As the flu continues to make inroads in the region, some area pharmacies have seen increased demand for the antiviral drug Tamiflu. But authorities say there is no cause for concern about supplies.
A temporary shortage of Tamiflu at Altru Health Center over the weekend affected two patients, but those patients "did receive adequate treatment" and the supply was replenished Monday, according to a statement from Altru.
"The shortage of the medication is a nationwide issue," the hospital noted.
A sampling of pharmacies in and around Grand Forks on Monday indicated that individual retail pharmacies were seeing an increased number of Tamiflu requests, but either had good supplies on hand or were confident that wholesalers could resupply them.
At Wall's Medicine Center on South Washington Street, pharmacist Todd Galbreath said that "especially today (Monday) we've seen an uptick, and our other pharmacy at the Aurora Medical Park said they've had quite a run on it. But they stocked up, and we're not having a problem at this point getting it from our wholesaler."
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Meanwhile, about 14 percent of Ben Franklin Elementary School's 343 students were held out of school all or part of Monday with flu-like symptoms, assistant superintendent Jody Thompson said.
"This was the latest location to be hit," he said. "We had 49 kids whose parents reported flu-like symptoms. They were excused from school and their parents have been asked to keep them home until they've been fever-free for at least 24 hours."
At Central High School, however, flu-related absences have declined from more than 70 early last week to 55 on Friday and 25 on Monday, Thompson said.
Don Shields, director of public health in Grand Forks, said Monday that his office is monitoring "reports of increased absences in the schools" due to flu-like symptoms, including increased numbers last week at St. Michael's School and Central High School.
But "based on the absentee rate, the North Dakota Department of Health is not yet recommending closures for the level we are seeing," he said.
Not severely ill
Central students "were reporting fever but not a severe illness" and staying out of school from three to seven days, Thompson said. "Younger kids are staying out a little longer than the older ones."
He said that absences due to the flu at Central this week "are not as bad as last week," and that the numbers at Ben Franklin "are within the range we've dealt with in the past with seasonal flu."
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At Larimore High School, Principal Dave Wheeler said that 47 students -- nearly a fifth of the grades 7-12 student body of 255 -- were kept home Monday, while Elementary Principal Leslie Wiegandt reported 33 of 200 students were absent, or 16.5 percent. "That's certainly higher than usual, but not drastic at this point," she said. The higher absences started last week when a couple dozen didn't come to school, she said.
In the past week and a half, Wheeler said, just three students in his building have tested positive for H1N1. Not all flu cases are tested for the presence of the H1N1, or swine flu, virus.
"The 47 students today, that's a pretty significant number for us," Wheeler said. "Last week, we had 24 to 30 students out on any given day. But today we saw a real spike. I definitely don't want to see it go up."
Most students who are sick report a fever, sore throat and bad cough, but they are not becoming violently ill, he said.
He said school officials would confer today to make sure that students are aware of and have access to teachers' Web pages and that arrangements are in place for homebound students to keep up on school assignments through the Internet.
Antivirals -- who gets them?
Shields said that "with the number of flu-like illnesses that we are seeing, we would expect the demand for antiviral medications like Tamiflu to increase," but there is a two-part process for pharmacies to obtain additional supplies.
The pharmacies should first apply directly through their regular suppliers, he said. When those sources are limited or not available, pharmacies and hospitals can access state supplies that were stockpiled for such an event.
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On Sept. 22, CDC updated its recommendations for priority use of influenza antivirals.
The priority use continues to be for people with more severe illness, such as those hospitalized with flu, and people at increased risk of flu-related complications, including children younger than 2, adults 65 and older, pregnant women, people with certain chronic medical or immunosuppressive conditions, and people younger than 19 who are receiving long-term aspirin therapy.
"Children 2 years to 4 years old are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children, although the risk is much lower than for children younger than 2 years old," the CDC guidelines state. "Children aged 2 years to 4 years without high risk conditions and who are not severely ill do not necessarily require antiviral treatment."
According to the CDC, treatment with antiviral drugs generally isn't appropriate for people not requiring hospitalization and not at higher risk for complications. However, a patient showing such warning signs as difficulty breathing, shortness of breath or signs of lower respiratory tract illness "should seek medical care promptly (and) receive antiviral therapy when indicated."
Ultimate decisions on whether to prescribe an antiviral remains with physicians, the CDC notes, "based on their clinical judgment." Treatment "should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from antiviral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset."
Waiting on vaccine
Shields said it will be two to three weeks before more vaccine for seasonal flu arrives here.
"There'll be enough for everyone," he said. "It's just a matter of time."
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Shipments of seasonal flu vaccine came to a halt about 10 days ago when manufacturers switched distributing priorities to vaccine for the H1N1 flu, also called swine flu.
A limited supply of the H1N1 vaccine reached Grand Forks last week, earmarked for health care workers who have priority because they'll treat other people who get sick, Shields said.
Shields and June Bergh, Polk County Public Health, said there are no walk-in or drive-through vaccine clinics scheduled now in Grand Forks and Polk counties. Bergh said she hopes the vaccine clinics for seasonal flu can be scheduled in November.
The CDC recently posted warning signs that may signal a patient with H1N1 flu is taking a turn for the worse and needs immediate medical help.
In children, the warning signs include fast breathing or difficulty breathing, skin turning bluish, not drinking enough liquids, being unusually hard to wake up or not interacting, and becoming irritable and not wanting to be held. Other warning signs: flu-like symptoms subside but then return with fever and a worse cough, or the child develops fever with a rash.
For adults, the warning signs are difficult breathing, shortness of breath, pain or pressure in the chest or abdomen, severe or persistent vomiting, dizziness or confusion.
Herald staff writers James R. Johnson and Ryan Johnson contributed to this report.
Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .
