Sunday, June 24, 2007

June 24 Flu Update

78,000 chickens have been killed in six days in Bangladesh.

Vietnam has "prioritized" fighting the bird flu.

Revere blogs the stories this week on anti-viral resistance of the flu virus. As always, cautions against over-interpretation, and notes that anti-virals have a "synergy" with other basic, solid public health measures.

More response in NZ to bird flu planning exercise.

1 Comments:

At 6:42 PM, Blogger Wulfgang said...

Orange;

I found Revere’s discussion of Tamiflu resistance fairly informative (as usual), especially in regard to implications applied to pandemic planning and readiness. There still appears to be more unanswered questions, than answers, when it comes down to it. Here are the facts, which seem fairly accurate:

1. Viral susceptibility is not the same as clinical effectiveness or the lack of.
2. Numerous clades and sub-clades of the virus may translate into differences in attack rates or disease severity.
3. Antiviral use favors the spread of resistance (no brainer – history proves this)
4. Regardless of resistance, antiviral deployment for prophylactic or treatment purposes, coupled with non-drug interventions, will result in some major benefits to impede the pandemic.
5. It is impossible at this time to determine how widespread resistance mutations are, but it is likely these mutations are “hitchhiking or co-riding with other genetic changes that confer a selective advantage”.

Whether or not Tamiflu resistance is an isolated instance just in Indonesia, or it is caused by Indonesia and China feeding it directly to poultry (as suspected) – or even caused by the massive use of Tamiflu by humans in these countries - is a matter of speculation. We’ll probably never know for certain, but it appears they may have done this.

What is terribly disconcerting and concerning is that Indonesia is now unilaterally ready to launch into pre-pandemic vaccine inoculation experiment of its citizens, virtually on its own accord. They have reached a point where they believe they are running out of options and doubt Tamiflu’s effectiveness. The WHO is trailing ten miles behind, because they have very little corroborating information, little or no viral isolates to base any recommendations on, and no molecular insight of the mutations which have occurred. In fact, the WHO has much more data on global MDR and XDR TB and the measures needed to prevent, treat and extensively control the disease, then they do H5N1.

This is a bad situation “fixin” to get a lot worse, in my view, and I don’t believe it’s a misinterpretation. We are clearly seeing: evidence of viral resistance; documented high CFR’s of 60-80%; numerous strains and sub-strains circulating worldwide; questionable unregulated poultry vaccinations using mismatched vaccines being given to billions of fowl, suspicions of H5N1 mutations circulating, suspicions of changed disease characteristics surfacing in humans in Indonesia; and discussions being held to “dilute” pre-pandemic vaccines in populations to sustain a minimum level of immunization. These are all bright red warning flags.

In my opinion, one of two things is going to occur: the H5N1 will never cross over to become highly transmissible to/or between humans (it will keep sputtering intermittently – you will close down your website out of frustration);

or,

the H5N1 virus will transform itself into a highly virulent air-born pandemic influenza, “like a Type A - H1 or H3 - on Schwartzennger steroids”, which will shake civilization to its roots. (in which case you won’t have enough space on your server to accommodate all your daily bird flu news, you may have to hire Interns to post the articles).

If history is any guide, then the latter case will occur.

Wulfgang

 

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