Original Title: État des connaissances: maintien d’une réserve d’antiviraux contre l’influenza en prévision d’une pandémie de grippe

Authors' objectives: In preparation for an influenza pandemic, Quebec’s Ministère de la Santé et des Services sociaux (MSSS) set-up, in the early 2000s, an antiviral stockpile. The latter was used during the 2009 influenza pandemic and was replenished and maintained up to the present time. This state-of-knowledge report presents the results of a literature review based on a rapid review method and is aimed at guiding the MSSS in its decision-making process regarding the maintaining and replenishing of the stockpile.

Authors' results and conclusions: RESULTS: Here are the main findings: • Neuraminidase inhibitors (NAIs) are safe to use in adults during a pandemic and appear to be safe in children and pregnant women. • Oseltamivir and zanamivir appear to be effective in decreasing secondary influenza virus transmission during a pandemic when used as prophylaxis in a household with an infected member. • Community-based NAI treatment of patients with the influenza virus during a pandemic decreases the odds of hospital admission. This treatment is more effective when administered promptly ( 48 hrs). • In cases of influenza virus infection during a pandemic, prompt NAI treatment lowers the risk of hospital mortality in adults and appears to lower the risk in children. • A greater NAI supply was associated, in a statistically significant manner, with a reduction in virus A(H1N1)pdm09-related mortality during the 2009 pandemic. • The analysis of the impact of a national antiviral stockpile during a pandemic seems to indicate that it was useful and effective in several countries during the 2009 pandemic. • The information gathered on antiviral stockpiles in countries with a health-care system comparable to Quebec’s reveals that they will be maintained and replenished. Furthermore, they contain oseltamivir and zanamivir for average coverage of 30% of the population, and the average oseltamivir/zanamivir ratio in these stockpiles is 80/20. Thus far, none of these stockpiles contained peramivir, and there is generally little information on the proportion of doses reserved for the pediatric population. • The analysis of pharmacoeconomic studies indicates that setting up an antiviral stockpile is cost-effective when there is a major pandemic and when there is an appropriate use and a good efficacy of the antiviral drug. CONCLUSION: In brief, the results presented in this state-of-knowledge report seem rather favourable to maintaining a strategic stockpile of antivirals. Several mathematical models for determining optimal coverage of the population were analyzed. However, the size of Quebec’s antiviral stockpile will have to be determined theoretically by adjusting one of these models by incorporating Quebec contextual data into it while considering new recommendations issued by the Public Health Agency of Canada

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/maintien-dune-reserve-dantiviraux-contre-linfluenza-en-prevision-dune-pandemie-de-grippe.html

Year Published: 2017

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/maintien-dune-reserve-dantiviraux-contre-linfluenza-en-prevision-dune-pandemie-de-grippe.html

Requestor: Minister of Health

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec