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Pandemic Planning Toolkit A resource to assist your organization in preparing for pandemic influenza

TAMIFLU® (oseltamivir phosphate) has been studied only in strains of influenza that were circulating at the time. The magnitude of effect of TAMIFLU in treating and preventing novel strains of influenza, such as those that may be involved in a pandemic, cannot be predicted.

How would a pandemic impact mortality?

A wide range of estimates15

Central to preparedness planning is estimating the mortality rates of the next pandemic. Experts' answers to this fundamental question have ranged from 2 million to more than 50 million. All of these predictions are scientifically grounded. The reasons for the wide range of estimates are numerous.
 
Some estimates are based on extrapolations from past pandemics, but significant details of these events are disputed, such as the true numbers of resulting deaths. The most precise predictions are based on the pandemic in 1968, but even in this case estimates vary from 1 million to 4 million deaths. Similarly, the number of deaths from the Spanish flu pandemic of 1918 is posited by different investigators to range from 20 million to well over 50 million.
 
Extrapolations are problematic because the world of today is a different place from the world of 1918. The impact of greatly improved nutrition and healthcare needs to be weighed against the contribution the increase in international travel would have on global spread. The specific characteristics of a future pandemic virus cannot be predicted. It may affect 20% to 50% of the total population. It is also unknown how pathogenic a novel virus would be.

Millions likely to be affected-even in a moderate pandemic15

Even in the best case scenarios of the next pandemic, 2 to 7 million people could die and tens of millions would require medical attention worldwide.
 
Two scenarios for the potential impact
of a flu pandemic on the US12
 
Characteristic
Moderate (1958/68-like)
Severe
(1918-like)
Illness 90 million (30%) 90 million (30%)
Outpatient medical care 45 million (50%) 45 million (50%)
Hospitalization 865,000 9,900,000
ICU care 128,750 1,465,000
Mechanical ventilation 64,975 742,500
Deaths 209,000 1,903,000
 

Learn about the role vaccines will play in the event of a pandemic.

 
FOOTNOTE
12. Osterholm MT. Understanding pandemic influenza in the modern world. Paper presented at: Business Planning for Pandemic Influenza:
A National Summit; February 14, 2006; Minneapolis, Minn.
15. World Health Organization. Estimating the impact of the next influenza pandemic: enhancing preparedness. December 8, 2004. Available at: http://www.who.int/csr/disease/influenza/preparedness2004_12_08/en/. Accessed April 13, 2006.
Indications

TAMIFLU is indicated for the treatment of uncomplicated influenza caused by viruses types A and B in patients 1 year and older who have been symptomatic for no more than 2 days.

TAMIFLU is also indicated for the prophylaxis of influenza in patients 1 year and older.

TAMIFLU is not a substitute for early and annual vaccination as recommended by the Centers for Disease Control's Advisory Committee on Immunization Practices (ACIP).

Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use 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 >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.

Please see TAMIFLU full Prescribing Information for additional safety information.
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