Skip to main content

Preparing for Pandemic Influenza: Should Hospitals Stockpile Oseltamivir?

  • Sandro Cinti (a1) (a2), Carol Chenoweth (a1) (a3) (a4) and Arnold S. Monto (a4)

The outbreak of H5N1 avian influenza in Asia has reignited concerns about an influenza pandemic. It is clear that influenza vaccine will be in short supply (or nonexistent) early in an influenza pandemic. Without vaccine, the role of antiviral agents, especially oseltamivir, in treatment and prophylaxis is of paramount importance. Unfortunately, the government cannot possibly stockpile enough oseltamivir to provide long-term prophylaxis or treatment for every healthcare worker in the United States. We think that hospitals should consider stockpiling oseltamivir, and we provide a strategy for doing so at a reasonable cost.

Corresponding author
Infectious Diseases, University of Michigan Hospitals/Ann Arbor VA Health Systems, 2215 Fuller Rd., Ann Arbor, MI 48105,
Hide All
1.Crosby A. America's Forgotten Pandemic. Cambridge, UK: Cambridge University Press; 1989.
2.World Health Organization. WHO: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Since 28 January 2004. Geneva: World Health Organization; 2003. Available at Accessed June 30,2005.
3.Schoch-Spana M. Implications of pandemic influenza for bioterrorism response. Clin Infect Dis 2000;31:14091413.
4.Meitzer ML, Cox NJ, Fukuda K. The economic impact of pandemic influenza in the United States: priorities for intervention. Emerg Infect Dis 1999;5:659672.
5.Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2003;52(RR-08):150.
6.World Health Organization. WHO guidelines on the use of vaccines and antivirals during influenza pandemics. Global Health Security: Epidemic Alert and Response 2004:111.
7.Patriarca PA, Cox NJ. Influenza pandemic preparedness plan for the United States./Infect Dis 1997;176(suppl 1):S4S7.
8.Stohr K, Esveld M. Public health: will vaccines be available for the next influenza pandemic? Science 2004;306:21952196.
9.Taubenberger JK, Reid AH, Fanning TG. Capturing a killer flu virus. Sci Am 2005;292:4857.
10.Moser MR, Bender TR, Margolis HS, Nable GR, Kendal AP, Ritter DG. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol 1979;110:16.
11.Saigado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting. Lancet Infect Dis 2002;2:145155.
12.Peiris JSM, Chu CM, Cheng VCC, et al.Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003;361:15191520.
13.Gopalakrishna G, Choo P, Leo YS, et al.SARS transmission and hospital containment. Emerg Infect Dis 2004;10:395400.
14.Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, et al.Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis 2005;11:201208.
15.Hien TT, Liem NT, Dung NT, et al.Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med 2004;350:11791188.
16.Wainright PO, Perdue ML, Brugh M, et al.Amantadine resistance among hemagglutinin subtype 5 strains of avian influenza virus. Avian Dis 1991;35:3139.
17.Saito R, Oshitani H, Masuda H, Suzuki H. Detection of amantadine-re-sistant influenza A virus strains in nursing homes by PCR-restriction fragment length polymorphism analysis with nasopharyngeal swabs. J Clin Microbiol 2002;40:8488.
18.Fauci A. Preparing for pandemic flu. The Washington Times. March 3, 2005.
19.Ward P, Smith I, Small J, Suter P, Dutkowski R. Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic. JAnti-microb Chemother 2005;55(suppl I):i5i21.
20.Brady MT, Sears SD, Pacini DL, et al.Safety and prophylactic efficacy of low-dose rimantidine in adults during an influenza A epidemic. An-timicrob Agents Chemother 1990;34:16331636.
21.Shilling M, Povinelli L, Krause P, et al.Efficacy of zanamivir for chemoprophylaxis of nursing home influenza outbreaks. Vaccine 1998;16:17711774.
22.Hayden FG, Altmar RL, Schilling M, et al.Use of the selective neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999;341:13361343.
23.Bowles SK, Lee W, Simor AE, et al.Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999-2000. J Am Geriatr Soc 2002;50:608616.
24.Longini IM, Halloran ME, Nizam A. Containing pandemic influenza with antiviral agents. Am J Epidemiol 2004;159:623633.
25.Kaiser L, Wat C, Mills T, Mahoney P, Ward P, Hayden F. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med 2003;163:16671672.
26.Whitley RJ, Hayden FG, Reisinger KS, et al.Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J 2001;20:127133.
27.Hayden FG. Pandemie influenza: is an antiviral response realistic? Pediatr Infect Dis J 2004;23(suppl):S262S269.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *