Pandemic Influenza Plan - Questar III

Section 7: Antiviral Medication Procurement, Distribution, and Use
that protect continuation of essential services, such as healthcare, law enforcement, etc.,
have sufficient priority.
V. Antiviral Medication Procurement and Distribution
For a detailed description of the logistics involved with the procurement, storage and
distribution of antiviral medications, refer to Appendix 6-C: Vaccine and Antiviral
Medication Procurement. The requirements and activities described in Appendix 6-C
apply to public health crises involving pandemic influenza where local and State medical
treatment capabilities are exceeded, necessitating the use of Strategic National Stockpile
(SNS) assets (antiviral medications) or locally procured supplies of antivirals.
VI.
Antiviral Medication Safety
Adverse events associated with antiviral drug use inevitably will occur. Adverse events
are currently monitored nationally by FDA’s MedWatch system. The NYSDOH will set
up an antiviral safety monitoring system that will coordinate with the MedWatch system.
Important components of antiviral safety planning include evaluations of antiviral drug
effectiveness and resistance, contraindications, adverse event monitoring, and the use of
an Investigational New Drug protocol.
A. Antiviral Medication Effectiveness
In a pandemic, it is likely that federal agencies will conduct antiviral drug effectiveness
studies in collaboration with state and local health departments, and other health care and
academic partners.
B. Antiviral Drug Resistance
CDC will work with state and local partners to monitor the development of resistance to
antivirals. Because resistance to M2 inhibitors may involve a single base pair change,
resistance may develop rapidly if these drugs are used widely. Information about
resistance to M2 inhibitor and neuraminidase inhibitors can be found in the July 2005
recommendations of the ACIP at http://www.cdc.gov/mmwr/PDF/rr/rr5408.pdf.
Surveillance for antiviral resistance may be particularly important during the later stages
of the pandemic, especially if M2 agents have been widely used. Under these
circumstances, the detection of widespread M2 inhibitor resistance might require a reevaluation
of priorities for prophylaxis and treatment.
CDC will test the drug susceptibilities of viruses isolated from different age groups and
geographic areas over the course of the pandemic. The NYSDOH should encourage
LHDs and clinicians to obtain specimens from patients who develop severe disease while
receiving treatment or prophylaxis. The NYSDOH will consider developing the
capability to test for resistance.
February 7, 2006 7-8