# 8109
With the 2013-14 influenza season now well underway, and concerns over the severity of the H1N1 virus – particularly in younger patients and those with co-morbidities – the CDC is urging doctors to consider the early use of antivirals in high risk patients with suspected or confirmed influenza (see CDC HAN Advisory On Early pH1N1 Influenza Activity).
While there does not seem to be a national shortage of oseltamivir (Tamiflu ®) – the most commonly prescribed antiviral for influenza – in a few regions (mainly in the South) that have already been hit hard by the flu, some pharmacies are reporting trouble keeping the drug in stock.
A couple of reports on these shortages, after which I’ll be back with a little more on Tamiflu, and this year’s H1N1 flu.
Shortage in flu medication worries pharmacists
LITTLE ROCK, Ark. (KTHV) - "We can't find the regular adult dose anywhere right now," Dr. Ray Turnage explained.
Turnage is one of many pharmacists dealing with a shortage of Tamiflu. He said, "There's only one manufacturer for that drug and nationwide all the wholesalers are saying it's a manufacture delay."
Tamiflu is the only medication on the market used to treat the flu and with a shortage in the drug, it could create problems for patients needing it. "Probably the demand is exceeding their supply. So that's the problem is we can't even get adult doses right now," Turnage continued.
Although there have been very minimal cases of the flu this year in Little Rock, with 3 to 4 months left in the flu season, that could change pretty quickly. If it does, Tamiflu in stock could disappear. Turnage said, "That's part of the situation is a few families can, if they can find it, can take all that the pharmacy may have."
Shortage reports on Tamiflu in Atlanta, local pharmacies stocked – WSOC-TV
The bottom line is, that if you are prescribed Tamiflu, you may have to call around to more than one pharmacy to locate the drug.
While Tamiflu continues to get a strong recommendation from the CDC (see CDC Research On Benefits Of Antivirals For Uncomplicated Influenza), you’ll find no shortage of critics of the drug. Due in large part to a prolonged reluctance on the part of Roche laboratories to release all of their clinical trial data, and a not totally undeserved reputation of `Big Pharma’ to massage test results.
This has resulted in a vociferous backlash against the government stockpiling of Tamiflu in some quarters (see Dr. Ben Goldacre Opinion Piece).
While academics and activists tend to have a dim view of Roche and their antiviral drug, clinicians obviously see value in oseltamivir, and continue to prescribe it. The CDC continues to recommend its use – particularly for high-risk influenza patients - or for the treatment of novel flu (see 2012 blog The CDC Responds To The Cochrane Group’s Tamiflu Study).
Although this year’s flu season is being billed in the media as `The Return of Swine Flu’, in truth, the H1N1 virus never departed. But it has been dominated in North America by the H3N2 virus for the past couple of years. The following snapshot of last year’s moderately severe flu season comes from last summer’s MMWR Influenza Activity — United States, 2012–13 Season and Composition of the 2013–14 Influenza Vaccine.
Among the seasonal influenza A viruses, 34,922 (68%) were subtyped; 33,423 (96%) were influenza A (H3N2) viruses, and 1,497 (4%) were pH1N1 viruses. In addition, two variant influenza A (H3N2v) viruses were identified.
The season before that (2011-12) was the mildest flu season in decades (see 2011-2012 Flu Season Draws to a Close), that while H3N2 dominated, neither strain had a huge impact.
The truth is, flu seasons can vary greatly in impact from year-to-year,and with two influenza A strains in global circulation, we usually see one strain or the other dominate (although what strain is dominant in North America my differ from what is dominant in Europe, or Asia the same year). Often we see 2 or 3 years with one strain in control, and then – as community immunity levels wane – the other takes hold.
The CDC’s most recent attempt to estimate the number of deaths associated with flu in the United States finds:
An August 27, 2010 MMWR report entitled “Thompson MG et al. Updated Estimates of Mortality Associated with Seasonal Influenza through the 2006-2007 Influenza Season. MMWR 2010; 59(33): 1057-1062.," provides updated estimates of the range of flu-associated deaths that occurred in the United States during the three decades prior to 2007. CDC estimates that from the 1976-1977 season to the 2006-2007 flu season, flu-associated deaths ranged from a low of about 3,000 to a high of about 49,000 people.
As much as a 16-fold difference in the number of estimated deaths between a mild flu season, and a heavy one.
Thus far, its been H1N1’s year to roar, and since that strain often impacts those under the age of 65, it tends to get more publicity. The flu death of a young adult from influenza is more unexpected, and has more societal impact, than that of an octagenarian. And this year, sadly, we are seeing a fair number of such reports (see Texas DSHS Statement On Recent Spike In Flu Activity).
Regardless of the strain of flu in circulation, you are much better off avoiding infection rather than treating it. So while it may only provide moderate protection, getting the flu shot each year is cheap insurance.
That, and following good flu hygiene practices (covering coughs, washing hands frequently, staying home when sick, avoiding close contact with those who are sick), are your best defense against our yearly flu epidemic.
