Prompt treatment of ill Americans with antivirals will be an important part of any future pandemic influenza response, according to a journal article.
National Centers for Disease Control and Prevention researchers looked at key lessons learned from the 2009 H1N1 pandemic, as well as the changing arsenal of antiviral drug availability. Their review published in the American Journal of Public Health identifies and describes the multiple components needed to ensure the timely administration of antiviral drugs during a future pandemic.
The article noted that “antiviral drugs are also critically important for use in treating persons who are sick, and can thus mitigate the effects of emerging pandemics before effective vaccines become available. When used appropriately, antiviral drugs can reduce the severity of influenza symptoms and shorten the time of illness by approximately 1 or 2 days. Research also suggests that in past pandemics, hospitalizations were likely averted through use of antiviral drugs.”
Still, the authors wrote, “A vaccine that is effective against a circulating virus would have the greatest overall public health impact by preventing persons from becoming ill. However, antiviral drugs are also critically important for use in treating persons who are sick, and can thus mitigate the effects of emerging pandemics before effective vaccines become available.”
Public health officials pointed out that the 2009 H1N1 response elucidated factors crucial to the well-timed distribution and dispensing of antivirals during a pandemic. Furthermore, the researchers noted that high demand for the medications during the 2017–2018 season underscored the importance of additional planning to ensure access to antivirals when needed.
The report discussed how antiviral drugs are currently the only pharmacological option available for treating patients with influenza. Complicating the issue is that flu antiviral drugs work best when started as early as possible after symptoms appear, ideally within 48 hours after onset of illness, although the review emphasized that the medications have shown effectiveness when used after that time period.
During a pandemic, the article noted, several complex factors affect timely administration of antivirals. Among them are:
availability of expert clinical guidance on the use of antivirals based on the epidemiology and virulence of the pandemic virus;
viral susceptibility to the available drugs;
regulatory and legal considerations;
a sufficient drug supply; acceptance of the drug by health care providers, pharmacists, and the public;
adequate drug distribution systems;
patient access to prescriptions and medication; and patient adherence to the drug regimen.
The report revealed that federal officials are considering use of rapid care and telemedicine approaches without requiring an in-person visit to a healthcare provider to receive a prescription for antivirals in seasons where flu is widespread.
Being tested by the CDC and its public health partners is a telephone triage capability called Flu on Call that can be activated during a pandemic to improve access to care and prescriptions for antivirals. Another option, according to the article, is authorizing the use of collaborative practice agreements between physicians and pharmacists to enable ill patients who meet certain criteria to obtain antivirals in pharmacies without an additional provider visit.
“Clinicians and pharmacists must be aware of the utility of antivirals during a pandemic, the need for rapid treatment, and the importance of prompt treatment for those at higher risk of influenza complications, study authors concluded. “Providers play an important role in communicating with and educating patients about antivirals, particularly during a pandemic emergency. Although clinical benefit is greatest when antiviral treatment is administered as early as possible after illness onset (within 48 hours), and recommendations for prompt treatment of those at higher risk for complications of seasonal influenza have been published and disseminated, one study showed that fewer than a fifth of those who were ill and at higher risk for complications were offered antivirals after the diagnosis of influenza was confirmed by laboratory tests.”