Several challenges are unique to managing pediatric medical surges, particularly for the healthcare workforce and supply chain. For one, pediatric hospitals require more intensive nursing resources to treat and monitor patients, especially in intensive care and neonatal intensive care units.
 
Additionally, pediatric supply chains can also be more vulnerable to supply chain disruptions, as some critical products have only one supplier or manufacturer capable of producing the necessary pediatric-specific equipment and supplies.

Product Availability

• Definitions for product shortage varies by organization. Healthcare Ready sources data from multiple organizations that maintain drug shortage lists, including:
  • American Society of Health-System Pharmacists (ASHP), which defines a drug shortage as “a supply issue that affects how the pharmacy prepares or dispenses a drug product or influences patient care when prescribers must use an alternative agent.”
  • US Food and Drug Administration (FDA), which defines a drug shortage as “a situation where the total supply of all versions of the approved product available at the user level will not meet the current demand, and a registered alternative manufacturer will not meet the current and/or projected demands for the potentially medically necessary use(s) at the user level.”
• Amoxicillin remains in short supply.
  • On November 7, USAntibiotics, the sole-licensed American manufacturer of penicillin-based Amoxicillin and Amoxil Clavulanate (Augmentin), noted that they have reached out to the Biden Administration to inform them that every dose of Amoxicillin that will be needed in the US over the next five years can be manufactured and stored at their facility in Tennessee.
  • Physicians should be aware of alternatives for amoxicillin when prescribing it to their patients. Some manufacturers have placed limits on the amount of pharmacies can order to respond to this shortage.
• ASHP’s current drug shortages list includes the following drugs that could negatively impact treatment of RSV and other respiratory illnesses:
  • As of 11/21, Sodium chloride solution of various formulations for injection from Fresenius Kabi and Pfizer. The reasons for the shortage are manufacturing delays. Resupply dates are anticipated at the end of November for Pfizer and early December for Fresenius Kabi.
  • As of 11/21, Rocuronium injection, used during tracheal intubation, is in shortage from several manufacturers due to increased demand and manufacturing delays. Estimated resupply dates vary based on manufacturer.  
  • As of 11/21, certain formulations of Oseltamivir, commonly known as Tamiflu, have been reported in short supply by several manufacturers. The FDA has yet to report a national shortage of this drug as they believe other manufacturers can meet demand. As this antiviral is used to treat influenza, physicians may need to prescribe other medications if their patients cannot find Tamiflu in pharmacies.
• FDA’s drug shortage database list the following updates regarding drugs that may be related to treating respiratory illness:
  • As of 11/21, Amoxicillin oral powder for suspension is available for current customers from Hikma pharmaceuticals. However, as of 11/21, most of the amoxicillin oral powder product for suspension from Sandoz is unavailable.
  • As of 11/21, albuterol sulfate, a bronchodilator for oral inhalation, manufactured by Akorn Pharmaceuticals, remains unavailable and is estimated to be back in stock by Q2 2023. A 5 mL version from Nephron Pharmaceuticals is available.

According to some pediatric clinics, RSV, influenza, and COVID-19 testing kits have been on backorder.

Treatments for RSV

A monoclonal antibody therapy called palivizumab is available as a precautionary measure to prevent severe RSV illness in certain infants and children at high risk for severe disease during the normal respiratory season. It cannot cure or treat children who are already suffering from severe cases of RSV; it is a preventative treatment.

• On 11/17, AAP updated its guidance: Given the known efficacy of palivizumab along with the unpredictable surge capability of RSV, AAP recommends programmatic consideration of providing more than five consecutive doses of palivizumab depending on the duration of the current RSV surge in a particular region of the country.
• Palivizumab is sold under the brand name Synagis, and is marketed by Sobi in the United States. Sobi purchased US rights to Synagis from AstraZeneca in 2018. Before COVID-19, physicians prescribed Palivizumab more frequently as a preventative measure, yet, this treatment strategy slowed during the pandemic.
• AAP says that it recommends Palivizumab in eligible infants in regions that are experiencing high rates of RSV and that it will release updated guidance as they monitor the seasonal trends.

While there is not yet a vaccine for RSV, on 11/1, Pfizer announced that they would seek FDA approval for their RSV vaccine by the end of 2022.

Workforce Shortages

Ongoing workforce shortages may threaten the ability for facilities to establish a predictable quality of care for patients. Because pediatrics is a specialty practice, there may be additional strain on the workforce with pediatric care experience. Reports indicate that pediatricians are requesting increased federal support as they deal with RSV, COVID-19, and influenza treatment in unison. Physicians state that they can only successfully handle this “tripledemic” with the assistance of a federal emergency declaration and dissemination of support.
 
Hospitals and other healthcare facilities may need to increase surveillance for respiratory illnesses among staff to reduce spread and the potential for staff being out sick. Practitioner mental health should also be considered and protected. Additional training and support for practitioners that are not used to caring for acute pediatrics cases for prolonged periods should be provided whenever possible.