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Antivirals for Pandemic Influenza: Guidance on Developing a Distribution and Dispensing Program
Statement of Task
An Institute of Medicine committee would plan and convene a workshop of state and local pandemic influenza planners, as well as national and relevant international influenza experts, to consider best practices and policies for implementing a pandemic influenza antiviral drug program. Components of the program to be addressed include treatment of cases, post-exposure prophylaxis for their household contacts, and prophylaxis of “front-line” health care workers and emergency services personnel. With respect to treatment of cases and post-exposure prophylaxis of their household contacts, key planning issues include, but are not limited to, determining where drugs are dispensed; allocation and distribution of drugs to those sites; diagnostic approach for cases; strategy to enumerate household contacts and assess appropriateness of dispensing drugs for them; potential regulatory barriers to dispensing; and monitoring antiviral drug use and safety. With respect to prophylaxis for targeted health care and emergency services personnel, key issues include, but are not limited to, determining where drugs are dispensed; potential regulatory barriers to dispensing; labor issues that may arise from targeting some workers, but not others; and monitoring antiviral drug use and safety. The committee will review current state plans and lessons learned from drills and exercises, and will explore the challenges and barriers to rapid and efficient distribution of the drugs for treatment and prophylaxis in the general population and in targeted occupationally defined groups. The committee will issue a brief report with conclusions and recommendations regarding components of an effective antiviral program for patients and their household contacts and for prophylaxis of health care and emergency services personnel.
the context of planning may evolve considerably over the coming years, requiring frequent revisiting of planning assumptions, and adapting of policies and plans. For example, it is not known whether the antivirals that are effective against seasonal influenza will be similarly effective against a pandemic strain, and different doses and regimens may be needed for effective treatment and prophylaxis (Hayden and Pavia, 2006; WHO, 2008). The geographic origin (that may or may not be outside the United States) and epidemiologic profile of the disease will only be known once the pandemic has begun and patterns of attack and transmission have become clear. The extent and speed of emerging antiviral resistance also may limit drugs’ effectiveness. For discussion and planning purposes, the committee found it helpful to think about the implications of a severe, 1918-type pandemic, occurring in waves, characterized by a mortality rate considerably higher than that of seasonal influenza and a different than usual epidemiologic profile.