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Antiviral adherence low during H1N1 pandemic in England
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New data published in PLOS One suggest that approximately half of the prescriptions for oseltamivir during the 2009 influenza A(H1N1) pandemic went unused in England.
Researchers from England and Sweden concluded this after conducting a study estimating the levels of oseltamivir (Tamiflu, Genentech) in water samples taken from two waste water treatment plants. According to Andrew Singer, PhD, of the Natural Environment Research Council’s Centre for Ecology and Hydrology, nearly all of the oseltamivir consumed is released into the sewage in the active viral form.
Andrew Singer
“During the 2009 H1N1 pandemic, oseltamivir became the focal point for an in-depth study when accurate records about how much of the drug was dispensed became available,” Singer told Infectious Disease News. “These records afforded us the opportunity to compare the drug allocation with the amount of drug actually in the sewage influent. These two numbers should match well, as oseltamivir doesn’t degrade in the body or rapidly degrade in waste water.”
Singer and colleagues evaluated waste water from one rural plant and one urban plant using samples that were taken every hour during a 24-hour period. They also made predictions on oseltamivir consumption based on data from two sources of government statistics.
The data suggested that three to four people in the rural setting used oseltamivir, and in the urban setting, the data suggested that 120 to 154 used oseltamivir. These numbers indicate a compliance rate of 45% to 60%.
Singer said this study has two main implications for public health. First, pandemic preparedness plans must account for the possibility that adherence could be low. Second, understanding adherence can be greatly improved through the use of the waste water epidemiology approach.
“It is my hope that health professionals will see this opportunity and choose to collaborate with environmental chemists to provide this insight,” Singer said. “Many models are used to estimate the number of hospital beds, respirators, etc, that are needed during a pandemic. We might need to consider that delivery of antivirals to those who need it might not yield any societal benefit.”
Andrew Singer, PhD, can be reached at NERC Centre for Ecology & Hydrology, Maclean Building, Crowmarsh Gifford, Wallingford, Oxfordshire, OX10 8BB; email: acsi@ceh.ac.uk.
Disclosure: The researchers report no relevant financial disclosures.
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