| Health Advisory -- October 17, 2005
Information Related to Personal Stockpiles of Antiviral Drugs for Influenza
This advisory contains information for King County health care providers related to prescribing personal stockpiles of antiviral drugs for influenza, and will be updated as new information becomes available. At this time, the CDC has not issued a recommendation for or against personal stockpiles of antiviral drugs, and Public Health does not recommend personal stockpiles. The issue of management of antiviral drug supplies may differ depending on who controls the supplies, with supplies held in the public sector and health care organizations subject to restrictions not placed on drugs available through private pharmacies.
Arguments in favor of personal stockpile:
| 1) |
The existing national stockpile is insufficient to meet the needs of all persons requiring treatment and/or prophylaxis if a severe pandemic occurred in the near future. The federal government currently has enough oseltamivir treatment courses for approximately 1-2% of the population. |
| 2) |
The drug is widely available in the private sector for prevention and treatment of "seasonal" influenza. |
| 3) |
Drug available in the private sector, even if conserved at this time in the absence of stockpiling, might not contribute significantly during a subsequent pandemic response. The amount of oseltamivir available locally in the private sector is relatively small at any time, and there are no plans to reallocate private sector supplies to governmental or public health authorities during a pandemic. |
| 4) |
There are no official recommendations by CDC or HHS against personal stockpiles and it is not known if a recommendation is going to be forthcoming. Moreover, any recommendations that are issued should be national to prevent antiviral drugs from being disproportionately supplied to areas where restrictions are either not in effect or not being enforced over areas where restrictions are in effect. |
Arguments against a personal stockpile:
| 1) |
Personal stockpiles are not recommended in the draft national pandemic preparedness plan for use of antiviral drugs during a pandemic. The plan calls for use of limited supplies of antiviral drugs for treatment rather than prophylaxis and for targeting priority groups (i.e., persons requiring hospitalization, persons at risk for severe influenza) for antiviral use during a pandemic. Personal stockpiles could make less drug available in the private sector for treatment of priority groups should a pandemic arise in the near future. |
| 2) |
Personal stockpiling may result in shortages of drug for use in treatment and prevention of seasonal influenza infections. |
| 3) |
There is no pandemic occurring currently. Although many experts are concerned that the expanding avian influenza A H5N1 outbreak may result in a pandemic, it is not known when the pandemic might begin, the specific virus that will ultimately emerge, and the associated health impacts. |
| 4) |
The drug might not be effective in preventing severe illness or death and the optimal dose is not known for the current avian H5N1 strain. |
| 5) |
Inappropriate use: How will persons know when to initiate treatment? The drug will be wasted if taken for non-influenza infection or when a pandemic is not occurring. If the virus is susceptible, the drug should be administered early in the course of illness when symptoms may be nonspecific. The shelf life is limited and may give false assurance if relied upon after expiration or after suboptimal storage conditions. |
| 6) |
Inequitable distribution: The drug is expensive and if shortages occur, persons who do not choose to stockpile or cannot afford to stockpile might subsequently have less access to the drug. |
Note: Healthcare facilities and organizations with antiviral drug supplies can optimize their supplies and institutional pandemic preparedness by restricting personal stockpiling. This would assure that available antiviral drug is preserved for use according to national recommendations both during a pandemic and for treatment of seasonal influenza in high-risk patients.
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