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Pharmacist handling medication

Flu antiviral oseltamivir unavailable from some manufacturers as virus surges and vaccination lags

November 15, 2022

Pediatricians may need to check with several pharmacies to find influenza antiviral oseltamivir due to supply constraints. If none is available, an AAP expert said several other treatments may be considered, adding that vaccination remains the best way to protect children as the virus surges.

Several manufacturers are reporting limited or no supply of certain oseltamivir formulations, according to lists maintained by the Food and Drug Administration (FDA) and the American Society of Health-System Pharmacists. However, the FDA has not declared a nationwide shortage, indicating that it believes other manufacturers can meet overall market demand. Supply constraints among some manufacturers may be resolved later this month, according to the FDA data.

Still, the shortages are hitting as flu is spiking earlier than usual in some parts of the country. Cumulative hospitalization rates for both children and adults are higher than rates during the same time during any season in the past decade, and five pediatric deaths already have been reported, according to the Centers for Disease Control and Prevention (CDC).

The AAP recommends antiviral treatment be offered as early as possible to any child hospitalized with confirmed or suspected influenza; any child with severe, complicated or progressive influenza in any setting; and any child with confirmed or suspected influenza of any severity who is at high risk for influenza complications.

Treatment also can be considered in an outpatient setting for any child with confirmed or suspected influenza who is not at high risk for complications, if treatment can be initiated within 48 hours of illness onset, and any child with suspected or confirmed influenza whose siblings or household contacts are younger than 6 months or at risk for complications.

Kristina Bryant, M.D., FAAP, a member of the AAP Committee on Infectious Diseases and a lead author of the AAP’s flu policy, said pediatricians should make an effort to find oral oseltamivir, as it is the best treatment option for children with influenza.

A recent study of nearly 56,000 children hospitalized with influenza found children who received oseltamivir had shorter hospital stays and lower odds of intensive care transfer or hospital readmission than children who did not receive the antiviral.

“I think this is a really powerful study in a season when we’re seeing rising flu hospitalizations and pediatric hospitals that are overwhelmed with patients with a variety of respiratory illnesses,” said Dr. Bryant, a hospital epidemiologist at Norton Children’s Hospital in Louisville, Ky.

If oseltamivir is not available, pediatricians may be able to use baloxavir or inhaled zanamivir depending on the patients’ age and underlying conditions, according to Dr. Bryant. The AAP policy has detailed information on indications for each of these drugs. However, oseltamivir is the only oral treatment indicated for children under 5 years.

“We don’t really have good oral alternatives, though, for the youngest children, and we know that the youngest children are the ones at biggest risk for hospitalization,” Dr. Bryant said.

This lack of alternatives makes vaccination even more important. However, only 28.3% of children have been vaccinated this season, eight percentage points lower than the same time in 2020, according to CDC data.

“The best thing we can do is to prevent the youngest kids from getting flu to begin with,” Dr. Bryant said. “ … Flu vaccine is recommended for pregnant persons to protect them as well as their infants. Household contacts of young infants should be immunized against flu to prevent flu from coming into the household, and when those kids reach 6 months of age, flu vaccine should be a priority.”



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