Hospitals scramble to stockpile drugs for treatment of flu

With sudden vaccine shortage, more cases of illness expected

October 09, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

There's just one commodity likely to get hotter than the vaccine used to prevent flu: the medicines doctors prescribe to treat it.

Within 90 minutes of learning that the nation's supply of vaccine had been cut nearly in half, infectious disease specialists at Johns Hopkins Hospital - which has just 500 of the 27,000 doses it had expected to get - were calculating their need for antiviral drugs.

"We really sat down and looked at how much we used in the past," said Dr. Trish Perl, Hopkins' chief of infection control. And then they upped the order - more than 12-fold in the case of the leading influenza drug.

"If we're unable to get any vaccines, it's very, very grim," said Perl. "[But] you have to have a plan that assumes you're not getting any vaccine."

Several large teaching hospitals found themselves scrambling this week to get more - or just any - vaccine after British officials suspended the manufacturing license of Chiron Corp. on Tuesday.

The California-based company, which makes the vaccine in Liverpool, was expected to supply 46 million to 48 million doses to the U.S. market this year.

Vanderbilt University Medical Center in Nashville had been relying solely on Chiron for its supply; Massachusetts General Hospital had just 10,000 of the 60,000 doses it had planned to administer this year.

Nancy Fiedler, a senior vice president at the Maryland Hospital Administration, said that preliminary information from a survey of hospitals by the state health department revealed bad news: 12 of 27 had no vaccine at all.

"Clearly, there is a level of great concern," she explained. "One of our hospital administrators said [of the problem]: `It's sort of like trying to turn an ocean liner on a dime.' "

Hospitals have two primary constituencies for influenza vaccine: Patients at high risk of complications from the flu, which kills 36,000 people in the United States every year, and the doctors, nurses and other workers who care for them.

At Hopkins, the pharmacy placed bulk orders this week for three antiviral treatments. Instead of the 800 bottles of amantadine the hospital bought last year, it will get 4,000 this year. Instead of last year's 33 bottles of rimantadine, it wants 100. Instead of 80 10-day courses of Tamiflu treatment, it will stock 1,000.

"Because I've never been in this situation, I can't tell you if it's enough," said Perl. "It's my best guess."

All three drugs can be used both to mitigate symptoms for people who have flu and to prevent it in the short term for those who have been exposed to the virus but are not yet sick.

Physicians said amantadine, which is approved for use in Parkinson's patients, has some potentially troubling side effects, including dizziness and blurred vision.

Dr. Harold C. Standiford, medical director of infection control at the University of Maryland Medical Center, which has only 300 vaccine doses, said antiviral drugs will likely become critical this year: "We'll be looking at that - as will the rest of the country."

A spokesman for Roche, the New Jersey-based maker of Tamiflu, said it's too early to know whether the vaccine shortage will ultimately mean a boost in sales. But there has been increased interest already.

"The sales force is getting inundated with calls from physicians asking them to stop by and asking them to bring samples," said Terence Hurley.

Sales of Tamiflu totaled about $260 million in last year's fourth quarter.

Starting next Friday, Baltimore area residents will be able to get a test for influenza - and a prescription for an antiviral drug should they need it - at local Target stores.

MinuteClinic, a Minnesota-based company that provides rapid immunizations, pregnancy tests and other health services at retail stores, has opened eight "mini-clinics" in the Baltimore area to diagnose people with flu symptoms.

A nasal swab test will reveal within 10 minutes whether they are infected. If they are, a certified nurse practitioner will write a prescription, on the spot, for amantadine or Tamiflu.

The only problem so far: the 28 nurse practitioners who will administer the swab tests haven't yet been able to get flu shots themselves.

"We'll keep looking," said Donna Haugland, a nurse practitioner and director of Maryland operations for MinuteClinic.

Maxim Healthcare of Maryland, which provides flu vaccines to grocery stores and pharmacies nationwide, said yesterday that it will follow federal guidelines that call for only the highest-risk people to get shot this year. To that end, patients will be required to sign a form declaring they are part of that group.

At Hopkins, in addition to rationing the vaccine doses she has, Perl has been considering other ways of addressing the shortage. She describes one as a kind of a humanitarian effort.

"I've actually been thinking about going to businesses in the city and saying, `Would you contribute some?' " she said. "If I could get an employer to donate 5 or 10 percent of what they have - maybe it's only 50 or 100 doses - what I could essentially do is offer vaccine to extremely high-risk patients and high-risk employees."

Standiford said getting through this year's shortage is one thing. Preventing it from happening again is another.

"You remember in the '70s, when we had the gas lines and everybody said ... `Boy, will we have to do some things differently. We have to get off the world's oil supply and get our own.' And it wasn't done," he said. "I hope this is a wake-up call that works."

Staff writer Julie Bell and wire services contributed to this article.

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