Pandemic Influenza Plan - Questar III

Section 7: Antiviral Medication Procurement, Distribution, and Use
I. Overview
The targeted use of antiviral agents could, as part of a response strategy to susceptible
strains, decrease the health impact of an influenza pandemic. Use of antiviral
prophylaxis has been up to 70% to 90% effective in preventing symptomatic influenza
infection caused by susceptible strains, if prophylaxis is begun before exposure to
influenza. Also, treatment with one class of agents, neuraminidase inhibitors, has been
shown to decrease severe complications such as pneumonia and bronchitis and to reduce
hospitalizations. These interventions may be particularly important before vaccine is
available and for those in whom vaccination may be medically contraindicated.
Protection afforded by antiviral medications is virtually immediate and does not interfere
with the response to inactivated influenza vaccines. It is important to avoid inappropriate
use of antiviral medications that may lead to viral resistance.
Drugs with activity against influenza viruses (antivirals) include the adamantanes,
amantadine and rimantadine, and the neuraminidase inhibitors, oseltamivir and zanamivir.
Appropriate use of these agents during an influenza pandemic may reduce morbidity and
mortality and diminish the overwhelming demands that will be placed on the healthcare
system. Antivirals might also be used during the Pandemic Alert Period in limited
attempts to contain small disease clusters and potentially slow the spread of novel
influenza viruses.
The Department of Health and Human Services (DHHS) and the National Vaccine
Advisory Committee (NVAC), in cooperation with the Centers for Disease Control and
Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), have
provided guidance on prioritization of persons to be given antivirals during a pandemic.
This guidance will most likely change when epidemiologic data on a specific pandemic
virus becomes available. Once this information is known, the NYSDOH, in conjunction
with the CDC, health care organizations, and local health departments (LHDs), will
determine the prioritization of the population groups to receive influenza antiviral
medication. These recommendations will then be distributed as statewide guidelines.
It is also important to monitor the use of antiviral medications. These drugs are in
frequent use both during the influenza season, and for other indications year round.
There is information and data available on the side effects of antiviral medications.
However, there are no data available on the large scale use of these medications in a
pandemic situation. Monitoring and tracking of antiviral use, compliance, effectiveness,
resistance, and adverse events are important aspects of responding to a pandemic.
This section of the pandemic influenza plan provides recommendations on the
distribution and use of antiviral drugs for treatment and prophylaxis during an influenza
pandemic. It discusses the strategies available for the use of antiviral medications,
including how they can be used, the timing of their use, and facilities or settings in which
they may be offered. This section also reviews the issues surrounding the procurement
and distribution of antiviral medications, safety monitoring, and data collection. Finally,
February 7, 2006 7-2