- The Washington Times - Tuesday, May 16, 2006

The effectiveness the nation’s primary drug against an avian flu pandemic could be undermined by its unpleasant aftertaste, a D.C. nonprofit warned yesterday.

“If a mother and father actually does procure the drug, can they get it down their child’s throat?” asked Gunjan Koul, director of the International Association of Medicinal Compliance, at a taste test for the antiviral drug Tamiflu.

Ms. Koul cited an American Academy of Pediatrics study that found the rate of medicinal compliance among children — the primary carriers and transmitters of influenza — to be less than 50 percent, which she attributed largely to their reluctance to take medicine that tastes bad.

Tamiflu, one of two antiviral drugs being stockpiled by the Department of Health and Human Services, has a bitter, lasting aftertaste in its liquid form. Unless the drug is flavored with an additive, Ms. Koul warned, infected children might not take all their doses and risk causing the virus to mutate.

“No one’s talking about this issue,” said Ms. Koul. Along with executives from FlavoRx, a Bethesda company that makes flavorings for medicine, the IAMC has met with senators and HHS officials to persuade the government to stockpile flavoring in addition to the drug.

Woodie Neiss, chief financial officer for FlavoRx, said that government officials are probably “looking at the big picture right now.”

“You really have to taste it to have any understanding of how this would be a problem,” Mr. Neiss said.

The bitter aftertaste of Tamiflu is due to its base chemical, FlavoRx founder Kenny Kramm explained. Flavor additives designed for Tamiflu use a “bitterness suppressor” to prevent receptors on taste buds from sending bitterness signals to the brain.

Children have more taste buds than adults and are therefore more sensitive to taste, Mr. Kramm said.

To prepare for a potential flu pandemic, HHS plans to store enough antivirals to treat 25 percent of the population, a number based on historical data from the 1918 Spanish flu outbreak. So far, the government has purchased 26 million doses of antivirals and plans to have 81 million on hand by the end of 2008. About 80 percent of the U.S. stockpile consists of Tamiflu, which is manufactured by Roche Pharmaceuticals of Switzerland.

The number of documented human cases of avian flu as of Friday was 208 — 115 of which have resulted in death, according to the World Health Organization. While avian flu can infect humans on rare occasions, it mainly affects birds. A flu pandemic occurs when a new strain that has not been circulated among humans emerges.

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