CDC Stockpile Releases Remaining Oseltamivir Liquid

Kate Traynor

BETHESDA, MD 30 October 2009—All of the remaining pediatric oseltamivir liquid in the Strategic National Stockpile (SNS) is being released to the states in response to widespread reports of influenza, Centers for Disease Control and Prevention (CDC) Director Thomas Frieden told reporters today.

The 234,000 treatment courses that are now available are in addition to 300,000 courses that were released at the beginning of the month, Frieden said. He said this last supply of treatment courses had been held in reserve to meet the needs of states with an unusually high burden of influenza.

Influenza Resources

For important information about seasonal and pandemic influenza, visit ASHP's H1N1 Flu Resource Center, the new Stop the flu—it starts with you! resource center, and the ASHP Foundation's Pandemic Influenza Assessment Tool for Health-System Pharmacy Departments.

"With disease throughout the country, it makes sense to release what we have and to get more" from the manufacturer, he said.

Frieden said more pediatric liquid oseltamivir is on order, with delivery expected after the first of the year.

Forty-eight states are now reporting widespread influenza, with almost all of the illness caused by the 2009 H1N1 virus, according to CDC. The agency knows of 114 laboratory-confirmed H1N1-related deaths in children so far, more than the number of influenza-related deaths typically seen in an entire season.

H1N1 vaccine is becoming increasingly available, but the demand remains greater than the supply, Frieden said. He said 26.6 million doses have been made available for states to order, an increase of 10.5 million from a week ago.

"We're seeing more schools doing vaccine clinics, we're seeing more health care workers getting vaccinated, more people at high risk are getting vaccinated," Frieden said. But he acknowledged that the vaccine is not as widely available as CDC would like.

That is not really the case with oseltamivir, agency officials said.

"What we think is going on is really much more of a spot shortage," Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases, told reporters yesterday.

Both officials said CDC appreciates the willingness of pharmacies to compound pediatric liquid from the oseltamivir capsules, which are more widely available than the commercial oral liquid formulation.

Some capsules contain doses appropriate for pediatric patients. Schuchat said parents who receive such capsules and cannot get their child to swallow them can break open the capsules and mix the contents "with a little syrup" for the child to ingest.

Frieden emphasized that preparing a pediatric liquid from an adult-strength oseltamivir capsule is called "compounding" and must be performed by a pharmacist, not a parent.

Schuchat said antiviral production and use are increasing, but the overall supply situation does not appear to be worsening. She said CDC believes there has been an increase in antiviral use in people with underlying health conditions who have flu symptoms.

"What we recommend right now for antiviral medicines is that focus be on treatment, not on preventative use of the medicines, and that the focus be on treatment of people who have severe presentations," Schuchat said. "The vast majority of people get better without medicines, [but] some people need medicines very promptly."

Frieden said there continues to be "very strong demand for seasonal flu vaccinations," with 89 million doses distributed so far. He said additional vaccine is expected to become available through the end of the year.

"There is, right now, not enough seasonal flu vaccine for all who would want to receive it," he said.

Although all forms of influenza vaccine remain scarce, vaccinators are increasing in number.

At Montefiore Medical Center in the Bronx, New York, 34 pharmacists have been newly certified to administer influenza vaccines, and 27 more are expected to become certified by the end of the year, according to Frank P. Sosnowski, director of pharmacy at Montefiore, and Keith T. Veltri, assistant professor at Touro College of Pharmacy in Harlem.

The pharmacists stated that through October 21, more than 7000 influenza vaccine doses have been administered to Montefiore staff, 60% of them by certified pharmacist vaccinators.

Montefiore was one of the first places to treat H1N1-infected patients this spring, when many young New Yorkers became ill with the virus. A 2008 change to New York state law allows specially trained pharmacists to administer pneumococcal and influenza vaccines. Trained pharmacists may also administer H1N1 vaccines during mass vaccination campaigns, the governor's office announced yesterday.