndromes (MODS) caused by the highly pathogenic avian flu virus. However, these medical advancements have not been reflected in the guidelines of foreign countries or WHO.

An overview of the 2011 edition of the Chinese flu guideline shows that the guideline not only adopted the standard format of foreign guidelines and made reference to them, but also summarized China’s experience in the prevention and treatment of respiratory tract infections after SARS, and further proposed and promoted positive local experience. According to the writer’s observation, the guideline has the following attractive features. Firstly, it is very comprehensive and its standards are already comparable to international guidelines. In contrast to previous Chinese guidelines which only focused on specific subtypes of flu (such as the four separate guidelines in respect of the seasonal flu, the highly pathogenic avian flu and the new armor flu), the present guideline is applicable to all subtypes of flu. This change makes the guideline more widely applicable. With subsequent improvement, it will certainly serve as a valuable reference in dealing with any unforeseen flu attacks in the future. This is of particular practical significance for a global hot spot region for flu study like China. Secondly, this guideline is highly enriched with Chinese characteristics. The previous Chinese guidelines mainly referred to foreign literature and exclusively reported foreign flu treatment strategies. The present edition continued to build on this basis but however supplemented with Chinese medicinal treatment and latest Chinese clinical experience. For example, in the diagnostic aspect, it has extensively referenced to the research experience in the northern China. This is an encouraging step forward even though the resources and experience of China are still very limited when compared with that in overseas guidelines. In the guideline, flu treatment with Chinese medicine is no longer a simple empirical summary, but supported by evidence-based medicine, e.g. the clinical efficacy of two Chinese medicine formulas recommended by the guideline have been reported in international journals in the field of evidence-based medicine (11,12). These accomplishments show that Chinese medicine formulas are effective in alleviating symptoms, such as the fever, caused by flu virus infection. It is also a new attempt for Chinese alternative medicine to enter mainstream medical practice. Meanwhile, considering the recent increase in drug resistance of M2 ion channel inhibitor and the appearance of Duffy resistance, these alternative Chinese medicine formulas are likely to be considered as drug candidates for further investigation in respiratory medicine.