Q: CDC medical officer Craig Hales, MD, MPH ("Doctor in the News,” June 2006), advised that if bird flu reaches the United States, physicians should consult their local health department about accessing stockpiles of antiviral medications. However, I have heard that the mortality of patients treated with oseltamivir (Tamiflu) was the same as in a nontreated group. If that’s the case, why are government agencies stockpiling oseltamivir?
A: Both you and the government are correct. Remember that these antivirals demonstrate clinical efficacy if used within 48 hours of symptom onset. In addition, prophylaxis is protective to those at risk but without signs of infection. Unfortunately, by the time influenza leads to significant symptoms that necessitate medical interventions and support, usually more than 48 hours have elapsed. In a pandemic, high-risk populations would be given oseltamivir as prophylaxis; those who are still at risk but not actually exposed would take the drug the moment any flulike symptoms developed. The efficient distribution of these stockpiles could save thousands of lives.
