Stockpiling antiviral medications for pandemic influenza

Last updated July 02, 2024

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.

Rank	Country / Territory	Population	Treatments	Date Last Updated	Source
1	China	1,337,722,000
2	India	1,396,450,000
3	United States	336,628,000	50,000,000	April 27, 2009	Bloomberg.com Report of antiviral stockpile sales
4	Indonesia	230,014,115
5	Brazil	229,070,572
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
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	19,413,000	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
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
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

Related Research Articles

Antiviral drugs are a class of medication used for treating viral infections. Most antivirals target specific viruses, while a broad-spectrum antiviral is effective against a wide range of viruses. Antiviral drugs are a class of antimicrobials, a larger group which also includes antibiotic, antifungal and antiparasitic drugs, or antiviral drugs based on monoclonal antibodies. Most antivirals are considered relatively harmless to the host, and therefore can be used to treat infections. They should be distinguished from virucides, which are not medication but deactivate or destroy virus particles, either inside or outside the body. Natural virucides are produced by some plants such as eucalyptus and Australian tea trees.

<i>Orthomyxoviridae</i> Family of RNA viruses including the influenza viruses

Orthomyxoviridae is a family of negative-sense RNA viruses. It includes seven genera: Alphainfluenzavirus, Betainfluenzavirus, Gammainfluenzavirus, Deltainfluenzavirus, Isavirus, Thogotovirus, and Quaranjavirus. The first four genera contain viruses that cause influenza in birds and mammals, including humans. Isaviruses infect salmon; the thogotoviruses are arboviruses, infecting vertebrates and invertebrates. The Quaranjaviruses are also arboviruses, infecting vertebrates (birds) and invertebrates (arthropods).

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

Zanamivir is a medication used to treat and prevent influenza caused by influenza A and influenza B viruses. It is a neuraminidase inhibitor and was developed by the Australian biotech firm Biota Holdings. It was licensed to Glaxo in 1990 and approved in the US in 1999, only for use as a treatment for influenza. In 2006, it was approved for prevention of influenza A and B. Zanamivir was the first neuraminidase inhibitor commercially developed. It is marketed by GlaxoSmithKline under the trade name Relenza as a powder for oral inhalation.

<span class="mw-page-title-main">Oseltamivir</span> Antiviral medication used against influenza A and influenza B

Oseltamivir, sold under the brand name Tamiflu, is an antiviral medication used to treat and prevent influenza A and influenza B, viruses that cause the flu. Many medical organizations recommend it in people who have complications or are at high risk of complications within 48 hours of first symptoms of infection. They recommend it to prevent infection in those at high risk, but not the general population. The Centers for Disease Control and Prevention (CDC) recommends that clinicians use their discretion to treat those at lower risk who present within 48 hours of first symptoms of infection. It is taken by mouth, either as a pill or liquid.

<span class="mw-page-title-main">Rimantadine</span> Drug used to treat influenzavirus A infection

Rimantadine is an orally administered antiviral drug used to treat, and in rare cases prevent, influenzavirus A infection. When taken within one to two days of developing symptoms, rimantadine can shorten the duration and moderate the severity of influenza. Rimantadine can mitigate symptoms, including fever. Both rimantadine and the similar drug amantadine are derivates of adamantane. Rimantadine is found to be more effective than amantadine because when used the patient displays fewer symptoms. Rimantadine was approved by the Food and Drug Administration (FDA) in 1994.

<span class="mw-page-title-main">Amantadine</span> Medication used to treat dyskinesia

Amantadine, sold under the brand name Gocovri among others, is a medication used to treat dyskinesia associated with parkinsonism and influenza caused by type A influenzavirus, though its use for the latter is no longer recommended because of widespread drug resistance. It acts as a nicotinic antagonist, dopamine agonist, and noncompetitive NMDA antagonist. The antiviral mechanism of action is antagonism of the influenzavirus A M2 proton channel, which prevents endosomal escape.

Neuraminidase inhibitors (NAIs) are a class of drugs which block the neuraminidase enzyme. They are a commonly used antiviral drug type against influenza. Viral neuraminidases are essential for influenza reproduction, facilitating viral budding from the host cell. Oseltamivir (Tamiflu), zanamivir (Relenza), laninamivir (Inavir), and peramivir belong to this class. Unlike the M2 inhibitors, which work only against the influenza A virus, NAIs act against both influenza A and influenza B.

In virology, influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus. Major outbreaks of H1N1 strains in humans include the 1918 Spanish flu pandemic, the 1977 Russian flu pandemic and the 2009 swine flu pandemic. It is an orthomyxovirus that contains the glycoproteins hemagglutinin (H) and neuraminidase (N), antigens whose subtypes are used to classify the strains of the virus as H1N1, H1N2 etc. Hemagglutinin causes red blood cells to clump together and binds the virus to the infected cell. Neuraminidase is a type of glycoside hydrolase enzyme which helps to move the virus particles through the infected cell and assist in budding from the host cells.

An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.

<span class="mw-page-title-main">Peramivir</span> Antiviral drug targeting influenza

Peramivir is an antiviral drug developed by BioCryst Pharmaceuticals for the treatment of influenza. Peramivir is a neuraminidase inhibitor, acting as a transition-state analogue inhibitor of influenza neuraminidase and thereby preventing new viruses from emerging from infected cells. It is approved for intravenous administration.

Transmission and infection of H5N1 from infected avian sources to humans has been a concern since the first documented case of human infection in 1997, due to the global spread of H5N1 that constitutes a pandemic threat.

Treatments for influenza include a range of medications and therapies that are used in response to disease influenza. Treatments may either directly target the influenza virus itself; or instead they may just offer relief to symptoms of the disease, while the body's own immune system works to recover from infection.

Influenza, commonly known as "the flu" or just "flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin one to four days after exposure to the virus and last for about two to eight days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia from the virus or a subsequent bacterial infection. Other complications include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

Viral neuraminidase is a type of neuraminidase found on the surface of influenza viruses that enables the virus to be released from the host cell. Neuraminidases are enzymes that cleave sialic acid groups from glycoproteins. Viral neuraminidase was discovered by Alfred Gottschalk at the Walter and Eliza Hall Institute in 1957. Neuraminidase inhibitors are antiviral agents that inhibit influenza viral neuraminidase activity and are of major importance in the control of influenza.

The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus. The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".

<span class="mw-page-title-main">Laninamivir</span> Chemical compound

Laninamivir (CS-8958) is a neuraminidase inhibitor that is a drug used for the treatment and prophylaxis of Influenzavirus A and Influenzavirus B. It is currently in Phase III clinical trials. It is a long-acting neuraminidase inhibitor administered by nasal inhalation.

<span class="mw-page-title-main">Favipiravir</span> Experimental antiviral drug with potential activity against RNA viruses

Favipiravir, sold under the brand name Avigan among others, is an antiviral medication used to treat influenza in Japan. It is also being studied to treat a number of other viral infections, including SARS-CoV-2. Like the experimental antiviral drugs T-1105 and T-1106, it is a pyrazinecarboxamide derivative.

Neuraminidase inhibitors inhibit enzymatic activity of the enzyme neuraminidase (sialidase). These type of inhibitors have been introduced as anti-influenza drugs as they prevent the virus from exiting infected cells and thus stop further spreading of the virus. Neuraminidase inhibitors for human neuraminidase (hNEU) have the potential to be useful drugs as the enzyme plays a role in several signaling pathways in cells and is implicated in diseases such as diabetes and cancer.

Baloxavir marboxil, sold under the brand name Xofluza, is an antiviral medication for treatment of influenza A and influenza B. It was approved for medical use both in Japan and in the United States in 2018, and is taken as a single dose by mouth. It may reduce the duration of flu symptoms by about a day, but is prone to selection of resistant mutants that render it ineffectual.

References

1 2 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.
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.
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.
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.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.

[pmid17182341-1] 1 2 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.

[pmid14753128-2] 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.

[pmid15709056-3] 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.

[pmid17115954-4] 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.

[1]

[2]

[3]

[4]

v t e Lists of countries by population statistics
Global	Current population United Nations Demographics of the world
Continents/subregions	Africa Antarctica Asia Europe North America Caribbean Oceania South America
Intercontinental	Americas Arab world Commonwealth of Nations Eurasia European Union Islands Latin America Middle East
Cities/urban areas	World cities National capitals Megacities Megalopolises
Past and future	Past and future population World population estimates 1 1000 1500 1600 1700 1800 1900 1939 1989 2000 2005 2010 2015 Population milestones
Population density	Current density Past and future population density Person-to-arable land ratio
Growth indicators	Population growth rate Natural increase Net reproduction rate Number of births Number of deaths Birth rate Mortality rate Fertility rate Past fertility rate
Life expectancy	world Africa Asia Europe North America Oceania South America world regions past life expectancy
Other demographics	Age at childbearing Age at first marriage Age structure Dependency ratio Divorce rate Ethnic and cultural diversity level Ethnic composition Immigrant population Linguistic diversity Median age Net migration rate Number of households Religion / Irreligion Sex ratio Urban population Urbanization
Health	Antidepressant consumption Antiviral medications for pandemic influenza HIV/AIDS adult prevalence rate Infant and under-five mortality rates Maternal mortality rate Obesity rate Percentage suffering from undernourishment Health expenditure by country by type of financing Suicide rate Total health expenditure per capita Total healthcare spending as % of GDP Body mass index (BMI)
Education and innovation	Bloomberg Innovation Index Education Index Global Innovation Index International Innovation Index Literacy rate Programme for the International Assessment of Adult Competencies Programme for International Student Assessment (PISA) Progress in International Reading Literacy Study (PIRLS) Trends in International Mathematics and Science Study (TIMSS) Tertiary education attainment World Intellectual Property Indicators
Economic	Access to financial services Development aid donors Official Development Assistance received Employment rate Irrigated land area Human Development Index by country inequality-adjusted planetary pressures–adjusted HDI Human Poverty Index Imports Exports Income equality Labour force Share of income of top 1% Number of millionaires (US dollars) Number of billionaires (US dollars) Percentage living in poverty Public sector Unemployment rate Wealth inequality
List of international rankings Lists by country