Flu Activity (By type) from China's National Influenza Center
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Over the past six months - with the return of seasonal flu - we've seen scattered reports of shortages of oseltamivir (aka `Tamiflu') around the globe.
First, last August, in Vietnam: Summer Flu Continues - Tamiflu In Short Supply, New Restrictions On Use, and here in the United States last December (see CDC HAN #0482: Prioritizing Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir).
Fortunately, our flu season had already begun to peak in December, and combined with the HHS's decision to Release Some Tamiflu Supplies From the Strategic National Stockpile, a bigger crisis was averted.
While we don't get much official reporting anymore from China's National Health Commission or China's CDC, state run media are reporting on a large surge of seasonal H1N1 influenza, overcrowded hospitals, and shortages of oseltamivir in many cities across the country.
The latest influenza report (week 8 of 2023) from China's National Influenza Center (see chart at the top of this blog) suggests H1N1 is rising, but the numbers reported are far lower than what has been previously reported in 2021 and 2022.
Typical of these reports is the following (translated) item, posted on the Xinhua News Agency website.
Why is this year's A stream "fierce" than in previous years?
2023/03/01
On the afternoon of February 28, the Zhejiang Provincial Center for Disease Control and Prevention issued a document on its official account saying, “Recently, there have been outbreaks of influenza in schools in many places in our province, and the results of influenza surveillance at sentinel hospitals have also shown that the intensity of influenza epidemics in our province is on the rise. Mainly H1N1 flu."
(SNIP)
The Zhejiang Provincial Center for Disease Control and Prevention stated that since the Influenza A H1N1 has not been prevalent in Zhejiang Province for the past three years, the vaccination rate is low and the population is generally susceptible. With the adjustment of new crown prevention and control measures, crowd mobility and gathering activities have increased, providing more convenient conditions for the spread of the virus. At the same time, the turn of winter and spring is still the influenza epidemic season, and the risk of clustered epidemics in crowded places continues to exist.
Previously, on February 27, the Beijing Municipal Center for Disease Control and Prevention reported that the intensity of seasonal influenza epidemics in Beijing is currently showing a clear upward trend, in which influenza A viruses dominate, accounting for 99%.
How much of this surge in ILI across China is due to seasonal influenza, and how much may be the result of COVID, RSV, or other respiratory viruses is unclear. But it appears to have led to panic buying - and hoarding - of oseltamivir.
At least based on the reporting from state run media.
Over the past few days headlines have warned of shortages of the antiviral in major cities, urging people not to hoard the drug, and not to take it without a doctor's advice.
There is no need to hoard antiviral drugs such as oseltamivir in large quantities
March 01, 2023 06:35 Beijing Daily client
"Oseltamivir and other influenza A treatment drugs should be taken according to the doctor's advice, and self-administration is not recommended." Liu Wei, director of the Pharmacy Department of You'an Hospital, introduced that patients of different age groups have different dosages, and patients with impaired renal function also need to adjust dosages. Patients cannot judge by themselves. In addition, patients do not need to stock up on medicines. Oseltamivir is taken within 48 hours after the onset of symptoms of influenza A. The therapeutic effect is the best, and it is meaningless to stockpile a large amount of drugs.
Another report suggests local governments are cracking down on the sale of oseltamivir to the public without a prescription.
Tianjin strengthens the quality supervision of influenza prevention and control drugs to ensure the safety of citizens' medication
Manuscript source: Jin Yun Editor: Liu Yang 2023-03-07 00:29
In response to the recent season of high incidence of influenza (hereinafter referred to as "flu"), the demand for influenza medicines has increased sharply. Carry out special inspections on influenza prevention and control drugs, strictly control the outposts, and protect the lives and health of the people.
(SNIP)
During the inspection process, the market supervision department discovered an illegal act of selling the prescription drug "Oseltamivir Phosphate Capsules" without a prescription, and the case has now been investigated and dealt with.
Many recent articles also downplay the usefulness of oseltamivir - particularly for healthy adults - and are recommending TCM (Traditional Chinese Medicine) instead.
Beijing released the recommended catalog of Chinese patent medicines related to influenza treatment in spring 2023
According to the official website of the Beijing Municipal Administration of Traditional Chinese Medicine, Beijing is currently in an influenza epidemic period in which influenza A (H1N1) viruses are predominant and co-circulate with influenza A (H3N2) subtypes. The number of fever outpatient clinics in some medical institutions continues to increase, and pediatrics in particular are under greater pressure.
In order to ensure the medical needs of the masses, and give full play to the characteristics and functions of traditional Chinese medicine in a scientific, effective, safe and secure manner, the Beijing Municipal Administration of Traditional Chinese Medicine organized the Beijing Expert Group on Prevention and Treatment of Influenza with Traditional Chinese Medicine to formulate the "2023 Beijing Spring Influenza Prevention and Control Plan with Traditional Chinese Medicine (Trial)" .
Regardless of what is happening on the ground in China, the shortages of oseltamivir over the past year in Vietnam, the United States, and now China are warning signs that improvements are needed both in the supply - and in the distribution - of influenza antivirals before the next severe flu epidemic or pandemic arrives.
