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Tuesday, Feb. 4, 2003
EPIDEMIC HITS EARLY
Docs find flu drug dearth hard to swallow
By TOMOKO OTAKE
Pediatrician Jiro Tsukada says that being stingy has become part of his job.
Every day, Tsukada, who runs a clinic in Joetsu, Niigata Prefecture, carefully monitors the inventory of one particular drug in his pharmacy, counting the number of capsules he receives from wholesalers and the number he prescribes to patients.
The reason? Since a strong type-A Hong Kong influenza virus started spreading rapidly in Japan's snowiest regions in mid-December, the drug oseltamivir -- known to significantly relieve flu symptoms -- has been in short supply.
"I make sure not to waste any," Tsukada said.
Thousands of doctors across the country are strictly rationing the drug as a flu epidemic grips the nation. In the week ending Jan. 18, 18,737 schoolchildren fell ill and 491 classes were canceled nationwide.
Chugai Pharmaceutical Co., which distributes the prescription drug oseltamivir, or Tamiflu as it is more commonly known, called a news conference Jan. 17 to apologize for the drug's shortage.
Even before the flu season arrived, a new powdered version of the drug was eagerly awaited by doctors. Encapsulated Tamiflu, the first orally administered medicine that can treat both type-A and type-B strains of influenza, quickly gained popularity after hitting the Japanese market in February 2001.
Government approval of a sweetened, powdered type developed for children followed in April, and pediatricians, including Tsukada, were hoping to be able to prescribe it this season.
Influenza, which during major outbreaks in Japan has claimed more than 1,000 lives in a single season, is characterized by three or four days of high fever coupled with soar throat, headache and muscle soreness.
Flu drugs are known to significantly relieve the symptoms if they are taken within 48 hours of the first signs of illness.
But Chugai failed to cash in on its own highly touted medicine. One reason is that the powdered Tamiflu that was to be shipped last summer for sale this season was not suitable for distribution, Chugai spokesman Hiroshi Araki explained.
During quality-control inspections prior to shipment, yellow dots were detected in the powder -- suggesting the sweetening additive was overheated in production.
Word that shipments of the powder were to be delayed spurred an ordering frenzy, both for powdered and encapsulated Tamiflu, by drug wholesalers.
With the shortage of Tamiflu, less desirable prescription drugs are being doled out instead. One of them, amantadine, only works for type-A strains and has side effects. There are also reports that amantadine creates drug-resistant viruses.
A newer drug, zanamivir, which blocks a virus-spreading enzyme, is highly effective in treating both type-A and -B flus, and has fewer reported side effects. However, zanamivir is available only in inhaler form.
Making matters worse was the early arrival of a flu epidemic this season.
After the government issued the nation's first flu alert in Hokkaido and three areas in western Japan at the beginning of December, the virus quickly spread, covering the entire archipelago by mid-January. In the past few years, this hasn't occurred until mid-February, experts said.
While Chugai recently sent 790,000 emergency orders for Tamiflu to its Swiss-based parent, Roche, which will boost production for this season to cover 4.46 million people, the shortage will persist for some time, since it normally takes three months to fill such orders, according to Chugai officials.
Some experts also believe that demand for Tamiflu was boosted at least in part by the fact that flu vaccinations -- used in the United States as a primary method for preventing influenza -- are not widely administered in Japan.
Government subsidies for vaccinations for the elderly were instituted two years ago, but the rest of the population must pay for their own flu shots, which range in cost from 2,500 yen to nearly 10,000 yen.
The shortage of Tamiflu has caused another problem.
Jun Saito, a doctor in Shinagawa Ward, Tokyo, said that due to the drug's scarcity, he has been forced to prescribe only enough for three days, even though the recommended duration of the treatment is five days.
Many of his patients feel better after taking Tamiflu for a few days and return to work or school, even though the virus has not been eradicated. In the past, before the widespread use of Tamiflu and other drugs, a lingering fever would often keep sufferers in bed for up to five days.
"It seems that many people are now spreading the virus without knowing it," Saito said.
Tsukada of Niigata, who is tired of worrying about his drug supplies, said the government should consider stockpiling vaccines and drugs as part of a "crisis management" plan.
"Three seasons ago, there was a massive shortage of vaccines," he said. "Then last year and the year before there was a fuss over not having enough flu-test kits available. Now this. And these are supposed to be 'normal' seasons because the viruses are old.
"What are we going to do if a brand new strain breaks out?"