SACRAMENTO – California physicians are being discouraged from prescribing the drug Tamiflu for individuals who want it just in case a bird flu pandemic occurs, according to new guidelines issued today by the California Department of Health Services. Currently, the top priority for the drug, which is in limited supply worldwide, is for the treatment of seasonal flu among the elderly and others who are at high risk of complications from the disease, according to the guidelines.

"While it is understandable that concerns over a potential influenza pandemic may lead some individuals to request, and some healthcare providers to prescribe, Tamiflu when there is no immediate medical necessity, the department strongly discourages such practices," said State Health Officer Dr. Mark Horton. "It’s important to make sure that the drug is available now for those who really need it."

The guidelines note that "the indiscriminate and inappropriate use of Tamiflu may promote the development and spread of resistance among influenza viruses."

In preparation for a potential bird flu pandemic, President Bush released a $7.1 billion plan last week that calls for spending $1 billion to stockpile antiviral drugs such as Tamiflu.

No sustained or ongoing transmission of bird flu among humans has occurred and there is no evidence of bird flu in humans or birds in the United States.

"These guidelines will help preserve the limited supplies of Tamiflu for patients who are seriously ill from the seasonal flu that is circulating," said Dr. Glennah Trochet, Sacramento County health officer and president of the California Conference of Local Health Officers.

The guidelines also encourage healthcare providers to educate their patients about how to stay healthy during the current flu season by getting a flu shot, washing their hands often, covering their mouth and nose when coughing or sneezing and staying home from work or school when sick.

See Following Guidelines

Outbreaks of H5N1 avian influenza ("bird flu") in poultry in a number of countries and human cases in Southeast Asia have prompted some individuals to seek prescriptions for oseltamivir (Tamiflu) for future use in the event of a pandemic. While concern about avian influenza is understandable, no sustained or ongoing transmission of H5N1 avian influenza among humans has occurred and there has been no H5N1 avian influenza in poultry or humans in the United States.

Tamiflu is in limited supply worldwide. Individuals who acquire this drug for use during a potential future pandemic could make Tamiflu less available for those who need it to treat seasonal influenza. In addition, the indiscriminate and inappropriate use of Tamiflu may promote the development and spread of resistance among influenza viruses. Roche, the maker of Tamiflu, states its priority is to ensure Tamiflu will be available for seasonal use to patients and to fulfill government pandemic orders.

The U.S. Department of Health and Human Services Pandemic Influenza Plan states that, "It is not recommended that individuals, fearing a pandemic, stockpile oseltamivir in homes or that healthcare providers prescribe oseltamivir to individuals for prophylaxis against pandemic influenza. At the present time, quantities are insufficient to address all of the interim pre-determined groups,

and thus stockpiling oseltamivir will take away limited resources from those with highest priority."

Therefore, the California Department of Health Services (CDHS) issues the following guidelines regarding Tamiflu:

• While CDHS understands why concerns over a potential influenza pandemic may lead some individuals to request, and some healthcare providers to prescribe, Tamiflu when there is no medical necessity, the Department strongly discourages such practices.

• The highest current priority for use of Tamiflu is for treatment of seasonal influenza among people who are at highest risk from serious complications from influenza infection (e.g., persons 65 years of age or older, young children, and persons with certain chronic diseases).

• The next highest priority for use of Tamiflu and other influenza antiviral medications is for prophylaxis in persons at high risk of serious complications from influenza infection who are exposed to influenza (e.g., household in which someone has been diagnosed with influenza or hospital or nursing home with an outbreak of influenza) during the regular influenza season.

• Healthcare providers should educate their patients about steps they can take to keep themselves and others healthy this influenza season, including: getting a flu shot, covering mouth and nose when coughing or sneezing, staying home from work or school when sick, and washing hands often.

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