Abstract
The recent spread of highly pathogenic strains of avian influenza has highlighted the threat posed by pandemic influenza. In the early phases of a pandemic, the only treatment available would be neuraminidase inhibitors, which many countries are considering stockpiling for pandemic use. We estimate the effect on hospitalization rates of using different antiviral stockpile sizes to treat infection. We estimate that stockpiles that cover 20%-25% of the population would be sufficient to treat most of the clinical cases and could lead to 50% to 77% reductions in hospitalizations. Substantial reductions in hospitalization could be achieved with smaller antiviral stockpiles if drugs are reserved for persons at high risk.
Highlights
The recent spread of highly pathogenic strains of avian influenza has highlighted the threat posed by pandemic influenza
Three influenza pandemics occurred during the 20th century, with varying degrees of severity; outcomes ranged from the high levels of illness and death observed during the 1918 Spanish flu pandemic to the much lower levels observed during the pandemics of 1957 and 1968 (≈1 million deaths each [2])
The development of antiviral resistance has been reported for neuraminidase inhibitors (NIs), related to oseltamivir use in children [14], current evidence suggests that resistant strains are pathogenically weakened [15]
Summary
The recent spread of highly pathogenic strains of avian influenza has highlighted the threat posed by pandemic influenza. In the early phases of a pandemic, the only treatment available would be neuraminidase inhibitors, which many countries are considering stockpiling for pandemic use. 2 groups of antiviral drugs are available for the treatment and prophylaxis of influenza These are the adamantanes (amantadine and rimantadine) and the neuraminidase inhibitors (oseltamivir and zanamivir). Resistance to amantadine has been demonstrated in a number of avian H5 strains [11] and its use for treatment of influenza is not recommended [12]. The use of NIs for treatment of pandemic influenza remains an option since they may improve individual disease outcomes and the effect of the disease in the population
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