Q&A: Tamiflu and Relenza

Following are questions regarding the possible bird flu treatments Tamiflu and Relenza, along with responses from Dr. Anne Moscona, professor of pediatrics (infectious diseases) and of microbiology and immunology, and vice chair of pediatrics for research, Weill Medical College of Cornell University and New York-Presbyterian Hospital/Weill Cornell Medical Center.

Q: I have two small children, and would like to have medications ready prior to infection, as medical facilities will most likely be overwhelmed almost immediately. Are there national or local U.S. sites for obtaining viral medications, such as Tamiflu, in home and community preparation for the pending pandemic? -- Natalie, Coral Springs, Fla.

A: Antiviral medicines are being stockpiled by the U.S. government for distribution in the time of need. Physicians and hospitals will be ready to dispense medicines as needed, and we are currently working on strategies for communities to efficiently distribute antivirals. At this time it is generally not recommended that individuals or families develop their own supply of antiviral medications.

Q: Are doctors generally authorized to prescribe preparatory doses of viral agents to currently healthy people? -- Natalie, Coral Springs, Fla.

A: It has been strongly suggested that physicians in the U.S. not dispense antiviral medications to people who are neither infected with influenza nor exposed to influenza. Exceptions are made for people who are at specific risk, for example, due to their travel or occupational needs. Physicians need to make decisions on a case-by-case basis and need to be very judicious in the prescription of medication to individuals who are not ill.

Q: I've read that the government is stockpiling 25 million doses of Tamiflu, an antiviral drug that could ease the symptoms of "bird flu." Since 25 million would cover basically the New York City metropolitan area, what are the rest of us supposed to do? Why are private citizens not allowed to stockpile Tamiflu? -- Brandy, Toledo, Ohio

A: At this point in time, it is not possible to protect every human being with Tamiflu; there is simply not enough. Therefore the medicines [Tamiflu and Relenza] are being stockpiled by the government for distribution in the time of need. Plans are being put in place to make the most effective use of this scarce resource. For many of us, this is the first time that we have to deal with a situation where these kinds of choices must be made, and it is putting a tremendous stress on our society.

If individuals stockpile Tamiflu, we run the risk that the drug will be used inappropriately [shared between individuals in families, taken at lower doses or for shorter courses to stretch this resource] and this could lead to the emergence of Tamiflu-resistant influenza in the U.S. This would dramatically worsen our situation, by incapacitating one of our main weapons against influenza [seasonal and/or pandemic].

Q: Isn't it more effective to work on a bird flu vaccine than stockpiling Tamiflu? - Nhi, Lincoln, Neb.

A: We need both strategies to protect us against a potential pandemic caused by a new strain of influenza. Vaccines will be the best first-line of defense, but will likely not be available in time for the first wave of a pandemic, since there is a lag time between identification of the relevant strain and manufacture of the vaccine against it. There are many people who will not be protected by a vaccine, even when vaccines are available, for a variety of reasons. Thus, while scientists around the world are working very hard and cooperatively to develop appropriate and effective vaccines, we need to consider that we will also need antiviral medications, and we need to stockpile the drugs that we have as well as develop new antiviral medicines.