Analysis of Strategies of the Use of Antiviral Medication in Patients with H1N1 2009 Influenza in Taiwan

Before the start of H1N1 2009 influenza pandemic, Taiwan has stockpiled antiviral medication enough for 10% of the total population. However, because the medication is not covered under the National Health Insurance Program, it was not widely used in the past. In April, 2009, when the pandemic first started, the Central Epidemic Command Center (CECC) adopted the policy of containment, and gave antiviral medication to treat all confirmed H1N1 2009 influenza cases and prophylax their close contacts with government-sponsored medication. However, following the announcement of the mild pandemic phase of H1N1 2009 influenza by the World Health Organization (WHO), the overall prevention and control strategies of H1N1 2009 influenza in Taiwan were shifted to mitigation, where screening with rapid influenza diagnostic test (RIDT) and antiviral treatment were employed as the primary control strategy before vaccines became available. Starting August 15, 2009, antiviral medication against influenza is covered under the National Health Insurance. It is approved for patients with influenza-like illnesses (ILIs) who are tested positive for influenza A with RIDT. Due to the inadequate sensitivity of the RIDT, antiviral medication is also approved in patients with ILIs who present danger signs of developing severe diseases, regardless of test results from RIDT. The cost of antiviral medication and screening is paid for by the government so that these expenses will not affect the maximum quota allocated to each medical provider under the National Health Insurance. Special clinics for ILIs and influenza clinics are also set to improve the accessibility of medial care for the general public. Analysis of the first 96 cases of hospitalized H1N1 2009 influenza cases due to pneumonia in Taiwan indicated that the proportion of patients taking Tamiflu within 48 hours from the onset of symptoms showed a statistically significant increase since August 15. In addition, the time from the onset of symptoms to seeking medical help was shortened, and the severity of diseases at the time of physician consultation was also reduced. These results suggest that by providing influenza screening and antiviral medication paid for by the government, as well as increased accessibility to medical care facilities, may have resulted in more rapid diagnosis and treatment for patients with influenza. We believe that as long as the general population has the correct concept about influenza, coupled with effective prevention and control strategies, we will be able to survive this influenza pandemic.