Bird Flu Update

by DemFromCT

An interesting (not in a pleasant way) thing happened in Southeast Asia. While countries around the world have been stockpiling tamiflu, and the US Senate and House are wrangling over how much pandemic flu prep to fund, the H5N1 virus has been marching (well, flying, actually) around the world. Ukraine has it. And Malawi may have it - well, maybe. Tests from South Africa will be back next week.

But the report that has everyone's attention is the one from Vietnam.

Serious questions are raised today about the ability to combat an anticipated bird flu pandemic following the deaths of two people who were being treated with the drug the world is stockpiling as a safeguard against the virus.

To the dismay of medical experts and concern among those responsible for the worldwide efforts to fight a pandemic, the H5N1 bird flu virus in the bloodstream of the two patients in Vietnam rapidly developed resistance to the drug, Tamiflu. One, a 13 year-old girl, appeared to be stable at first and then rapidly worsened as the virus mutated, became more aggressive, and eventually killed her.

What's scary is the speed at which the virus seemed to develop tamiflu resistance during treatment. other cases may have been treated late, but this set was treated early and well.

An eminent professor at Cornell University in New York calls the report "frightening" in a commentary in the journal. Anne Moscona, from the department of paediatrics, microbiology and immunology at Weill medical college, says Tamiflu-resistant H5N1 "is now a reality", and calls for efforts to prevent individuals stockpiling the drug. Its misuse, she says - by people who, for instance, take too low a dose - will breed resistance and further undermine its effectiveness if a pandemic sweeps the world.

There's been a debate about personal stockpiling, different than governmental stockpiling, for some time. This page at Flu Wiki collects some of the official recommendations as well as opinion by others. The bulk of official opinion is 'don't stockpile'. While there are eloquent dissensions from that, the NEJM has this week presented a summary of that position in a free access article entitled The Run on Tamiflu — Should Physicians Prescribe on Demand?. Their answer is no, reinforced by the other NEJM reports refernced in the news article above.

Meanwhile, there's still no pandemic, just one nasty flu bug still surprising the medical community.  While some things has changed, nothing has changed. There's still time to prepare, and still need to do so.

See Flu Wiki for more. And Revere at Effect Measure has more of the details. Pandemic preparedness is more than stockpiling tamiflu... it's a community need, recognized at every level of government. Business, schools, local community leaders will all need to play a role. And how well we do afterwards will depend on how well we organize beforehand.

Comments

[DemFromCT]

from revere's post:

The bottom line, however, should be obvious (although it isn't a part of the news coverage so far). The best protection against the most serious effects of an epidemic infectious pandemic is not a magic bullet pharmaceutical like Tamiflu or biological like a vaccine, but a sturdy, effective and adequately supported social services and public health infrastructure.

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