Intermittent shortage of liquid kids' Tylenol in Kotzebue is a sign of Alaska's busy respiratory virus season

Jan. 14—Maniilaq Pharmacy in Kotzebue was out of liquid children's Tylenol last week, following a national trend of children's medication shortages fueled by the spread of respiratory viruses, and at least one other site in the community had a diminished supply.

"There is no Tylenol at AC right now," said a Kotzebue resident and mother of two, Suskran Candice Baldwin. "I knew the flu and RSV season was coming so ... I ordered some infants' and children's Tylenol ahead of time."

Maniilaq Pharmacy did have chewable Tylenol and liquid ibuprofen available, according to a Facebook post from Maniilaq Association, and it was working on boosting its stock of liquid Tylenol.

"The pharmacy is sourcing all options to obtain the liquid Tylenol," Maniilaq officials said. "The FDA is aware of the shortages and is working with manufacturers to remedy the problem."

Liquid Tylenol and liquid ibuprofen are the two most commonly used drugs for treating the symptoms of colds, RSV and influenza among children, said Coleman Cutchins, a clinical pharmacist with the Alaska Department of Health. While the medications don't treat viruses, they decrease fevers and relieve pain, and health officials say the busy respiratory virus season has brought intermittent shortages to some areas.

"All over the nation, really since about the middle to late November, since we've started to see these large surges and respiratory viruses, have there been localized rolling shortages of both children's liquid Tylenol and liquid ibuprofen," Cutchins said.

Liquid formulations are easier to take for children, some of whom might have difficulty swallowing capsules. It's also easier to measure the right dosage with liquid drugs — an important factor, given that the medications' recommended doses are based on the weight of the child.

While there's almost always something in short supply in the pharmaceutical world, what's most concerning for health specialists is drug shortages caused by manufacturing problems, Cutchins said. For example, a manufacturing line shut down or a big batch of medications recalled can cause a long-lasting shortage.

"The shortages we're seeing right now with children's liquid Tylenol and children's liquid formulations of ibuprofen are not due to manufacturing issues, so that's good news," Cutchins said.

Increased respiratory virus cases

The rise in the spread of several respiratory viruses is at the heart of the shortages, Maniilaq officials said.

Alaska overall experienced an earlier-than-usual start to this year's flu season, which now appears to have peaked, according to recent data from the state Department of Health.

Health officials said this week that influenza rates have been falling across much of the state since December but that the virus is still circulating at relatively high levels, and activity varies by region.

[Alaska's flu season appears to have peaked. Anchorage's 'snowmageddon' may have helped.]

While it's difficult to say what causes regional differences, in some cases, they depend on how much health care providers are testing people for influenza, and in others, on how much virus circulates in the area, state epidemiologist Joe McLaughlin said.

"In the Northwest, you can see there appears to be a lot more influenza activity that started sort of earlier on and then peaked at a higher rate compared to most of the other regions in the state," McLaughlin said. "You can see that that activity was sort of more prolonged than we've seen in other regions. "

Nationally, there was a big spike in influenza activity, then a pretty significant decline, McLaughlin said. In Alaska, the situation is similar.

"A big spike that we had here in Alaska, it peaked sort of mid-December-ish," McLaughlin said. "We've been on a constant and very steady precipitous decline in influenza activity statewide."

While this spike — led by influenza type A — is trending downward, it's possible that we could also see a big influenza B spike, similar to a trend seen recently in South Africa, McLaughlin said.

"If you've already had flu this year, you're not completely out of the woods because you could still get infected with another strain of the virus," he said. "That's why it's important to get the vaccine."

When it comes to respiratory syncytial virus, or RSV, in Alaska and in the western part of the United States the rates are a little higher but on a decline, McLaughlin said.

"Overall, a downward trajectory, but again, some regional variation there," McLaughlin said. "We've had much higher RSV activity (this year) and the RSV peak occurred much earlier than in recent previous years."

In the United States, RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year old, according to the state health department, so it's important to make sure children are safe from catching it.

Lastly, there was a slight increase in COVID-19 nationally, gradually traveling from the east. It is driven by several omicron variants, and the most dominant one, XBB.1.5, is a little more efficient at evading prior immunity and is leading to more hospitalizations among vulnerable populations.

"The vaccine is still effective," McLaughlin said. "That bivalent booster really does a great job of protecting against hospitalization."

Antiviral treatment options are available for both COVID and influenza for those who are high risk, but the treatments need to be started soon after you start experiencing symptoms, Cutchins said.

[New variant XBB.1.5 is 'most transmissible' yet, could fuel covid wave]

Addressing the shortage

While several of the viruses are currently declining, intermittent shortages of liquid Tylenol and liquid ibuprofen could stick around for some time.

The manufacturers of Tylenol and ibuprofen were able to significantly increase capacity, and "are producing more drugs than they did this time last year or even this time three months ago," Cutchins said.

Still, short-lived, several-days-long issues might persist until the end of the season, and in rural Alaska, shipping and logistics issues are making the situation trickier.

"I think we're going to see short, localized, rolling shortages of these types of drugs, until the respiratory virus season really subsides," Cutchins said.

In the absence of Tylenol or ibuprofen, it's important to not give children aspirin, Cutchins said.

Instead, he recommended that parents purchase necessary medicine when it's available and keep it at home during the flu season.

"When my kids were young, we just always kept a bottle of both ibuprofen and Tylenol," he said.

Staying at home when sick, distancing, avoiding group gatherings when others are sick, choosing to wear masks and washing hands "all help protect us from all of these other viruses like flu, RSV and other cold viruses," he said.

"Keep your child well hydrated," he said, "make sure they're eating, make sure they're getting well rested."