title: Oseltamivir storage, distribution and dispensing following the 2009 H1N1 influenza outbreak in Mexico.
abstract: OBJECTIVE
  During an influenza outbreak or pandemic, timely access to antivirals is essential to reduce disease severity and transmission. Best practices in antiviral procurement, storage, distribution, prescription and dispensing must be followed for prompt drug delivery.
  
  
  METHODS
  Mexico implemented a national pandemic preparedness plan in 2006 and created a strategic antiviral stockpile. Oseltamivir powder was stored centrally in bulk for distribution to all 31 states and the capital district during an influenza outbreak.
  
  
  METHODS
  San Luis Potosí, in northern Mexico, was one of the states most intensely affected by the 2009 H1N1 influenza outbreak.
  
  
  RESULTS
  The oseltamivir powder was meant to be reconstituted locally but had to be reconstituted centrally during the 2009 influenza outbreak. Doubts arose surrounding the shelf-life of the reconstituted product. As a result of these problems, the first supply of the drug reached San Luis Potosí 11 days after the influenza outbreak had begun. Furthermore, dispensing criteria at the state level had to be changed in conformity with the availability of oseltamivir.
  
  
  CONCLUSIONS
  Antiviral demand forecasts should be based on clearly defined distribution and dispensing criteria and decentralization of some of the medication stockpile should be considered. Mexico's national pandemic preparedness plan needs to be updated in accordance with the lessons learnt in 2009 to improve strategic stockpile management and ensure rapid delivery of oseltamivir to the population.
authors.affiliation: Centre for Health Systems Research, National Institute of Public Health, Av Universidad 655, Col St Maria, Cuernavaca, Morelos, CP 62100, Mexico.
authors.forename: Luis Meave
authors.initials: LM
authors.lastname: Gutiérrez-Mendoza
authors.forename: Brian
authors.initials: B
authors.lastname: Schwartz
authors.forename: José de Jesús
authors.initials: Jde J
authors.lastname: Méndez de Lira
authors.forename: Veronika J
authors.initials: VJ
authors.lastname: Wirtz
mesh_terms: D000998:Antiviral Agents / Q000600:supply & distribution / Q000627:therapeutic use; D004304:Dosage Forms; D004356:Drug Storage / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects; D007251:Influenza, Human / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D008800:Mexico / Q000453:epidemiology; D053139:Oseltamivir / Q000600:supply & distribution / Q000627:therapeutic use*; D058873:Pandemics / Q000517:prevention & control*; D062205:Strategic Stockpile / Q000379:methods / Q000592:standards*
chemical_list: D000998:Antiviral Agents; D004304:Dosage Forms; D053139:Oseltamivir