Masks going to schools to curb H1N1

California school districts will receive 23 million masks and pairs of gloves to help curb the spread of swine flu, the state schools chief announced Friday.
"We want to keep students, teachers and staff healthy and in school," Superintendent of Public Instruction Jack O'Connell O'Connell said in a statement.
Details of the program were being released at a Los Angeles County warehouse in Santa Fe Springs packed with boxes of disposable gloves and masks.
The items, paid for by federal grants, will be shipped free to 58 county offices of education and to the Los Angeles Unified School District, which is the nation's second-largest district.
They are intended for roughly 10,000 public schools with about 6.3 million students in more than 1,000 districts, said Hilary McLean, a spokeswoman for the California Department of Education.
Stanislaus County's share includes 1,554 boxes of the masks and 1,243 boxes of gloves.
Though they'll be used in the emergency of an H1N1 outbreak, they can also be used in cases where a student or adult has flulike symptoms and is waiting to be taken home, Stanislaus County Office of Education officials said. Schools already have been stocked with other gloves and masks.
The new items will be disseminated to Stanislaus County schools based on their student enrollment, and schools can use them as they wish, officials said.
Shipping of the supplies began late last month, McLean said.
Federal guidelines recommend that students with H1N1 symptoms such as fever, cough and sore throat be sent to a separate office or sick room until they can leave campus.
But it can take several hours before parents can pick up their children, McLean said.
Surgical masks for children
In the meantime, the child will be asked to wear a surgical mask while the school nurse or other staffer will wear a different type of mask and gloves, McLean said.
There have been more than 7,200 cases of swine flu reported in California this year, 366 of them fatal, according to the state Department of Public Health.
Although some counties have reported drops in the number of new swine flu cases, indicating the pandemic may have peaked locally, McLean said schools always can store the masks and gloves in case there's an outbreak of another type of flu.
"Next year, we're sure to have another flu season," she said.

Swine Flu Kids Getting Faster Drug Treatment

More than 80 percent of U.S. children severely ill with H1N1 flu have been treated swiftly with antiviral drugs, a trend that could be saving lives, U.S. health officials said on Friday.
Public education campaigns about swine flu have translated into quicker and better treatment with Tamiflu, Roche AG and Gilead Sciences Inc's influenza pill, they said.
Usually, at most 20 percent of children severely ill with influenza ever get treatment with Tamiflu or GlaxoSmithKline's inhaled drug Relenza, said Centers for Disease Control and Prevention Director Dr. Thomas Frieden.
"In this year it been over 80 percent. That means doctors are getting the message that severely ill children need to be treated," Frieden told reporters in a telephone briefing.
Given within the first day or so of a fever, Tamiflu and Relenza can greatly reduce symptoms. A third drug in the same class, BioCryst Inc's peramivir, has emergency authorization for intravenous use in the most severe cases.
The quick treatment is important, as H1N1 is more likely to infect younger adults and children, as opposed to seasonal flu, which takes it heaviest toll among the over-65s.
"We have already had three times the number of deaths among children than we would (have) in a usual flu season," Frieden said. He said 17 more child deaths from swine flu had been reported in the past week, bringing the total confirmed number of H1N1 pediatric deaths to 210.
But the CDC estimates that more than 500 U.S. children have actually been killed by H1N1 -- far more than in a normal flu season.
MORE VACCINE

Frieden said supplies of H1N1 vaccine should improve in coming weeks and said 73 million doses had now been distributed or were ready for distribution -- still less than half of what had originally been hoped for by this week .
"We expect at least 10 million more doses in the coming week," Frieden said.
So far safety monitoring has shown no worrying side-effects from the vaccine, Frieden said, such as the rare neurological condition called Guillain-Barre Syndrome linked to a 1976 vaccination campaign against a different strain of swine flu.
"The likelihood that we will have a 1976-like problem with this year's H1N1 vaccine is vanishingly remote," Frieden said.
Frieden said some school districts had managed to vaccinate virtually every student. "That's an important accomplishment for this year and for the future," he said." School-based vaccination programs are unusual in the United States and this year's has been difficult to organize.
The World Health Organization said separately on Friday that the pandemic appears to have peaked in Canada and the United States.
"Worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 8,768 deaths," WHO said in a statement on its website at http://www.who.int.
"In Europe, widespread and intense transmission of pandemic influenza virus continued to be observed across most of the continent," it added. "In Western and Central Asia, influenza transmission remains active."
Both WHO and the CDC note that the confirmed number of deaths and cases are a small fraction of the actual numbers.

22 Million Americans Have Been Ill With H1N1 Influenza

The CDC has updated its estimates related to the spread of the novel influenza A (H1N1) virus, and the numbers are staggering.
The agency estimates that from April to mid-October, there were 22 million H1N1 illnesses in the United States, with 98,000 hospitalizations and 3,900 deaths, according to Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases.
People with diabetes represent a large percentage of H1N1 cases, Schuchat said during a Nov. 12 media briefing. Individuals with diabetes accounted for 12 percent of all hospitalizations associated with H1N1 infection during this period, and 19 percent of adults hospitalized with the infection had diabetes. Moreover, one-fourth of people with diabetes who were hospitalized with H1N1 illness required intensive care.
But, according to Schuchat, people with diabetes can take a number of steps to protect themselves from influenza and its complications.
The CDC recommends that people ages 6 months to 64 years who have any type of diabetes should be vaccinated against H1N1 flu when the vaccine is available in their communities. When supply of the vaccine increases, patients with diabetes who are 65 years and older also should get the vaccine. All people with diabetes ages 6 months and older, including the elderly, also should receive the seasonal flu vaccine.
The agency also recommends that people ages 2 years and older who have diabetes or other chronic conditions also should receive the pneumococcal polysaccharide vaccine because influenza infection can increase the likelihood of developing bacterial pneumonia. The vaccine may be administered at the same time as influenza vaccines. CDC recently released a letter to physicians encouraging them to vaccinate patients with these indications.
People with diabetes who are suspected to have seasonal or H1N1 flu should receive antiviral treatment. The CDC said physicians should not wait for the lab results to confirm the type of influenza before prescribing antiviral medications. Oseltamivir (Tamiflu) and zanamivir (Relenza) both can be taken by people with diabetes.
H1N1 has taken a heavy toll among individuals with asthma, as well. CDC Director Thomas Frieden, M.D., said during a Nov. 3 media briefing that among patients with asthma who have been hospitalized for H1N1 infection, only about one-half sought medical care at the onset of their illness.
"If you have asthma or another underlying condition, seek care promptly when you have fever with cough," Frieden said.
Young children also have been hit hard by the novel virus. Schuchat said during the Nov. 12 media briefing that the CDC estimates that 8 million children had contracted the virus as of Oct. 17, with about 36,000 hospitalizations and 540 deaths.
Among adults ages 18-64, there were an estimated 12 million illnesses, with about 53,000 hospitalizations and 2,900 deaths. Adults 65 and older accounted for about 2 million illnesses, 9,000 hospitalizations and 440 deaths.
Schuchat said the CDC plans to release updated estimates every three to four weeks.

Roche Announces Shipments of New Supplies of Children's Tamiflu(R) in the U.S.

Tamiflu Oral Suspension (Liquid) & Low Dose Capsules Begin Arriving at Pharmacies
SOUTH SAN FRANCISCO, Calif., Dec. 2 /PRNewswirel/ -- Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that it has begun shipping additional quantities of Tamiflu® (oseltamivir phosphate) oral suspension (liquid). The added supplies of Tamiflu will begin arriving in pharmacies nationwide and will continue to roll out to wholesale and retail pharmacies during the next several weeks. These shipments add to the millions of treatment courses of the adult-sized capsules already available nationwide and significant quantities of smaller, lower dose capsules shipped in November. Together, the formulations provide various dispensing options for treating children with influenza.
Tamiflu is available in 75 mg capsules for adults, 30 mg and 45 mg capsules for children or oral suspension (liquid) for children or people who have difficulty swallowing capsules. Roche continues to make all forms of Tamiflu, and increasing quantities of Tamiflu oral suspension will become available over the next several weeks through the beginning of next year. The small, low-dose capsules may be easier for children to swallow or may be opened and mixed with sweetened liquids, such as regular or sugar-free chocolate syrup, by parents or caregivers. Also, pharmacies can convert the adult (75 mg) size capsules into a liquid for children if neither the liquid nor small capsule forms of Tamiflu are in stock.
"As influenza continues to be widespread throughout the U.S. and the winter flu season nears, we remain committed to making sure there is enough Tamiflu to meet the needs of both adults and children," said Alexander Hardy, vice president, Anti-Infectives, Genentech, a member of the Roche Group. "We are hopeful that news of these shipments will provide added reassurance to parents that there are Tamiflu options available for their children when they need it."
Tamiflu attacks the flu virus at its source, preventing it from replicating in the body. Recommendations from the U.S. Centers for Disease Control and Prevention (CDC) on use of antivirals, such as Tamiflu, in management of seasonal and pandemic H1N1 influenza are available at http://www.cdc.gov/H1N1flu/recommendations.htm.
Tamiflu Manufacturing Capacity
Roche has invested significantly to increase its global manufacturing capacity to meet Tamiflu demand during pandemic preparedness and response. The expanded global manufacturing network, which includes 19 partners in 10 countries on three continents, has enabled Roche to boost Tamiflu production 15-fold since 2004. As a result, Roche has the ability to produce 400 million treatment courses annually, roughly 33 million courses per month if required. At the request of the U.S. Department of Health and Human Services (HHS), Roche established the capacity to produce 80 million treatment courses from start to finish in the U.S. each year. Roche continues to work with the U.S. government to provide for the Strategic National Stockpile of antivirals for pandemic preparedness and response.
Worldwide Tamiflu Access
To facilitate availability of Tamiflu on every major continent, Roche has granted four sub-licenses to generic manufacturers for production in China, India and Africa. Roche has donated a total of 10.75 million Tamiflu treatment courses to the World Health Organization (WHO) and offered substantially discounted pandemic pricing to all governments.
About Tamiflu
Tamiflu, co-developed by Gilead Sciences, Inc., based in Foster City, CA, is indicated for the treatment of uncomplicated influenza caused by viruses types A and B in patients one year and older who have had flu symptoms for no more than two days. Tamiflu is also indicated for the prevention of influenza in patients one year and older. Tamiflu is not a substitute for annual early vaccination as recommended by the CDC. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use Tamiflu.
Tamiflu Safety Information
There is no evidence for efficacy against any illness caused by agents other than influenza types A and B.
Treatment efficacy in subjects with chronic cardiac and/or respiratory disease has not been established. No difference in the incidence of complications was observed between the treatment and placebo groups in this population.
No information is available regarding treatment of influenza in patients at imminent risk of requiring hospitalization.
Efficacy of Tamiflu has not been established in immunocompromised patients.
Safety and efficacy of repeated treatment or prophylaxis courses have not been studied.
Influenza can be associated with a variety of neurologic and behavioral symptoms, which can include events such as hallucinations, delirium and abnormal behavior, in some cases resulting in fatal outcomes. These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease. There have been postmarketing reports (mostly from Japan) of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving Tamiflu. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made, but they appear to be uncommon based on Tamiflu usage data. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution. The contribution of Tamiflu to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behavior. If neuropsychiatric symptoms occur, the risks and benefits of continuing treatment should be evaluated for each patient.
In postmarketing experience, rare cases of anaphylaxis and serious skin reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme, have been reported with Tamiflu.
The most common adverse events reported in >1% of patients treated with Tamiflu and more commonly than in patients treated with placebo are:
* Treatment of adult and pediatric patients: nausea, vomiting
* Prophylaxis of adult and pediatric patients: nausea, vomiting, abdominal pain
Vaccination is considered the first line of defense against influenza.
Tamiflu is available for the treatment of influenza in more than 80 countries worldwide.

Swine flu still down in U.S. but 198 children dead

Swine flu continues to wane across the United States, but it has killed more than 30 children since the last count, U.S. health officials said on Monday.
The latest update on the H1N1 virus, posted at cdc.gov/flu/weekly/, shows the infection is still at epidemic levels but below its October peak, the Centers for Disease Control and Prevention reported.
Since March, 198 children have been reported killed by H1N1, although the true number is likely far higher because many people with the flu don't go to the doctor and only a few who do are tested for swine flu.
The CDC said just over 20 percent of specimens sent for testing from patients with flu-like illness were positive for H1N1 swine flu, meaning that 80 percent of patients had something else. At the worst, this proportion was over 30 percent.
Swine flu continues to dominate, with 99 percent of flu cases being due to the H1N1 strain.
"The proportion of outpatient visits for influenza-like illness was 4.3 percent, which is above the national baseline of 2.3 percent," the report reads.
The CDC got reports in the week ending November 21 of 35 children who died, although one died from seasonal influenza in March -- bringing to 128 the confirmed pediatric death toll from seasonal flu in 2008-2009.
"A total of 198 deaths in children associated with 2009 influenza A (H1N1) virus infection have been reported to CDC," the report reads.
Many of the children who died had bacterial infections known to worsen a flu infection. Thirty-one percent of the children who died and who were tested for bacterial infections had one, and nearly a third of these had Staphylococcus aureus.
The virus remains mostly treatable by oseltamivir, the flu pill made by Roche AG and Gilead Sciences under the brand name Tamiflu. "A total of 23 cases of oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States since April 2009," the CDC said.
All viruses tested, including those resistant to Tamiflu, can be treated with Relenza, GlaxoSmithKline Plc and Biota's inhaled drug also known as zanamivir.
The CDC estimates that more than 22 million Americans have been infected with H1N1 and that 3,900 have died. The U.S. government has ordered 250 million doses of vaccine but companies have been struggling to make it, leading to widespread shortages.
The World Health Organization reports that more than 207 countries and overseas territories or communities have reported laboratory-confirmed cases of H1N1, with more than 7,820 confirmed deaths -- numbers the WHO says are the tip of the iceberg.

State Asks Pharmacies To Give Free Flu Meds

The state has sent letters asking pharmacies to give the medicine free of charge to those who can't pay.
"We're seeing an outbreak," said pharmacist Phillip Bradley of Bradley Drug Co., who said he's seeing a lot of patients with the flu, both H1N1 and seasonal, but not all of his patients are getting help.
"We're seeing a lot of prescriptions coming through here that are antivirals, but I know that a lot of my customers that are uninsured, I don't see them coming in with prescriptions," said Bradley.
The government sees the problem, too, which is why the state just sent letters to all the pharmacists in Tennessee asking them to dispense antiviral medications -- normally Tamiflu -- to uninsured and under-insured Tennesseans who can't afford it for free.
The pharmacies themselves have to sign up for the program, but Bradley said he thinks it's a good idea
"My initial thought is it's a great thing for Tennesseans," he said. "A lot of the uninsured do not have the ability to get antiviral medications because of the expense, so through the state and through the pharmacy association, we're going to be able to dispense these antiviral medications at no charge."
Tamiflu costs about $100 if it's paid for out of your pocket.
In an unprecedented move, the state will dispense the medicine to the pharmacies from a state stockpile to help prevent the spread of H1N1and perhaps counter the fact that it's been difficult keeping up with vaccination demand.
"We'll be able to hopefully help limit the antiviral activity in this community," said Bradley.
Doctors will let pharmacists know which patients can't afford the antiviral medicine by writing "TDH stockpile" on the prescriptions.
Pharmacies are still in the process of signing up with the state, so you will need to check with your doctor and pharmacy before you can get the free medicine.

Egypt to make own Tamiflu

Health Minister Hatem el-Gabali said on Tuesday that Egypt will produce the Tamiflu vaccine for both Avian and Swine flu patients, locally, at 75 Egyptian pounds ($14) per packet, explaining that it will import raw materials from different bodies accredited by the World Health Organization. The minister confirmed that the price of the virus testing in Private labs in the country would cost some 800 Egyptian pounds ($145).
Gabali stated during the fourth session of the 6th development of health services conference in Sharm El Sheikh that “strategic stockpiles of Tamiflu available in the ministry , are enough,” pointing out that the epidemic situation of the disease is “stable and the death rate did not exceed three per one thousand, less than a quarter of the death rate in countries the world.”
He also confirmed that the ministry continues to conduct the virus tests for free to selected groups of citizens in need, stressing that “not all the labs are equipped to conduct such tests, especially the provision of reagents used to make the testing possible,” explaining that allowing private labs the ability to make these tests does not mean that the ministry will give up conducting such examinations.
He stressed that the ministry will give the infected Tamiflu for free within and outside the hospitals run by the ministry, meaning that some people will be given Tamiflu without being held in hospital. It is part of the ministry’s efforts to help create a means to treat as many individuals as possible.
The ministry warned laboratories against the public declaration of the results of the tests they give, noting the need to inform the ministry of positive results before going public and to “be approved by a consultant physician or specialist who holds a doctorate degree” from the ministry.
Egypt has seen more than 3,000 H1N1, or Swine flu, cases since it was first discovered in the country last June. At least 10 people have died from the disease, but the ministry says its efforts to curtail the spread of the virus are “having results.” The Avian flu, or bird flu, has been more detrimental to Egypt, with dozens of people dying from the deadly virus since it first arrived in the country in early 2006.
Egypt is a major gateway for air-born diseases as it lies on the cusp of three continents and is a major migratory stop for birds. The ministry, and global health officials, fear a mutated form of Avian and H1N1 into a virus that could ravage the population.

1918 Flu Pandemic Genes Found in Current Swine Flu

Recombinomics has stated that a paper published by the National Institute of Health has reported the presence of similar binding receptors in swine flu samples from Brazil, Ukraine and Norway.
Although WHO stated that this change was "not significant" in the Ukraine samples, it was associated with the fatal cases and is cause for concern. The concern was increased by the announcement from Norway indicating the same change was found in fatal H1N1 lung infections there also.
Some have commented that this change was spontaneous and diid not spread, although this change was found in all four deceased patients in Ukraine from two distinct locations -- meaning they did indeed spread. What is serious, though, is what this means for the spread of the pandemic.
The concept of acquisition via recombination has serious implications for the current pandemic. It was used to predict the D225G change, in part because the change was "in play" and appearing in July/August sequences at increasing frequency, even though the H1N1 sequences represented different genetic backgrounds. Similarly the clusters of Tamiflu resistance in Wales and North Carolina are also driven by recombination, as happened when the identical change was acquired in H1N1 seasonal flu in patients who were not taking Tamiflu (oseltamivir).
These changes to the swine flu virus are making it resistant to Tamiflu, the best medicine to fight this kind of viral infection.
Similarly the clusters of Tamiflu resistance in Wales and North Carolina are also driven by recombination, as happened when the identical change was acquired in H1N1 seasonal flu in patients who were not taking Tamiflu (oseltamivir).

Cox Warns Consumers About Tamiflu Drug Prices

Attorney General Mike Cox today announced the results of an undercover survey that showed significant price variations at pharmacies across the state for the H1N1 drug Tamiflu. Cox’s team of investigators looked into the price of liquid Tamiflu, a form commonly used to treat children, at fifty different pharmacies across five Michigan communities and found that some consumers may be paying more than they need to.
Excluding select pharmacies offering free Tamiflu while their supplies last, the Attorney General discovered that statewide prices ranged from $28.00 at one Lansing pharmacy to $140.00 at a pharmacy in Grand Rapids. Pharmacies in Detroit, Flint, Grand Rapids, Lansing and Traverse City were contacted, and the price range in each community included:
Detroit- $50.00 to $122.00;
Lansing- $28.00 to $119.00;
Grand Rapids- $47.90 to $140.00;
Flint- $48.00 to $94.00; and
Traverse City- $54.90 to $129.99
Cox urges Michigan residents to shop around for the best price on Tamiflu and all their prescription needs. The Attorney General’s office is contacting pharmacies with higher prices to gain more insight into why some have prices that are significantly higher than others.
“The high cost at some pharmacies of a drug that can save lives is disturbing,” said Cox. “These prices show the importance of checking more than one pharmacy, especially residents without insurance.”
Cox also released a consumer alert today, titled “How to Safely Save Money on Prescription Drugs,” including tips to help consumers shop around for the best price on a prescription for Tamiflu and other drugs. The consumer alert, found at www.michigan.gov/tamiflu also warns consumers to stay away from so-called “miracle” H1N1 cures that they may find on the Internet.
Consumers who believe they have been charged an excessive amount for Tamiflu should contact the Attorney General’s Consumer Protection Division at (877) 765-8388. Complaints can also be filed at www.Michigan.gov/ag.
Michigan consumers looking for additional information about the H1N1 or seasonal flu, including tips to help prevent or treat the flu, and examples of fraudulent flu products, are encouraged to visit http://www.flu.gov.

Paranoia reaches pandemic proportions

“The only thing we have to fear is fear itself.” These were the immortal words delivered by U.S. President Franklin Roosevelt during his 1933 inaugural address. They helped inspire his nation through an economic depression and world war — but probably could do little to ease the pandemonium that now surround a microscopic organism with an identity crisis.
The warnings have been unrelenting — and they have come from all corners in the debate over the H1N1 virus. For months, health officials have warned that the virus formerly known as Swine Flu has reached pandemic proportions. And as the public’s fears continued to mount, they were advised of the imminent need to receive the H1N1 vaccination. Oh, and did we mention by the way that supplies of the vaccine are low so you’re probably going to have to wait a few weeks to ward off your impending death.
While that might not have been the exact message delivered by Canadian health authorities, it’s the one that came through for the average Canadian whose anxiety rose with each new reported H1N1 death. As of this week, 198 Canadians have died of H1N1.
The Canadian public is riveted to any news on the spread of the H1N1 virus. And who could blame them. The sight of young, otherwise healthy individuals being struck down by a microscopic organism is pretty hard to ignore. With those sights often accompanied by respected doctors calling the virus the “most frightening” thing they’ve ever seen. And with each new case, the public’s anxiety continues to grow. And as many Canadians are turned away from the vaccination clinics that fear turns to outrage. It’s enough to even turn Canadians against their hockey heroes.
But the H1N1 virus isn’t the only thing that’s spreading fear across the country. The vaccination itself has become a lightning rod for irrational fear.
“If you Google H1N1, most of what comes up is conspiracy theory paranoia that this is a government plot to kill you,” said provincial health officer Dr. Perry Kendall.
Those theories range from H1N1 being a plot cooked up by the major pharmaceutical companies to help immunize them from potential lagging profits; to the new strain being the result of a top-secret military bio-weapon hatched by former U.S. defence secretary Donald Rumsfeld and the original Dr. Evil, Dick Cheney, during their quest for world domination. (This strand of paranoia is helped along by the fact that Rumsfeld does hold millions worth of stock in the company that owns the rights to Tamiflu, the drug used to remedy symptoms of H1N1. That’s kind of like Cheney having a relationship with a company that stood to profit from the invasion of oil-rich countries. But now I’m starting to sound like an MSNBC newscast.)
Whatever the cause, fear of the virus and/or vaccination is spreading faster than Lindsay Lohan on her way to the bar at last call.
And as the resulting paranoia reaches a fevered pitch, Canadians are increasingly becoming divided into two camps: those scanning the internet for the latest conspiracy while frantically sealing their windows with tinfoil to block out the harmful gamma rays sent out by the government to indoctrinate the public into embracing the vaccine; and those who would sooner judge a talent show comprised solely of Kardashians than venture into any public spaces, and faithfully avoid all forms of human contact, save the goodnight kiss they give their children — after said child’s face has been properly sanitized, of course. 
But no matter what side of the debate you’re on, Canadians would be well advised to keep this all in perspective. We made it through bird flu, West Nile, SARS and who could forget flesh-eating disease. That one had panic written all over it. I mean, come on, even the official medical terminology — Necrotizing fasciitis — sounds like the title of a George Romero movie. 
So if we can manage to maintain the reserved Canadian composure that has made Canada synonymous with politely dull the world over, I’m convinced we can weather this storm. Keep in mind: it’s been my experience that incompetence and ineptitude make any form of government conspiracy about as likely as the Olympics coming in under budget. And you’re probably more likely to be trampled outside a flu clinic by crowds rushing to the scalpers offering up their spot in line to the criteria-challenged, than die from the flu itself.

Internet Littered With H1N1 'Sham' Products

"Stop swine flu in its tracks" and "Complete Flu Detox for $99" are some of the claims you can find online. There's even tea, shampoo, a spray that all claim to help guard against the H1N1 Swine Flu outbreak.
Local people believe it's gotten very serious, and it's made some very sick. With swine flu cases now reaching 22 million Americans, and the death toll growing, people are scared.
The internet is littered with all sorts of products claiming to be able to "resolve swine flu today."
"They're preying on people's fears and trying to take advantage of individuals by marketing sham products," said Dr. Neil Fishman, Chief of Infectious Diseases at the Hospital of the University of Pennsylvania.
One of the more popular scams is generic Tamiflu. We easily found it online. For $89, three weeks ago, we bought 10 antiviral pills that were supposed to arrive in five to nine days, and we're still waiting.
And Dr. Fishman says, "There is no generic form of Tamiflu. It's unlikely that it actually contains real drug." He also says the only trustworthy Tamiflu comes with a doctor's prescription from an established pharmacy, not the internet.
"During a public health emergency, they recognize that consumers want to protect themselves and their families," said Alyson Saben, with the FDA Swine Flu Task Force.
The FDA is cracking down on swine flu swindles, posting a fraudulent product list on its Web site. The agency has demanded that companies stop making unproven claims.
"We've warned over 75 Web sites offering more than 135 products with claims that they diagnose, cure, treat or prevent the H1N1 flu virus to stop making those claims and to stop offering those products to the public," said Saben.
Some are even so brazen to offer really expensive items, like the Photon Genie for $3,000. The FDA says after it issued the maker a warning letter, they stopped making claims of being able to "protect against the swine flu."
"They're really just get rich quick schemes," said Dr. Fishman.
Some people in Philadelphia think the Web sites are bunk and should be put out of business.
The FDA says it's working aggressively to identify and take action against any person or businesses wrongfully promoting a product.
Currently the only drugs proven to treat the H1N1 swine flu are Tamiflu and Relenza. The vaccine is for prevention.

Area drug stores cope with Tamiflu shortage

As local H1N1 cases increase during this flu season, central New York pharmacists are feeling the added pressure to keep up with the high demand of a liquid form of Tamiflu.
Many pharmacists in the central New York area are working hard to keep up with the demand of liquid Tamiflu by making their own due to shortages from the manufacturers.
“Yes, we (at Rite Aid) are feeling the pressure, there is a great demand for the liquid form of Tamiflu, more so than in recent years,” said Keegan Harse, a pharmacist who works at the Rite Aid location on 293 state Route 104, in Oswego.
“There is great demand for the liquid Tamiflu especially because the Tamiflu tablets are only for adults, and the tablets are too strong for children,” Harse explained.
Pharmacists at the Route 104 Rite Aid location in Oswego have been making their own form of liquid Tamiflu. 
“This is the first time at Rite Aid we have had to make the liquid form ourselves because the suspensions are just not available at this time,” Harse said, noting that Tamiflu is the best flu medication for children. 
Tamiflu is helpful with preventing flu symptoms, as well as treating the flu. “Nothing over-the-counter matches up with liquid Tamiflu, it is the best flu medication for children,” Harse said.
Tamiflu is the recommended medication for not only flu-like symptoms, but also for the H1N1 flu virus.
Harse was unable to provide a price for the liquid Tamiflu, but the price of 10 Tamiflu capsules is $109. Harse said most insurance companies do cover the expenses.
Craig Rowland, pharmacist at the Kinney Drugs Pharmacy in Brewerton, is feeling the pressure from the high demand of Tamiflu as well. “We are having supply trouble, but we make the liquid form ahead of time, so there is definitely pressure there,” Rowland said. “It’s a supply issue from the wholesaler and then they put pressure on the manufacturer,” Rowland explained.
Pharmacists at Kinney Drugs Pharmacy make the liquid form of Tamiflu from scratch. “The old-fashioned way by mixing the prescribed capsules with a sweetened liquid,” Rowland said.
Kinney receives a large inventory of the capsules, but it all depends on the severity of each flu season. “For one season, we did not use 25 percent of the Tamiflu we had in stock,” Rowland explained.
The Wal-Mart pharmacy is especially feeling the pressure of the high demand of liquid Tamiflu. Karen Komarnicki, Wal-Mart pharmacist in Oswego, said, “We are feeling a lot of pressure this year, we are unable to make the mixture here at Wal-Mart because we are short in supplies from the manufacturer.”
With Wal-Mart not having the liquid Tamiflu available to customers, Komarnicki and other Wal-Mart pharmacists have to refer Wal-Mart customers to other pharmacies.
“As people are having trouble with getting the flu shots, the same goes for us who are not receiving the proper supplies to make the liquid medicine,” Komarnicki said. “It is happening so much earlier this year also, flu season typically doesn’t start until January.”
Pharmacies such as Wal-Mart may have to wait until December to receive more liquid Tamiflu from the Swiss drugmaker and manufacturer, Roche Holding.
Recent information from a Roche October 2009 media release stated, Roche is increasing its “full-year outlook and Roche now expects at least high single-digit full-year sales growth for (the) pharmaceuticals division.”
The demand for Tamiflu due to the H1N1 flu virus has also caused a 10 percent rise in third quarter-sales. In the first nine months, Roche group sales in the United States are up by $6 billion, about a 6 percent jump.

What To Do About the Flu

Two strains of flu, seasonal flu and the 2009 H1N1 flu, are currently circulating in the U.S. Influenza is a serious illness that spreads from person to person through respiratory droplets from coughs and sneezes, and via saliva and mucus.
The word “flu” refers to illnesses caused by a number of different influenza viruses with a range of symptoms and effects, from mild to lethal. Most healthy people recover from flu without any problem. However, certain people and age groups are at higher risk for serious complications. As stated in the Healthy Home Guide published by the Hawai‘i State Department of Health (DOH), “Seasonal flu and 2009 H1N1 vaccines are recommended for anyone who wants to avoid getting the flu, but particularly for seniors, infants, toddlers, pregnant women and those with weakened immune systems.”
Influenza is very contagious. Moreover, it is not merely airborne.
“Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for two to eight hours after being deposited on the surface,” said state Department of Health Maui District Officer Dr. Lorrin Pang.
People may become infected by touching something with the flu virus on it and then touching their mouth or nose. The germs are spread by respiratory droplets when an infected person coughs or sneezes on a surface such as a desk or the handle of a shopping cart, for example.
“People infected with seasonal flu and 2009 H1N1 shed virus and may be able to infect others from one to two days before getting sick, to five to seven days after,” said Dr. Pang. It can be longer in some people, especially children and those with weakened immune systems.
Seasonal, or common flu strains, arrive every year from October through May, said Dr. Pang. Unexpectedly, at the end of the flu season last spring, a new type (H1N1) began to circulate around the world. By June 11, due to its rapid spread worldwide, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 was underway. President Obama recently declared it a national emergency, prompting hospitals and local governments to quickly set up alternate sites and procedures if needed to handle any surge of patients.
“We have not needed alternative sites so far on Maui,” said Dr. Pang, adding that prevention, knowledge and education are key factors to avoiding both seasonal flu and H1N1. “Get vaccinated as soon as the vaccines are available,” he said. He highly recommends receiving both the seasonal influenza and 2009 H1N1 vaccines, because most people have little or no natural immunity to new influenza viruses.
The flu vaccine used each year contains the strains of the virus that are most common that year. The 2009 H1N1 vaccine, made just like seasonal flu vaccines, is expected to be as safe and effective.
The reason the H1N1 vaccine has been taking so long to arrive is the amount of time it takes to prepare.
Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), said, “We take vaccine safety very seriously.” He wished we had the technology that could produce a vaccine in weeks or months, rather than the six to nine months it takes using the current tried-and-true technology.
“However, six months after the virus emerged, the H1N1 vaccine is becoming increasingly available with a high degree of confidence in its safety,” said Dr. Frieden. The CDC reports that the 2009 H1N1 vaccine includes all the same safeguards that gave hundreds of millions of doses of the seasonal flu vaccine an excellent safety record.
Dr. Frieden explained further, “If we had had the H1N1 vaccine ready earlier in the season, we would have most likely included it in the seasonal flu vaccination program, just as it will be in the Southern Hemisphere in their coming flu season.”
In the U.S., epidemiologists at the CDC are working with states to collect, compile and analyze reports of flu outbreaks while tracking the spread of all flu viruses.
In the meantime, practice safety and prevention by following the Department of Health guidelines. “A simple way to boost your overall health is to get a dose of seasonal flu and H1N1 vaccine,” according to DOH.
Other immunity-boosting and prevention safeguards recommended include: social distancing, not sharing drinking cups, covering your mouth when you sneeze or cough, washing your hands often, keeping surfaces clean, staying home when sick, keeping your pets healthy, practicing good hygiene and taking care of your own health with regular physical activity, getting enough sleep, and a diet that includes fruits and vegetables.
“This holistic message is becoming more and more important as the swine flu epidemic unfolds,” said Dr. Pang.
He recommends that those with underlying medical conditions (asthma, diabetes, heart disease, etc.), who are at a much higher risk of complications of the flu, should call their physician to discuss options before they become ill or if they become ill. Even without the vaccine, anti-viral drugs such as Tamiflu might be recommended.
But those without underlying risks, Dr. Pang said, who have flu symptoms (fever plus either a sore throat or cough), can treat themselves at home with hydration, rest and medicines (for fever, etc.). According to U.S. data, more than 95 percent of the cases were treating themselves at home.
Dr. Pang stated that the occurrences of H1N1 outbreaks are increasing on Maui, but said, “If you have flu symptoms, don’t panic. Please see your personal physician. It is extremely important to keep the hospital emergency room available for emergencies.”
But anyone with or without underlying conditions, who exhibits any one of the following symptoms should go to the hospital: difficulty breathing, cannot keep down fluids or food (vomiting), has changes in mental status (this covers a wide range from drowsiness to agitation/combativeness), or rebound fever (a second fever may be an indication of a bacterial infection).
High-risk individuals, healthcare workers and Critical Infrastructure Key Resource workers, such as police officers, have been given preference to receive the vaccine, but check with your healthcare provider or other designated distributors for H1N1 vaccine availability.

Boise pharmacy tests for flu

BOISE -- It’s a science experiment only eight pharmacies in the country are trying, and a store in Boise is one of them. Ladd Family Pharmacy wants to better understand the flu and how to treat it.
The primary focus of the study is to see whether pharmacists should be able to screen, diagnose and treat patients with flu-like symptoms.
"This is a great opportunity to be able to culture this virus and look at the epidemiology of it," said pharmacy owner Elaine Ladd. "I want to push the envelope." 
The closest pharmacy also doing this cutting-edge study is in Texas.
"So we are going to look at the strains, to see if they are mutating and we're going to look at resistance patterns to see. You know, is Tamiflu affective? Should we be looking at a different agent?" said Ladd.
That's just one benefit that will hopefully come from this study. Another is to see whether a jump start on treating the virus really makes a big difference.
"What we're seeing in the community right now is patients get influenza, and then, if it's not treated it can develop into pneumonia," said Ladd.
To make this study possible Ladd needs people with flu-like symptoms to test. People like Chetan Baxter whose husband and son are sick with the flu. Baxter sees the benefit of having the early screening, especially since her physician used only symptoms to diagnose her son. Ladd is doing a nasal swab and throat culture to actually test for the virus.
"I absolutely wish I would have known sooner, because we've been, the cough started last week. Had we gotten the jump on it, we'd be less concerned that now we're going into potentially Thanksgiving where we could still be sick," said Baxter.
In the pharmacy - those looking to get tested can be in and out in 20-minutes.
"If I'm sick now then I can take precautions to stay home and get well and not give it to everybody else," said Martha Vandivort who had the flu.
If someone shows up to the pharmacy to be tested, and the tests come back positive, the study then gives Ladd a random variable.
One option is for her to give the patient Tamiflu. The other would be to refer the patient to a doctor who prescribes Tamiflu. What that does is it delays the treatment three to four days. That way they can see the difference between immediate treatment compared to a delayed one. This study is free to the public and will be on going for the next one to two years. So far the pharmacy has screened only a handful of people.

Prescriptions for Tamiflu and other swine flu antivirals up 6%

U.S. prescriptions for Tamiflu, Relenza and two other antiviral drugs used in the fight against pandemic H1N1 influenza totaled 587,960 in the week ending Oct. 30, a 5.9% increase from the week before, according to Wolters Kluwer Pharma Solutions of Bridgewater, N.J. The number of prescriptions for the drugs filled in California during the week rose 2.2% to 15,048, according to the company. Nearly 98% of the prescriptions were for Tamiflu.
Wolters Kluwer provides information on prescriptions for the antivirals to the Food and Drug Administration to help that agency track progress of the flu. The company independently generated data about the prescriptions for The Times using a tool called Pharmaceutical Audit Suite.
There were 5,880 prescriptions filled in Los Angeles/Long Beach/Santa Ana during the week, an 8.5% increase from the week before; 1,873 filled in San Diego/Carlsbad/San Marcos, a 28.5% increase; and 1,135 in Riverside/San Bernardino/Ontario, a 2% decline. The rest of the state had much smaller numbers of prescriptions filled, and declines were common.
In other swine flu news:
- Asia will get its own stockpile of 500,000 courses of Tamiflu and Relenza by next April to help with shortages, a Japanese donor agency said today. The Japan Trust Fund will underwrite the $18-million stockpile, which will be held in Singapore and funneled to other countries as needed. That stockpile seems likely to be too late for the current flu season, however.
- Researchers at Ohio State University have put together another way to monitor how swine flu has been moving around the world. It can be seen here. The map uses genetic data from the swine flu virus to track how infections have moved from country to country.
- The debate continues over whether exposure to previous seasonal flu viruses or vaccination against them provides some protection against swine flu. Two papers last week reached diametrically opposite conclusions. A new report Monday from the La Jolla Institute for Allergy and Immunology comes down on the side of protection, although the amount of protection is not clear. In a study that was based in part on theory and in part on laboratory work, vaccine expert Alessandro Sette and his colleagues looked at the markers on the surface of seasonal flu viruses for the best 20 years and compared them to swine flu. They reported in the Proceedings of the National Academy of Sciences that there are enough similarities that T cells produced by the body against those markers should also recognize swine flu markers. Recognition of the swine flu virus by T cells would not prevent an infection, but it "may make the infection less severe," said co-author Bjoern Peters.
"This may explain why the pandemic has not been as severe as expected," said Alison Deckhut-Augustine of the National Institute of Allergy and Infectious Diseases, which funded the research.

Prices for H1N1 drug Tamiflu vary widely for same dose

Some pharmacies are charging three times what others are for a scarce liquid form of the H1N1 drug Tamiflu used by children, USA TODAY has found. At least two states' attorneys general are investigating.
The out-of-pocket price to fill the same liquid Tamiflu prescription can range from $43 to $130, according to USA TODAY's phone survey of more than 100 pharmacies in six states.
"We're very concerned because there is a shortage and exploiting a shortage is unconscionable," said Connecticut Attorney General Richard Blumenthal, who is investigating after finding similar price variations in his state. He's also probing potential price gouging with seasonal flu vaccine.
Mississippi is investigating, too. "We would ask that anyone who had any reports of overcharging for Tamiflu or the H1N1 vaccine to please call us," Attorney General Jim Hood said.
Swiss drugmaker Roche has focused on making Tamiflu capsules that are faster to produce. Because of the liquid shortage, some pharmacies make their own, mixing Tamiflu capsules into a sweet syrup. Liquid Tamiflu is mostly taken by children because it's easier to swallow and comes in lower doses.
About 2.2 million children younger than 6 have no health coverage, reports the Kaiser Family Foundation, a research group. The prices given to USA TODAY for the same liquid dose for children:
- Pennsylvania: $49-$94.
- Louisiana: $43-$110.
- Michigan: $49-$94.
- Kansas: $49-$99.
- Colorado: $65-$120.
- California: $55-$130.
"We're dealing with a national health epidemic," said Bruce Schneider, of Hart Pharmacy in Wichita whose price was $49. "If I want to sleep at night, I don't think I should be taking advantage of the situation."
Some variation in prices may be due to the cost and dosage of Tamiflu capsules a pharmacy stocks, said Mike DeAngelis, a CVS spokesman. CVS stores gave price quotes of $52 to $83.
Walgreens said it would charge $94.49, and Leanne Trela, director of retail clinical services, expressed surprise at lower prices.
Even parents with health coverage face delays in getting approval for the medicine, said Douglas Hoey of the National Community Pharmacists Association, which sent letters about coverage problems to some major prescription-benefits firms.
Inflated pharmacy charges are one reason claims are being rejected, said Maria Palumbo, a spokeswoman for Express Scripts, a leading benefits firm. "Unfortunately, we are seeing claims for compounded Tamiflu that are over five times the average costs for this product," she said.

Swine flu outbreak declared in Jersey

Jersey’s Health Department has declared a swine flu outbreak after a sharp increase in cases, particularly among children.
There were 119 cases last week compared with 34 cases the previous week. 50% of swabs taken for swine flu are now being confirmed as positive and 80% of these are children.
Consultant in Communicable Diseases, Dr Ivan Muscat, who's leading the control of the outbreak said: “Swine flu cases are now higher than the number of seasonal flu cases we would expect to see at this time of the year. We’re also seeing clusters in schools around the Island. 
"As a result, we will be moving to a heightened phase of containment during the next few weeks. By Wednesday (18 November), all school and nursery children will have been offered the vaccine. As it takes 14 days for immunity to develop, we have to do all we can to contain the virus until the vaccine takes effect. 
"This means that instead of waiting for lab results as we have been doing until now, we will assume that everyone who has a clinical diagnosis of swine flu has the virus and as a result, they and their contacts will be offered Tamiflu. To slow the spread of swine flu in schools, we will be offering Tamiflu more widely to school contacts."
These increased measures are being introduced because schools are a catalyst for outbreaks. Last week, between 80% and 90% of nursery and primary school children had the swine flu vaccine. If the take up is similar among secondary school children, it’s hoped these additional measures will only be in place for the next two to three weeks.
As part of the increased measures to contain swine flu, a free forehead thermometer is being sent to every home in Jersey from tomorrow (17 November). Householders will receive an envelope in the post with the thermometer, a letter (in English, Polish and Portuguese) explaining how it works and a leaflet with information about looking after children with flu symptoms. The thermometers are reusable and can be used by all the family. 
Dr Muscat said: "With numbers increasing on a daily basis now, it’s important that people are able to check their temperature as a fever of 38ºC or more is a key symptom of swine flu. People should still contact their doctor for treatment or to be signed off from work."
People are being urged to continue following the “catch it, bin it, kill it” message by practising good hygiene such as hand washing regularly and using tissues.

N.J. pharmacists face shortage of liquid Tamiflu, offer alternative

"There’s definitely a big increase in (requests for) the liquid Tamiflu compound," said Norton, whose group represents more than 20,000 independent pharmacies across the country, including 650 in New Jersey.
Because a vaccine for H1N1, or swine flu, is also in short supply, "parents are running to pharmacies to get the liquid Tamiflu," he said. The formula reduces the severity of the virus and is for children or anyone else unable to swallow the adult capsules. Chain pharmacies like Walgreens and CVS also create the compound.
At Panther Valley Pharmacy in Allamuchy, Anny Chan was ready when the H1N1 virus and seasonal flu hit. Like other pharmacists, Chan had already stocked up on the anti-viral Tamiflu capsules. Using guidelines set by the federal Centers for Disease Control and Prevention, Chan has been creating the liquid formula using crushed-up capsules and cherry syrup, a process she said that takes about 20 minutes for a 10-dose bottle.
Though the winter flu season is not quite under way, demand for liquid Tamiflu at Panther Valley is way up, co-owner Bob Eberle said. He called the confluence of H1N1 and seasonal flu, "the perfect storm."
The neighborhood pharmacy in Warren County has filled dozens of prescriptions for liquid Tamiflu in the last few weeks, including those for parents of children at an area school that registered a case of H1N1, Eberle said.
New Jersey has seen a steady increase in the amount of prescriptions filled for liquid Tamiflu, said Harvey Maldow, CEO of the New Jersey Pharmacists Association.
In late October, the government released its remaining 234,000 doses of liquid Tamiflu from a national stockpile. More supplies from Roche, the manufacturer, aren’t expected until next month.
Because the H1N1 virus qualifies as a national health emergency, the U.S. Food and Drug Administration issued an emergency use authorization for Tamiflu, relaxing some of the prescription rules and allowing some expired but still effective products to be used.
Children are at higher risk for catching H1N1 and developing serious complications. Since April, 540 children nationwide have died from the H1N1 virus, according to the CDC. Another 15 children have died from a non-specific flu virus.
On average, between 50 and 100 children die from seasonal flu each year.
While most people who catch H1N1 won’t need Tamiflu, the drug can be taken within 48 hours after symptoms start, to reduce the severity of the illness.
Alan Brown, pharmacist and owner of Liberty Drug and Surgical in Chatham, has filled hundreds of prescriptions for liquid Tamiflu in recent weeks, using the capsule-liquid compound.
That number represents a dramatic increase from this time last year, he said, when winter flu hadn’t hit. The compound, he said, takes pretty good. 
"Kids are not going to spit it out," Brown said.
Because of the time it takes to mix the adult Tamiflu capsule into liquid form, some big chain pharmacies have steered their customers to Liberty Drug, Brown said.
Others, like Walgreens, say nearly all its stores will make the compound. At CVS, pharmacists will mix Tamiflu "to make a liquid version when clinically appropriate," said Michael DeAngelis, a spokesman for the company.
Health officials have encouraged pharmacists to create the Tamiflu syrup compound, which is time-consuming and requires adjusting the dosage from capsule to liquid form.
Pharmacies generally charge about the same price for the liquid compound as for the regular liquid Tamiflu — about $90 without insurance — although the cost may be more in some places because of the added labor.
For Jim Cammarata, a pharmacist who runs the Valley Pharmacy in Pluckemin, Somerset County, the demand for the compound began about a week ago. He was ready, he said, with 200 boxes of the capsules compared with the usual six boxes he keeps in stock.
Cammarata, who has been in business for 19 years and is president of the Garden State Pharmacy Owners, said it’s the first time he’s had to compound liquid Tamiflu. "I know the procedure," he said. "Once you know it, it’s easy."

About 22 million Americans have become ill with pandemic H1N1 influenza in the past six months

About 22 million Americans have become ill with pandemic H1N1 influenza in the past six months and 3,900 have died, according to new estimates by the Centers for Disease Control and Prevention.
The number of pediatric deaths -- about 540 -- is four times as high as the number that physicians, hospitals and health departments had reported to the public health agency in Atlanta. 
The new estimates, drawn from detailed surveillance and record-checking in 10 states, sketch the most detailed picture by far of the national toll from the new flu strain that emerged in California and Mexico in April. 
"We feel we're finally able to update the public on how big a toll this virus is having so far," Anne Schuchat, a CDC physician helping to run the federal government's pandemic response, said Thursday. "I am expecting all these numbers, unfortunately, to continue to rise." 
The total number of people who have been hospitalized is 98,000, with 36,000 of them age 17 and younger. The vast majority of deaths -- about 2,920 -- have been in people age 18 to 64. 
In an average flu season, the seasonal virus contributes to the deaths of about 36,000 people -- 90 percent of whom are 65 or older. Many are close to death, with flu being only one factor leading to their demise. That is not the case with H1N1's victims, most of whom are much younger, and about 20 to 30 percent of whom were healthy before contracting the virus. 
All of the estimates come with substantial uncertainty. For example, total H1N1 cases in the United States range from 14 million to 34 million, and total deaths from 2,500 to 6,100. 
The CDC had previously said 129 people younger than 18 had died from H1N1 flu. That is compared with 88 deaths from seasonal flu in 2007-08 and 78 deaths in 2006-07 -- the most recent two flu seasons before the H1N1 strain emerged. 
The new estimate includes deaths that occurred outside hospitals, patients who tested negative for H1N1 but almost certainly had it, and other overlooked cases. 
"We don't think anything has changed," Schuchat said. "We think our 540 number is a better estimate for the big picture." She added, however, that the numbers affirm CDC's advice that "vaccination is the best effort to protect one's self or family." 
As of Thursday, about 42 million doses of pandemic vaccine had been delivered to the federal government, which is distributing it to states and cities. 
In an unrelated development, the World Health Organization on Thursday urged more aggressive use of antiviral medicines against the pandemic, especially in low-income countries where physicians may have been using the drugs only in severely ill people. 
"People in at-risk groups need to be treated with antivirals as soon as possible when they have flu symptoms," Nikki Shindo, a WHO physician, said Thursday in a news briefing for reporters. "This includes pregnant women, children under 2 years old, and people with underlying conditions such as respiratory problems." Specifically, practitioners should not wait for lab test results or a worsening of a patient's condition before prescribing oseltamivir (Tamiflu), which is the main drug used against the H1N1 strain. 
Roche, the Swiss pharmaceutical company that makes Tamiflu, is on track to make 33 million treatment courses a month by the end of the year, David Reddy, a company executive, said Thursday. The company has given 5 million courses to WHO and is delivering another 5 million. 
Reddy said that more than 100 countries have Tamiflu stockpiles. The company's drug-safety tracking system suggests that at least 80 percent of the drug made in the past seven months has not been used. 
Roche is selling Tamiflu at reduced prices to 72 countries, including Ukraine and several Central Asian nations formerly part of the Soviet Union, where the epidemic has been intense.

Rethink usage of Tamiflu, expert warns

Doctors should be cautious about giving Tamiflu to people to prevent them from becoming ill after they’ve been exposed to H1N1, an antiviral expert said Wednesday as he reported details of North America’s first reported case of Tamiflu-resistant H1N1 viruses.
Dr. Guy Boivin said people who’ve been exposed to the virus may already be in the process of becoming ill, a circumstance that can foster the emergence of Tamiflu-resistant viruses.
As of late last week the World Health Organization was reporting that 42 cases of Tamiflu-resistant pandemic H1N1 viruses had been seen globally since the pandemic began. The case Boivin reported on in the New England Journal of Medicine was the third, from late June.
"I have to admit I would have expected more cases, considering . . . the large volume of Tamiflu that has been used in the last few months, certainly more than in the last five years, probably," said Boivin, who is based at Laval University in Quebec City.
"But I’m still concerned that the same situation that has occurred with the seasonal H1N1 could be . . . repeated with the pandemic H1N1."
Seasonal H1N1 viruses developed resistance to Tamiflu a couple of years ago for reasons that remain unclear.
Though it had previously been thought that the mutation needed to confer resistance to the drug would cripple any resistant viruses that emerged, that proved not to be the case. The resistant viruses spread like wildfire, virtually crowding out susceptible seasonal H1N1 viruses and rendering Tamiflu useless against them.
Public health authorities worry that if that happened with seasonal H1N1 viruses, it could happen with the pandemic virus, especially at a time when much more of the drug is being used than ever before.
The case Boivin reported in the medical literature was played out in the popular press last summer.
A man from Quebec who had chronic lung disease was put on Tamiflu as prophylaxis after his teenage son, who had asthma, contracted H1N1 and was treated with the drug.
A prophylactic dose is one pill a day. A treatment dose is two pills a day.
The father started experiencing flu-like symptoms within about 24 hours of starting the drug, a likely signal that he was already sick. A prophylactic dose can stave off infection, but it isn’t powerful enough to kill off all the viruses in an infected person’s body. Those that survive are likely to be resistant to the drug.
In fact, about one-third of the cases of Tamiflu resistance that have been spotted so far have been in people who had been given the drug for prophylaxis.
"Because of that we need to limit as much as possible the use of Tamiflu prophylaxis and instead focus on early treatment," Boivin said.
He suggested if doctors do give patients Tamiflu to prevent H1N1 infection they should monitor them and switch them to a full treatment dose if they start experiencing symptoms.