Debate Regarding Oseltamivir use for Seasonal and Pandemic Influenza

Aeron C. Hurt; Heath Kelly


Emerging Infectious Diseases. 2016;22(6):949-955. 

In This Article

Implications for Stockpiling

Data from the randomized controlled trials of patients with mild influenza and the observational data from severely ill patients demonstrate the clear clinical benefits of initiating treatment as early as possible after infection.[32] NAI use in Japan is so widespread that almost every confirmed influenza case is treated, which is likely to have led to the extensive and rapid delivery of the drugs in the 2009 pandemic. For instance, in a study of Japanese children hospitalized with influenza A(H1N1)pdm09 virus infections, >98% (984/1,000) were treated with an NAI, and for those for whom the treatment time was recorded, 89% received NAIs within 48 hours and 70% within 24 hours. Only 1% of the hospitalized children ultimately required mechanical ventilation, and 1 death was recorded.[33]

Similar ecologic data were observed among pregnant women in Japan, a group of patients at increased risk for hospitalization and death when infected with influenza A(H1N1)pdm09. Pregnant Japanese women were treated prophylactically after close contact with an infected person, and if infected and hospitalized, >90% were given NAIs within 48 hours of symptom onset. In comparison to the high mortality rates among pregnant women in many countries around the world,[34] no maternal deaths occurred in Japan during the pandemic.[35]

Ecologic data from Japan, although regarded as the weakest form of epidemiologic evidence, suggest that rapid access to stockpiled NAIs in a pandemic is necessary to achieve the greatest benefit from their use. Rapid access during the 2009 pandemic in Japan was possible because rapid access represented routine care for seasonal influenza. In other countries, the 2009 pandemic confirmed that centralized stockpiles did not facilitate rapid distribution[36] and that decentralized stockpiles would be more efficient. Stockpiles in hospitals, for example, would facilitate rapid treatment of ill patients in a pandemic but might also allow the periodic use of some material for the treatment of interpandemic seasonal influenza to avoid wastage due to an expiring stockpile.[36]