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Stockpiling antiviral medications for pandemic influenza

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An antiviral stockpile is a reserve supply of essential antiviral medications in case of shortage. Many countries have chosen to stockpile antiviral medications against pandemic influenza.[1] Because of the time required to prepare and distribute an influenza vaccine, these stockpiles are the only medical defense against widespread infection for the first six months.[2] The stockpiles may be in the form of capsules or simply as the active pharmaceutical ingredient, which is stored in sealed drums and, when needed, dissolved in water to make a bitter-tasting, clear liquid.[3]

There are no evidence-based guidelines to guide the use of these stockpiled drugs,[1] and plans are based on assumed similarities to seasonal influenza. The most common antivirals are neuraminidase inhibitors, which, if begun during the first 48 hours after symptoms appear, will reduce the duration of seasonal influenza by about one day. Taken before symptoms appear, it may prevent disease in about three-quarters of people treated prophylactically.[4] Currently, this is recommended in institutionalized elderly people and other high-risk groups as a form of post-exposure prophylaxis during seasonal influenza outbreaks.[2] However, since pandemic influenza differs somewhat from normal seasonal influenza, it is not clear that these drugs will prove either safe or effective for their intended purpose.[4]

For a person who has very recently been exposed to seasonal influenza, effective post-exposure prophylaxis generally requires taking a drug like oseltamivir for seven to ten days, at half the daily dose needed for treatment. A person that is repeatedly exposed, such as hospital staff members, may require continuous treatment throughout the duration of the outbreak in a community. Based on experience with seasonal influenza in nursing homes, control of influenza requires full treatment of any ill persons and prophylactic treatment of all their contacts. In a pandemic situation, before a vaccine becomes available, this level of treatment and medical prevention may require providing drugs to 80% of the people in an affected community.[3] Consequently, very large supplies of the drugs must be made available — much larger supplies than could be produced on demand. Stockpiles are generally arranged in advance by government health authorities, due to fear of shortages and an awareness of manufacturing limitations during an outbreak.[3]

Supplies in each country

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List of available treatments of antiviral per country.

Rank Country / Territory Population Treatments Date Last Updated Source
1  China 1,337,722,000
2  India 1,403,580,000
3  United States 337,292,000 50,000,000 April 27, 2009 Bloomberg.com
Report of antiviral stockpile sales
4  Indonesia 230,014,115
5  Brazil 230,227,208
6  Pakistan 166,146,000
7  Bangladesh 162,221,000
8  Nigeria 154,729,000
9  Russia 141,833,393
10  Japan 127,630,000 47,700,000 November 27, 2017 Ministry of Health, Labour and Welfare
[1]
11  Mexico 109,610,000
12  Philippines 92,226,600
13  Vietnam 88,069,000
14  Germany 82,062,200
15  Ethiopia 79,221,000
16  Egypt 76,030,000
17  Turkey 71,517,100
18  Iran 70,495,782
19  Dem. Rep. of Congo 66,020,000
20  France 65,073,482
21  Thailand 63,389,730
22  United Kingdom 61,612,300 30,000,000 April 28, 2009 BBC News
Swine flu: How serious a threat?
23  Italy 60,090,400
24  Myanmar 50,020,000
25  South Africa 48,697,000
26  South Korea 48,333,000 21,100,000 August 21, 2009 The Korea Times
More Flu Virus Vaccines to Be Stockpiled
27  Ukraine 46,143,700
28  Spain 45,853,000
29  Colombia 44,830,423
30  Tanzania 43,739,000
31  Sudan 42,272,000
32  Kenya 39,802,000
33  Argentina 39,745,613
34  Poland 38,130,300
35  Algeria 34,895,000
36  Canada 33,476,688 1,400,000 April 27, 2009 Bloomberg.com
Report of Antiviral Stockpile Sales
37  Uganda 32,710,000
38  Morocco 31,394,044
39  Iraq 30,747,000
40    Nepal 29,331,000
41  Peru 29,165,000
42  Venezuela 28,685,400
43  Malaysia 28,200,000
44  Afghanistan 28,150,000
45  Uzbekistan 27,488,000
46  Saudi Arabia 25,721,000
47  North Korea 23,906,000
48  Ghana 23,837,000
49  Yemen 23,580,000
50  Taiwan 23,027,672
51  Mozambique 22,894,000
52  Syria 21,906,000
53  Australia 21,745,000
54  Romania 21,496,700
55  Côte d'Ivoire 21,075,000
56  Sri Lanka 20,238,000
57  Madagascar 19,625,000
58  Cameroon 19,522,000
59  Angola 18,498,000
60  Chile 19,489,000 950,000 June 6, 2009 Ministerio de Salud de Chile
Nueva Influenza Humana A (H1N1)
61  Netherlands 16,508,734
62  Burkina Faso 15,757,000
63  Kazakhstan 15,571,506
64  Niger 15,290,000
65  Malawi 15,263,000
66  Guatemala 14,027,000
67  Ecuador 13,938,115
68  Cambodia 13,388,910
69  Mali 13,010,000
70  Zambia 12,935,000
71  Senegal 12,534,000
72  Zimbabwe 12,523,000
73  Greece 11,262,500
74  Chad 11,206,000
75  Cuba 11,204,000
76  Belgium 10,741,000 3,000,000 1 Jan. 2007 Influenza [2]
77  Portugal 10,631,800
78  Czech Republic 10,474,600
79  Tunisia 10,327,800
80  Dominican Republic 10,090,000
81  Guinea 10,069,000
82  Haiti 10,033,000
83  Hungary 10,029,900
84  Rwanda 9,998,000
85  Bolivia 9,863,000
86  Serbia 9,850,000
87  Belarus 9,690,000
88  Sweden 9,264,000
89  Somalia 9,133,000
90  Benin 8,935,000
91  Azerbaijan 8,629,900
92  Austria 8,356,700
93  Burundi 8,303,000
94   Switzerland 7,705,800
95  Bulgaria 7,602,100
96  Honduras 7,466,000
97  Israel 7,411,000
98  Tajikistan 6,952,000
99  Papua New Guinea 6,732,000
100  Togo 6,619,000
101  Libya 6,420,000
102  Paraguay 6,349,000
103  Laos 6,320,000
104  Jordan 6,316,000
105  El Salvador 6,163,000
106  Nicaragua 5,743,000
107  Sierra Leone 5,696,000
108  Denmark 5,511,451
109  Kyrgyzstan 5,482,000
110  Slovakia 5,411,100
111  Finland 5,333,089
112  Turkmenistan 5,110,000
113  Eritrea 5,073,000
114  Singapore 4,839,400 500,000 April 28, 2009 Referenced. Confirmation expected.
115  Norway 4,814,075 1,400,000 April 28, 2009 [3]
116  United Arab Emirates 4,599,000
117  Costa Rica 4,579,000 3,000 April 28, 2009 Nacion.com (Spanish)
118  Ireland 4,517,800
119  Croatia 4,432,000
120  Central African Republic 4,422,000
121  Georgia 4,382,100
122  New Zealand 4,306,500
123  Lebanon 4,224,000
124  Puerto Rico (US) 3,982,000
125  Liberia 3,955,000
126  Bosnia and Herzegovina 3,767,000
127  Palestine 3,761,646
128  Republic of the Congo 3,683,000
129  Moldova 3,572,700
130  Panama 3,454,000
131  Uruguay 3,361,000
132  Lithuania 3,350,400
133  Mauritania 3,291,000
134  Armenia 3,230,100
135  Albania 3,170,000
136  Kuwait 2,985,000
137  Oman 2,845,000
138  Jamaica 2,719,000
139  Mongolia 2,671,000
140  Latvia 2,259,400
141  Namibia 2,171,000
142  Lesotho 2,067,000
143  Slovenia 2,053,355
144  North Macedonia 2,048,900
145  Botswana 1,950,000
146  Gambia 1,705,000
147  Guinea-Bissau 1,611,000
148  Gabon 1,475,000
149  Qatar 1,409,000
150  Estonia 1,340,341
151  Trinidad and Tobago 1,339,000
152  Mauritius 1,288,000
153  Eswatini (Swaziland) 1,185,000
154  East Timor 1,134,000
155  Djibouti 864,000
156  Fiji 849,000
157  Cyprus 801,600
158  Bahrain 791,000
159  Guyana 762,000
160  Bhutan 697,000
161  Comoros 676,000
162  Equatorial Guinea 676,000
163  Montenegro 624,000
164  Solomon Islands 523,000
165  Suriname 520,000
166  Western Sahara 513,000
167  Cape Verde 506,000
168  Luxembourg 491,700
169  Malta 412,600
170  Brunei 400,000
171  Bahamas 342,000
172  Iceland 319,326
173  Maldives 309,000
174  Belize 307,000
175  Barbados 256,000
176  Vanuatu 240,000
177  Netherlands Antilles (Netherlands) 198,000
178  Samoa 179,000
179  Guam (US) 178,000
180  Saint Lucia 172,000
181  São Tomé and Príncipe 163,000
182  Federated States of Micronesia 111,000
183  U.S. Virgin Islands (US) 110,000
184  Saint Vincent and the Grenadines 109,000
185  Aruba (Netherlands) 107,000
186  Grenada 104,000
187  Tonga 104,000
188  Kiribati 98,000
189  Jersey (US) 89,300
190  Antigua and Barbuda 88,000
191  Northern Mariana Islands (US) 87,000
192  Andorra 86,000
193  Seychelles 84,000
194  Isle of Man (UK) 80,000
195  Dominica 67,000
196  American Samoa (US) 67,000
197  Bermuda (UK) 65,000
198  Marshall Islands 62,000
199  Guernsey (UK) 61,811
200  Greenland (Denmark) 57,000
201  Cayman Islands (UK) 56,000
202  Saint Kitts and Nevis 52,000
203  Faroe Islands (Denmark) 48,797
204  Liechtenstein 35,700
205  Monaco 33,000
206  Turks and Caicos Islands (UK) 33,000
207  San Marino 30,800
208  Gibraltar (UK) 31,000
209  British Virgin Islands (UK) 23,000
210  Cook Islands (New Zealand) 20,000
211  Palau 20,000
212  Anguilla (UK) 15,000
213  Tuvalu 10,000
214  Nauru 10,000
215  Saint Helena (UK) 6,600
216  Montserrat (UK) 5,900
217  Falkland Islands (UK) 3,000
218  Niue (New Zealand) 1,500
219  Tokelau (New Zealand) 1,400
220  Vatican City 800
221  Pitcairn Islands (UK) 50

References

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  1. ^ a b Schünemann HJ, Hill SR, Kakad M, et al. (January 2007). "WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus". Lancet Infect Dis. 7 (1): 21–31. doi:10.1016/S1473-3099(06)70684-3. PMC 7106493. PMID 17182341.
  2. ^ a b de Jong JC, Beyer WE, Rimmelzwaan GF, Fouchier RA, Osterhaus AD (January 2004). "[Neuraminidase inhibitors oseltamivir and zanamivir: new means of defence against influenza]". Ned Tijdschr Geneeskd (in Dutch and West Flemish). 148 (2): 73–9. PMID 14753128.
  3. ^ a b c Ward P, Small I, Smith J, Suter P, Dutkowski R (February 2005). "Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic". J. Antimicrob. Chemother. 55 (Suppl 1): i5–i21. doi:10.1093/jac/dki018. PMID 15709056.
  4. ^ a b Harrod ME, Emery S, Dwyer DE (November 2006). "Antivirals in the management of an influenza pandemic". Med. J. Aust. 185 (10 Suppl): S58–61. doi:10.5694/j.1326-5377.2006.tb00709.x. PMID 17115954. S2CID 7932602.
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