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Antivirals: Treatment, Prophylaxis and Pandemic Control

The role of antivirals in pandemic control

An essential component of pandemic planning is the use of antiviral drugs early in the pandemic to treat illness and reduce transmission of the virus.26, 27, and 28 x AS Monto. The role of antivirals in the control of influenza. Vaccine 21 (2003) (1796 - 1800) Crossref. x K Stohr. Preventing and treating influenza. Br Med J 326 (2003) (1223 - 1224) Crossref. x AS Monto. Vaccines and antiviral drugs in pandemic preparedness. Emerg Inf Dis 12 (2006) (55 - 60) Crossref. This would buy time until a vaccine against the pandemic strain can be produced and available in sufficient quantities for mass vaccination. Although a matter of considerable debate, two recent studies, based on simulation of an influenza outbreak in Southeast Asia, have suggested that an emerging pandemic may even be contained altogether at the start with appropriate use of targeted antiviral prophylaxis. 29, x NM Ferguson, DA Cummings, S Cauchemez, et al.. Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature 437 (2005) (209 - 214) Crossref. 30 x IM Longini, ME Halloran, A Nizam, Y Yang. Containing pandemic influenza with antiviral agents. Am J Epidemiol 159 (2004) (623 - 633) Crossref.

Yet, many issues related to the use of antivirals in pandemic control remain. The relatively rapid induction of resistance to the M2 inhibitors when used for the treatment of influenza illness would quickly limit the efficacy of this class of antiviral drugs for preventing influenza illness and ameliorating the impact of pandemic influenza. The novel NAIs have thus been a welcome addition to the armament to be employed in pandemic control. However, a number of issues related to the use of this class of drugs remains to be addressed even as governments are stockpiling oseltamivir for pandemic preparedness. Recent reports of the development of resistance to oseltamivir during the treatment of H5N1 disease 24, x MD De Jong, TT Tran, HK Truong, et al.. Oseltamivir resistance during treatment of influenza A (H5N1) infection. New Engl J Med 353 (2005) (2667 - 2672) Crossref. 25 x QM Le, M Kiso, K Someya, et al.. Avian flu: isolation of drug-resistant H5N1 virus. Nature 437 (2005) (754) raise concerns about the potential for induction and spread of antiviral-resistant H5N1 strains. Issues related to the dependence on a single antiviral drug, stockpiling and how these drugs will be distributed, and indications for the prevention and treatment of pandemic influenza remain to be clarified. In addition, the efficacy of these drugs in the absence of vaccination in the very young 16 x R Dolin. Influenza – interpandemic as well as pandemic disease. New Engl J Med 353 (2005) (2535 - 2537) Crossref. and the very old 31 x A Ambrozaitis, S Gravenstein, GA van Essen, et al.. Inhaled zanamivir versus placebo for the prevention of influenza outbreaks in an unvaccinated long-term care population. J Am Med Dir Assoc 6 (2005) (367 - 374) Crossref. also remain in question in both pandemic and interpandemic influenza seasons.

The need for large stockpiles of lower cost, more efficacious and easily administered medications has been identified. 27 x K Stohr. Preventing and treating influenza. Br Med J 326 (2003) (1223 - 1224) Crossref. Plans could include the use of antivirals to treat severe illness during a pandemic and prophylax all health-care and related support workers, but this plan may have limited feasibility from a governmental perspective. 32 x S Cinti, C Chenoweth, AS Monto. Preparing for pandemic influenza: should hospitals stockpile oseltamivir?. Infect Control Hosp Epidemiol 26 (2005) (852 - 854) Crossref. Governments are attempting to stockpile oseltamivir to be used in an influenza pandemic, but who would receive the drug when supplies are limited? Also, the potential for criminal activities around the limited supplies is a significant concern. Drug distribution issues, including central vs local stockpiles, need to be carefully considered. Multiple drug strategies for prophylaxis and treatment indications could include the use of zanamivir (inhaled drug formulation) and potentially amantidine and rimantidine or generic formulations of the neuraminidase inhibitors where drug supply and cost are the major barriers to pandemic preparedness. Co-ordinated public health planning and the commitment of governments to the development of realistic plans for including antivirals in pandemic planning are necessary.26, 27, and 28 x AS Monto. The role of antivirals in the control of influenza. Vaccine 21 (2003) (1796 - 1800) Crossref. x K Stohr. Preventing and treating influenza. Br Med J 326 (2003) (1223 - 1224) Crossref. x AS Monto. Vaccines and antiviral drugs in pandemic preparedness. Emerg Inf Dis 12 (2006) (55 - 60) Crossref.

References

Label Authors Title Source Year
16

References in context

  • The dose of drug should be determined on an individual basis.16 Prevention can also be considered for controlling outbreaks in, for example, dormitories, schools, cruise ships.
    Go to context

  • In addition, the efficacy of these drugs in the absence of vaccination in the very young16 and the very old31 also remain in question in both pandemic and interpandemic influenza seasons.
    Go to context

R Dolin. Influenza – interpandemic as well as pandemic disease. Crossref. New Engl J Med 353 (2005) (2535 - 2537) 2005
24

References in context

  • To date, the use of NAIs for both prophylaxis and treatment has not been associated with clinically relevant development of antiviral resistance during interpandemic use – although, as discussed below, the avian H5N1 virus does appear to develop resistance to oseltamivir in the treatment of H5N1 disease.24,25 The lack of resistance development of the NAIs often makes them, despite the fact that they are expensive, the preferred drugs relative to the low-cost amantadine and rimantadine, but ultimately cost considerations may also influence the choice of the drug that is used.
    Go to context

  • Recent reports of the development of resistance to oseltamivir during the treatment of H5N1 disease24,25 raise concerns about the potential for induction and spread of antiviral-resistant H5N1 strains.
    Go to context

MD De Jong, TT Tran, HK Truong, et al.. Oseltamivir resistance during treatment of influenza A (H5N1) infection. Crossref. New Engl J Med 353 (2005) (2667 - 2672) 2005
25

References in context

  • To date, the use of NAIs for both prophylaxis and treatment has not been associated with clinically relevant development of antiviral resistance during interpandemic use – although, as discussed below, the avian H5N1 virus does appear to develop resistance to oseltamivir in the treatment of H5N1 disease.24,25 The lack of resistance development of the NAIs often makes them, despite the fact that they are expensive, the preferred drugs relative to the low-cost amantadine and rimantadine, but ultimately cost considerations may also influence the choice of the drug that is used.
    Go to context

  • Recent reports of the development of resistance to oseltamivir during the treatment of H5N1 disease24,25 raise concerns about the potential for induction and spread of antiviral-resistant H5N1 strains.
    Go to context

QM Le, M Kiso, K Someya, et al.. Avian flu: isolation of drug-resistant H5N1 virus. Nature 437 (2005) (754) 2005
26

References in context

  • An essential component of pandemic planning is the use of antiviral drugs early in the pandemic to treat illness and reduce transmission of the virus.26–28 This would buy time until a vaccine against the pandemic strain can be produced and available in sufficient quantities for mass vaccination.
    Go to context

  • The need for large stockpiles of lower cost, more efficacious and easily administered medications has been identified.27 Plans could include the use of antivirals to treat severe illness during a pandemic and prophylax all health-care and related support workers, but this plan may have limited feasibility from a governmental perspective.32 Governments are attempting to stockpile oseltamivir to be used in an influenza pandemic, but who would receive the drug when supplies are limited?
    Go to context

AS Monto. The role of antivirals in the control of influenza. Crossref. Vaccine 21 (2003) (1796 - 1800) 2003
27

References in context

  • An essential component of pandemic planning is the use of antiviral drugs early in the pandemic to treat illness and reduce transmission of the virus.26–28 This would buy time until a vaccine against the pandemic strain can be produced and available in sufficient quantities for mass vaccination.
    Go to context

  • The need for large stockpiles of lower cost, more efficacious and easily administered medications has been identified.27 Plans could include the use of antivirals to treat severe illness during a pandemic and prophylax all health-care and related support workers, but this plan may have limited feasibility from a governmental perspective.32 Governments are attempting to stockpile oseltamivir to be used in an influenza pandemic, but who would receive the drug when supplies are limited?
    Go to context

  • The need for large stockpiles of lower cost, more efficacious and easily administered medications has been identified.27 Plans could include the use of antivirals to treat severe illness during a pandemic and prophylax all health-care and related support workers, but this plan may have limited feasibility from a governmental perspective.32 Governments are attempting to stockpile oseltamivir to be used in an influenza pandemic, but who would receive the drug when supplies are limited?
    Go to context

K Stohr. Preventing and treating influenza. Crossref. Br Med J 326 (2003) (1223 - 1224) 2003
28

References in context

  • An essential component of pandemic planning is the use of antiviral drugs early in the pandemic to treat illness and reduce transmission of the virus.26–28 This would buy time until a vaccine against the pandemic strain can be produced and available in sufficient quantities for mass vaccination.
    Go to context

  • The need for large stockpiles of lower cost, more efficacious and easily administered medications has been identified.27 Plans could include the use of antivirals to treat severe illness during a pandemic and prophylax all health-care and related support workers, but this plan may have limited feasibility from a governmental perspective.32 Governments are attempting to stockpile oseltamivir to be used in an influenza pandemic, but who would receive the drug when supplies are limited?
    Go to context

AS Monto. Vaccines and antiviral drugs in pandemic preparedness. Crossref. Emerg Inf Dis 12 (2006) (55 - 60) 2006
29

References in context

  • An essential component of pandemic planning is the use of antiviral drugs early in the pandemic to treat illness and reduce transmission of the virus.26–28 This would buy time until a vaccine against the pandemic strain can be produced and available in sufficient quantities for mass vaccination.
    Go to context

NM Ferguson, DA Cummings, S Cauchemez, et al.. Strategies for containing an emerging influenza pandemic in Southeast Asia. Crossref. Nature 437 (2005) (209 - 214) 2005
30

References in context

  • An essential component of pandemic planning is the use of antiviral drugs early in the pandemic to treat illness and reduce transmission of the virus.26–28 This would buy time until a vaccine against the pandemic strain can be produced and available in sufficient quantities for mass vaccination.
    Go to context

IM Longini, ME Halloran, A Nizam, Y Yang. Containing pandemic influenza with antiviral agents. Crossref. Am J Epidemiol 159 (2004) (623 - 633) 2004
31

References in context

  • In addition, the efficacy of these drugs in the absence of vaccination in the very young16 and the very old31 also remain in question in both pandemic and interpandemic influenza seasons.
    Go to context

A Ambrozaitis, S Gravenstein, GA van Essen, et al.. Inhaled zanamivir versus placebo for the prevention of influenza outbreaks in an unvaccinated long-term care population. Crossref. J Am Med Dir Assoc 6 (2005) (367 - 374) 2005
32

References in context

  • The need for large stockpiles of lower cost, more efficacious and easily administered medications has been identified.27 Plans could include the use of antivirals to treat severe illness during a pandemic and prophylax all health-care and related support workers, but this plan may have limited feasibility from a governmental perspective.32 Governments are attempting to stockpile oseltamivir to be used in an influenza pandemic, but who would receive the drug when supplies are limited?
    Go to context

S Cinti, C Chenoweth, AS Monto. Preparing for pandemic influenza: should hospitals stockpile oseltamivir?. Crossref. Infect Control Hosp Epidemiol 26 (2005) (852 - 854) 2005

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