First it was the rush for hand sanitizer. Then it was the quest for the vaccine. Now, as increasing numbers of children are coming down with swine flu, more parents are facing yet another anxiety-provoking chase: the hunt for liquid Tamiflu for kids.
Spot shortages of the liquid form of the medicine are forcing mothers and fathers to drive from pharmacy to pharmacy, often late into the evening after getting a diagnosis and prescription from a pediatrician, in search of the syrupy concoction recommended for the youngest victims of the global pandemic.
"It was so frustrating," said Cheryl Copeland of Silver Spring, who finally found some of the elusive medication for her sick 5-year-old son, William, at an independent drug store Monday after being turned away by a CVS and Rite Aid. "There was a moment when the first pharmacist said, 'We don't have it. There's been a run on it,' When I said to myself, 'Where on Earth am I going to find it?' "
The drug can make the flu milder, go away more quickly and may cut the risk of serious, potentially life-threatening complications. The shortages are being caused by a surge in demand because of the second wave of swine flu sweeping the country, combined with a decision by the Swiss company that makes the medication to focus on producing the drug in capsules.
In response, the federal government has shipped hundreds of thousands of courses to states from the Strategic National Stockpile, which is on standby in case there are bioterrorism attacks or natural disease outbreaks. Officials have also instructed doctors to suggest that pharmacists break open capsules and mix the powdered contents with syrup to make a liquefied version for children on their own if the company's version is unavailable.
‘Patients are getting treated’
The Food and Drug Administration and federal Centers for Disease Control and Prevention have also posted the formula for pharmacists to follow, including guidelines for the correct dosing by each child's weight.
Taken together, federal health officials are confident that there is enough Tamiflu available in the capsule or liquid forms to make sure children can get treated promptly.
"For the most part, patients, are getting treated," said Greg Burel, director of the CDC's division of the Strategic National Stockpile. "There have been shortages in sporadic spots, but generally it's still available."
Roche, the manufacturer, is still producing the liquid form of the medication. But after consulting with U.S. and World Health Organization officials, the firm decided to focus on the capsules when it ramped up production to meet an expected surge in demand after the H1N1 virus emerged in the spring. That allows it to produce 25 times the amount of medication it would have otherwise, officials said.
"The bottom line is looking at how the company could ramp up as quickly as possible to get as much medicine out as possible. This was the best way to do it," said company spokeswoman Kristina Becker, noting that the company has been increasing production capacity in 2005 since the ominous avian flu virus emerged in Asia.
The company also makes lower-dose capsules that children can take or parents can open themselves to mix the powder with a sweetened liquid to help them take it. But they should do this carefully following a doctor's instructions to ensure the the proper dose, officials said.
Health and Human Services Secretary Kathleen Sebelius released 300,000 doses of the liquid formulation from the national stockpile earlier this month, including some doses that had to be tested by FDA to make sure they were still potent because their expiration dates had expired.
"We believe the shortage may become more severe as the disease progresses in coming weeks," Burel said. "So what we tried to do is take steps to fill a potential gap."
Anxious hours for parents
But the spot shortages are creating anxious hours for many parents, especially because children appear to be among those at greatest risk from the disease. While the overwhelming majority of children who get swine flu recover, nearly 100 children have died from the disease so far this year, which is about double the number that die from the flu in a typical winter. The antiviral medication, also known as oseltamivir, along with another called zanamivir or Relenza, is highly effective, especially when administered within the first 48 hours of developing symptoms.
"The earlier the better," said Tim Uyeki, a medical epidemiologist at the CDC's influenza division. "Antiviral treatment should be started as quickly as possible."
In fact, in response to the pandemic the FDA issued a special emergency authorization in April allowing the use of Tamiflu for children younger than age 1. But many infants, and many other young children, can only swallow the liquid form of Tamiflu.
‘It was pretty stressful’
Shelley Waters Boots of Silver Spring scrambled to find some liquid Tamiflu for her 2-year-old son, Carlin, who was prescribed the medication at Holy Cross Hospital last week after being diagnosed with the swine flu. Carlin is considered at high risk because of his asthma. The first seven pharmacies Boots tried did not have it, prompting her to start frantically calling relatives in New York, Florida and California before finally finding the medicine at the same pharmacy where Copeland did.
"I was like, 'Thank god!' It was pretty stressful," Waters Boots said. "They said it was so important to get it in the next 48 hours. So that night before I found it I was freaking out."
The Kensington Pharmacy, which filled the prescriptions for Copeland and Boots, has been getting requests for 10 to 15 prescriptions a day.
"The formula is very simple," Tunc Husseyin, the pharmacy's owner, adding, however, that the process was more time-consuming than filling a typical prescription. "A lot of other pharmacies are calling us to see if we make it and sending us their patients."
Stores still experiencing shortages
Major drug store chains, including Walgreens, CVS, Rite Aid and Wal-Mart, say pharmacists at all their stores can prepare the liquid form of the medication individually, a process known as "compounding." But several of the national chains said that some of their stores were still experiencing spot shortages if they ran low on the capsules or the syrup, which is made by two companies that have been racing to keep up with demand as well.
In some cases, pharmacies have run low because of sudden outbreaks, such as what recently occurred in Crystal Lake, Ill.
"All of a sudden you have hundreds of kids out of school and we couldn't anticipate hundreds of prescriptions coming in within several hours," said James Cohn, a Walgreens spokesman. "Within 24 hours or so we are able to get supplies back into the location. But over time we're seeing more and more instances where there have been shortages."
Combined with her hunt for vaccine for her son and daughter, who also got the flu, Boots was frustrated by the government's response to the pandemic.
"We've been too little too late on both counts," she said. "It's the same story."
Staff writer Michael Laris and staff researcher Madonna Lebling contributed to this report.