Swine flu is sickening so many children across the country, some of them fatally, that federal health officials decided Friday to release the last of the national stockpile of children’s Tamiflu.
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Ibrahim Usta/Associated Press
On Friday, workers in Istanbul disinfectanted a primary school classroom as a precaution against swine flu.
Barbara Lewis/Humco Holding Group
Bottles of Humco Cherry Syrup on the production line in Texas. It is a flavoring agent used for oral Tamiflu.
Even though the winter flu season has yet to begin, flu has now killed 114 children and teenagers in the United States since April, said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.
Since the C.D.C. began tracking children’s flu deaths five years ago, the highest toll was 88, in the winter of 2007-8; many more children died in the pandemics of 1918, 1957 and 1968, but there are no accurate counts.
Dr. Frieden’s figures were for deaths confirmed by laboratories. On Thursday, the C.D.C. estimated that in the swine flu’s spring wave there were 2.7 deaths for each confirmed one, so the actual number of children’s deaths may be closer to 300.
On Oct. 1, anticipating shortages of liquid Tamiflu for children, the government released 300,000 doses from the national stockpile. On Friday, it released the last 234,000 doses.
It has ordered more from Roche, its Swiss manufacturer, but that is not expected to arrive before January, Dr. Frieden said.
In the meantime, federal officials are encouraging pharmacies to empty powder from adult capsules and dilute it with syrup into children’s doses. Some large pharmacy chains are already doing so. Presumably, the same could be done with the 37 million adult doses still in the stockpile. (The Strategic National Stockpile has many more adult doses because they are lighter and easier to manage, and because it was created in anticipation of a pandemic of avian flu, which was not known to disproportionately affect children.)
Terence Hurley, a spokesman for Roche, said Friday that the company would have more of the liquid version to send to private pharmacies in December.
In addition, Dr. Frieden said he would consider importing generic Tamiflu if it could win Food and Drug Administration approval. The generic name is oseltamivir.
Yusuf Hamied, the chairman of Cipla Ltd., an Indian company that makes the only oseltamivir other than Roche’s to be approved by the World Health Organization, said he could supply the United States with about one million children’s doses in four to six weeks.
“Cipla is more than willing to cooperate in any way possible,” Mr. Hamied said. “I’ll work my factories night and day if necessary.”
His price, he said, would be 20 to 30 percent below Roche’s.
Roche has vastly increased its Tamiflu production in the last few years, in part to keep governments from canceling its patents or buying generic rivals during pandemic emergencies. Of the 114 children who have died, more than two-thirds had some kind of underlying health problem, Dr. Frieden said.
Local newspaper reports of deaths around the country have included children with cystic fibrosis, muscular dystrophy and other illnesses. But they have also included children who were healthy and athletic and yet died quickly and unexpectedly.
One disturbing trend, Dr. Frieden said, was that a C.D.C. survey showed that only about half of all people with flu symptoms who also had other potentially dangerous medical problems like diabetes, asthma or lung and heart disease sought care from a doctor.
“People with underlying conditions who have a fever or cough should see their provider promptly,” he said.
Deaths are expected to keep rising, he said. Flu activity is now widespread in 48 states, up from 46 last week. Hospitalizations start to go up about a week after people start falling ill in any community, and deaths tend to lag two to three weeks behind that, Dr. Frieden said.
People are usually ill for a few days before they are hospitalized, and dangerously ill people are usually on ventilators for at least a week before they recover or die. Laboratory reports and autopsies create further delays in reporting deaths.
There are now nearly 27 million doses of swine flu vaccine available, Dr. Frieden said, up from 16 million a week ago. The clamor for the shots continues to rise, however, and even some cities that had many cases in the spring, like Boston, are seeing a second wave.
Dr. Frieden singled out Maine as having done a particularly good job of vaccinating schoolchildren by creating teams that pulled them out of classes briefly for shots.
Maine had a serious flu outbreak in its summer camps; it also has a small population.
Dr. Frieden said he was “encouraged” when any school could vaccinate half its student body.
“We don’t expect to see anything like 80 or 90 percent of kids being vaccinated,” he said, “though if that happened, it would be great.”
Also on Friday, the World Health Organization said it would soon start shipping swine flu vaccine to 95 poor and middle-income countries.
About 200 million doses have been donated by from various countries and vaccine makers.
That will cover only 2 to 3 percent of the need, but the W.H.O.’s eventual goal is to provide enough vaccine for 10 percent of those countries’ populations.
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