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

List of available treatments of antiviral per country.

RankCountry / TerritoryPopulationTreatmentsDate Last UpdatedSource
1Flag of the People's Republic of China.svg China 1,337,722,000
2Flag of India.svg India 1,413,750,000
3Flag of the United States.svg United States 338,238,00050,000,000April 27, 2009Bloomberg.com
Report of antiviral stockpile sales
4Flag of Indonesia.svg Indonesia 230,014,115
5Flag of Brazil.svg Brazil 231,876,612
6Flag of Pakistan.svg Pakistan 166,146,000
7Flag of Bangladesh.svg Bangladesh 162,221,000
8Flag of Nigeria.svg Nigeria 154,729,000
9Flag of Russia.svg Russia 141,833,393
10Flag of Japan.svg Japan 127,630,00047,700,000November 27, 2017Ministry of Health, Labour and Welfare
11Flag of Mexico.svg Mexico 109,610,000
12Flag of the Philippines.svg Philippines 92,226,600
13Flag of Vietnam.svg Vietnam 88,069,000
14Flag of Germany.svg Germany 82,062,200
15Flag of Ethiopia.svg Ethiopia 79,221,000
16Flag of Egypt.svg Egypt 76,030,000
17Flag of Turkey.svg Turkey 71,517,100
18Flag of Iran.svg Iran 70,495,782
19Flag of the Democratic Republic of the Congo.svg Dem. Rep. of Congo 66,020,000
20Flag of France.svg France 65,073,482
21Flag of Thailand.svg Thailand 63,389,730
22Flag of the United Kingdom.svg United Kingdom 61,612,30030,000,000April 28, 2009BBC News
Swine flu: How serious a threat?
23Flag of Italy.svg Italy 60,090,400
24Flag of Myanmar.svg Myanmar 50,020,000
25Flag of South Africa.svg South Africa 48,697,000
26Flag of South Korea.svg South Korea 48,333,00021,100,000August 21, 2009The Korea Times
More Flu Virus Vaccines to Be Stockpiled
27Flag of Ukraine.svg Ukraine 46,143,700
28Flag of Spain.svg Spain 45,853,000
29Flag of Colombia.svg Colombia 44,830,423
30Flag of Tanzania.svg Tanzania 43,739,000
31Flag of Sudan.svg Sudan 42,272,000
32Flag of Kenya.svg Kenya 39,802,000
33Flag of Argentina.svg Argentina 39,745,613
34Flag of Poland.svg Poland 38,130,300
35Flag of Algeria.svg Algeria 34,895,000
36Flag of Canada (Pantone).svg Canada 33,476,6881,400,000April 27, 2009Bloomberg.com
Report of Antiviral Stockpile Sales
37Flag of Uganda.svg Uganda 32,710,000
38Flag of Morocco.svg Morocco 31,394,044
39Flag of Iraq.svg Iraq 30,747,000
40Flag of Nepal.svg   Nepal 29,331,000
41Flag of Peru.svg Peru 29,165,000
42Flag of Venezuela.svg Venezuela 28,685,400
43Flag of Malaysia.svg Malaysia 28,200,000
44Flag of the Taliban.svg Afghanistan 28,150,000
45Flag of Uzbekistan.svg Uzbekistan 27,488,000
46Flag of Saudi Arabia.svg Saudi Arabia 25,721,000
47Flag of North Korea.svg North Korea 23,906,000
48Flag of Ghana.svg Ghana 23,837,000
49Flag of Yemen.svg Yemen 23,580,000
50Flag of the Republic of China.svg Taiwan 23,027,672
51Flag of Mozambique.svg Mozambique 22,894,000
52Flag of Syria (2025-).svg Syria 21,906,000
53Flag of Australia (converted).svg Australia 21,745,000
54Flag of Romania.svg Romania 21,496,700
55Flag of Cote d'Ivoire.svg Côte d'Ivoire 21,075,000
56Flag of Sri Lanka.svg Sri Lanka 20,238,000
57Flag of Madagascar.svg Madagascar 19,625,000
58Flag of Cameroon.svg Cameroon 19,522,000
59Flag of Angola.svg Angola 18,498,000
60Flag of Chile.svg Chile 19,598,000950,000June 6, 2009Ministerio de Salud de Chile
Nueva Influenza Humana A (H1N1)
61Flag of the Netherlands.svg Netherlands 16,508,734
62Flag of Burkina Faso.svg Burkina Faso 15,757,000
63Flag of Kazakhstan.svg Kazakhstan 15,571,506
64Flag of Niger.svg Niger 15,290,000
65Flag of Malawi.svg Malawi 15,263,000
66Flag of Guatemala.svg Guatemala 14,027,000
67Flag of Ecuador.svg Ecuador 13,938,115
68Flag of Cambodia.svg Cambodia 13,388,910
69Flag of Mali.svg Mali 13,010,000
70Flag of Zambia.svg Zambia 12,935,000
71Flag of Senegal.svg Senegal 12,534,000
72Flag of Zimbabwe.svg Zimbabwe 12,523,000
73Flag of Greece.svg Greece 11,262,500
74Flag of Chad.svg Chad 11,206,000
75Flag of Cuba.svg Cuba 11,204,000
76Flag of Belgium (civil).svg Belgium 10,741,0003,000,0001 Jan. 2007Influenza
77Flag of Portugal (official).svg Portugal 10,631,800
78Flag of the Czech Republic.svg Czech Republic 10,474,600
79Flag of Tunisia.svg Tunisia 10,327,800
80Flag of the Dominican Republic.svg Dominican Republic 10,090,000
81Flag of Guinea.svg Guinea 10,069,000
82Flag of Haiti.svg Haiti 10,033,000
83Flag of Hungary.svg Hungary 10,029,900
84Flag of Rwanda.svg Rwanda 9,998,000
85Flag of Bolivia.svg Bolivia 9,863,000
86Flag of Serbia.svg Serbia 9,850,000
87Flag of Belarus.svg Belarus 9,690,000
88Flag of Sweden.svg Sweden 9,264,000
89Flag of Somalia.svg Somalia 9,133,000
90Flag of Benin.svg Benin 8,935,000
91Flag of Azerbaijan.svg Azerbaijan 8,629,900
92Flag of Austria.svg Austria 8,356,700
93Flag of Burundi.svg Burundi 8,303,000
94Flag of Switzerland (Pantone).svg  Switzerland 7,705,800
95Flag of Bulgaria.svg Bulgaria 7,602,100
96Flag of Honduras (2022-).svg Honduras 7,466,000
97Flag of Israel.svg Israel 7,411,000
98Flag of Tajikistan.svg Tajikistan 6,952,000
99Flag of Papua New Guinea.svg Papua New Guinea 6,732,000
100Flag of Togo (3-2).svg Togo 6,619,000
101Flag of Libya.svg Libya 6,420,000
102Flag of Paraguay.svg Paraguay 6,349,000
103Flag of Laos.svg Laos 6,320,000
104Flag of Jordan.svg Jordan 6,316,000
105Flag of El Salvador.svg El Salvador 6,163,000
106Flag of Nicaragua.svg Nicaragua 5,743,000
107Flag of Sierra Leone.svg Sierra Leone 5,696,000
108Flag of Denmark.svg Denmark 5,511,451
109Flag of Kyrgyzstan.svg Kyrgyzstan 5,482,000
110Flag of Slovakia.svg Slovakia 5,411,100
111Flag of Finland.svg Finland 5,333,089
112Flag of Turkmenistan.svg Turkmenistan 5,110,000
113Flag of Eritrea.svg Eritrea 5,073,000
114Flag of Singapore.svg Singapore 4,839,400500,000April 28, 2009 Referenced. Confirmation expected.
115Flag of Norway.svg Norway 4,814,0751,400,000April 28, 2009
116Flag of the United Arab Emirates.svg United Arab Emirates 4,599,000
117Flag of Costa Rica.svg Costa Rica 4,579,0003,000April 28, 2009 Nacion.com (Spanish)
118Flag of Ireland.svg Ireland 4,517,800
119Flag of Croatia.svg Croatia 4,432,000
120Flag of the Central African Republic.svg Central African Republic 4,422,000
121Flag of Georgia.svg Georgia 4,382,100
122Flag of New Zealand.svg New Zealand 4,306,500
123Flag of Lebanon.svg Lebanon 4,224,000
124Flag of Puerto Rico.svg Puerto Rico (US)3,982,000
125Flag of Liberia.svg Liberia 3,955,000
126Flag of Bosnia and Herzegovina.svg Bosnia and Herzegovina 3,767,000
127Flag of Palestine.svg Palestine 3,761,646
128Flag of the Republic of the Congo.svg Republic of the Congo 3,683,000
129Flag of Moldova.svg Moldova 3,572,700
130Flag of Panama.svg Panama 3,454,000
131Flag of Uruguay.svg Uruguay 3,361,000
132Flag of Lithuania.svg Lithuania 3,350,400
133Flag of Mauritania.svg Mauritania 3,291,000
134Flag of Armenia.svg Armenia 3,230,100
135Flag of Albania.svg Albania 3,170,000
136Flag of Kuwait.svg Kuwait 2,985,000
137Flag of Oman.svg Oman 2,845,000
138Flag of Jamaica.svg Jamaica 2,719,000
139Flag of Mongolia.svg Mongolia 2,671,000
140Flag of Latvia.svg Latvia 2,259,400
141Flag of Namibia.svg Namibia 2,171,000
142Flag of Lesotho.svg Lesotho 2,067,000
143Flag of Slovenia.svg Slovenia 2,053,355
144Flag of North Macedonia.svg North Macedonia 2,048,900
145Flag of Botswana.svg Botswana 1,950,000
146Flag of The Gambia.svg Gambia 1,705,000
147Flag of Guinea-Bissau.svg Guinea-Bissau 1,611,000
148Flag of Gabon.svg Gabon 1,475,000
149Flag of Qatar.svg Qatar 1,409,000
150Flag of Estonia.svg Estonia 1,340,341
151Flag of Trinidad and Tobago.svg Trinidad and Tobago 1,339,000
152Flag of Mauritius.svg Mauritius 1,288,000
153Flag of Eswatini.svg Eswatini (Swaziland) 1,185,000
154Flag of East Timor.svg East Timor 1,134,000
155Flag of Djibouti.svg Djibouti 864,000
156Flag of Fiji.svg Fiji 849,000
157Flag of Cyprus.svg Cyprus 801,600
158Flag of Bahrain.svg Bahrain 791,000
159Flag of Guyana.svg Guyana 762,000
160Flag of Bhutan.svg Bhutan 697,000
161Flag of the Comoros.svg Comoros 676,000
162Flag of Equatorial Guinea.svg Equatorial Guinea 676,000
163Flag of Montenegro.svg Montenegro 624,000
164Flag of the Solomon Islands.svg Solomon Islands 523,000
165Flag of Suriname.svg Suriname 520,000
166Flag of the Sahrawi Arab Democratic Republic.svg Western Sahara 513,000
167Flag of Cape Verde.svg Cape Verde 506,000
168Flag of Luxembourg.svg Luxembourg 491,700
169Flag of Malta.svg Malta 412,600
170Flag of Brunei.svg Brunei 400,000
171Flag of the Bahamas.svg Bahamas 342,000
172Flag of Iceland.svg Iceland 319,326
173Flag of Maldives.svg Maldives 309,000
174Flag of Belize.svg Belize 307,000
175Flag of Barbados.svg Barbados 256,000
176Flag of Vanuatu.svg Vanuatu 240,000
177Flag of the Netherlands Antilles (1986-2010).svg Netherlands Antilles (Netherlands)198,000
178Flag of Samoa.svg Samoa 179,000
179Flag of Guam.svg Guam (US)178,000
180Flag of Saint Lucia.svg Saint Lucia 172,000
181Flag of Sao Tome and Principe.svg São Tomé and Príncipe 163,000
182Flag of the Federated States of Micronesia.svg Federated States of Micronesia 111,000
183Flag of the United States Virgin Islands.svg U.S. Virgin Islands (US)110,000
184Flag of Saint Vincent and the Grenadines.svg Saint Vincent and the Grenadines 109,000
185Flag of Aruba.svg Aruba (Netherlands)107,000
186Flag of Grenada.svg Grenada 104,000
187Flag of Tonga.svg Tonga 104,000
188Flag of Kiribati.svg Kiribati 98,000
189Flag of Jersey.svg Jersey (US)89,300
190Flag of Antigua and Barbuda.svg Antigua and Barbuda 88,000
191Flag of the Northern Mariana Islands.svg Northern Mariana Islands (US)87,000
192Flag of Andorra.svg Andorra 86,000
193Flag of Seychelles.svg Seychelles 84,000
194Flag of the Isle of Man.svg Isle of Man (UK)80,000
195Flag of Dominica.svg Dominica 67,000
196Flag of American Samoa.svg American Samoa (US)67,000
197Flag of Bermuda.svg Bermuda (UK)65,000
198Flag of the Marshall Islands.svg Marshall Islands 62,000
199Flag of Guernsey.svg Guernsey (UK)61,811
200Flag of Greenland.svg Greenland (Denmark)57,000
201Flag of the Cayman Islands.svg Cayman Islands (UK)56,000
202Flag of Saint Kitts and Nevis.svg Saint Kitts and Nevis 52,000
203Flag of the Faroe Islands.svg Faroe Islands (Denmark)48,797
204Flag of Liechtenstein.svg Liechtenstein 35,700
205Flag of Monaco.svg Monaco 33,000
206Flag of the Turks and Caicos Islands.svg Turks and Caicos Islands (UK)33,000
207Flag of San Marino.svg San Marino 30,800
208Flag of Gibraltar.svg Gibraltar (UK)31,000
209Flag of the British Virgin Islands.svg British Virgin Islands (UK)23,000
210Flag of the Cook Islands.svg Cook Islands (New Zealand)20,000
211Flag of Palau.svg Palau 20,000
212Flag of Anguilla.svg Anguilla (UK)15,000
213Flag of Tuvalu.svg Tuvalu 10,000
214Flag of Nauru.svg Nauru 10,000
215Flag of Saint Helena.svg Saint Helena (UK)6,600
216Flag of Montserrat.svg Montserrat (UK)5,900
217Flag of the Falkland Islands.svg Falkland Islands (UK)3,000
218Flag of Niue.svg Niue (New Zealand)1,500
219Flag of Tokelau.svg Tokelau (New Zealand)1,400
220Flag of Vatican City (2023-present).svg Vatican City 800
221Flag of the Pitcairn Islands.svg Pitcairn Islands (UK)50

References

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  2. 1 2 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. 1 2 3 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. 1 2 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.