UN warns of bird flu pandemic risk - March 19, 2008
The UN has issued a grim warning on the “critical” bird flu situation in Indonesia.
“I am deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic,” Joseph Domenech, the UN Food and Agriculture Organization’s chief veterinary officer, warned yesterday (press release, news coverage from the US, Russia, India, Europe).
Indonesia has a worse H5N1 problem than any other country, with 31 out of its 33 provinces infected, and the virus endemic in Java, Sumatra, Bali and southern Sulawesi. Current vaccines may be failing to protect the 1.4 billion chickens in Indonesia from the disease
“The human mortality rate from bird flu in Indonesia is the highest in the world and there will be more human cases if we do not focus more on containing the disease at source in animals,” says Domenech.
Image: Punchstock
Comments
Confronting the Next Influenza Pandemic with Generic Agents
Avian influenza A/H5N1 presents a serious and possibly imminent pandemic threat. If the pandemic virus should emerge within the next year or two, the world will have to depend on conventional adjuvanted inactivated H5N1 pandemic vaccines. Today, all vaccine companies could produce in a 6-month period (i.e., approximately 9 months after the emergence of the pandemic virus) enough doses of H5N1 vaccine to vaccinate with two doses about 750 million people [1]. This number is less than the combined populations of the nine major influenza vaccine-producing countries. Moreover, during this 9-month period, the pandemic will have already spread to most countries in the world.
Many health officials have placed their hopes on stockpiles of antiviral agents. Recently, however, resistance to oseltamivir (Tamiflu) has cropped up in seasonal H1N1 viruses and this development has prompted concern that similar resistance could develop in a future pandemic virus. More important, government stockpiles of Tamiflu are sufficient to treat about 1% of the world's people who live in the "have not" countries that don't produce influenza vaccines. At a recent scientific meeting in Singapore, investigators reported that among people in Indonesia who had been infected with the clade 2 H5N1 virus, 33/33 (100%) of those who received no antiviral treatment died. It is not difficult to imagine that if this virus were to evolve into a human pandemic virus, we could see a global population die off. The conclusion is inescapable: for the foreseeable future timely supplies of affordable vaccines and antiviral agents to confront such a virus will be unavailable to most people in the world. The consequences could be disastrous.
Given the overwhelming need for effective alternatives for pandemic treatment and prophylaxis, generic agents that target the host immune response or the pandemic virus should be considered [2,3]. Many influenza scientists doubt these agents would be effective. Nonetheless, several retrospective studies suggest that statins improve outcomes in patients with bacteremia and pneumonia and might be similarly effective against influenza. A preliminary report of results from a randomized controlled trial of statin treatment of ICU pneumonia patients showed that hospital mortality was reduced by 50%. An experimental study has shown that the fibrate gemfibrozil, a PPARα agonist, reduced mortality in H2N2 influenza virus-infected mice by 54%. There is considerable molecular cross-talk between statins and PPAR agonists, and their clinical effects are additive in patients with cardiovascular diseases. Chloroquine increases endosomal pH and acts as an antiviral by impairing influenza virus release into the cytosol. Resveratrol, the polyphenol found in red wine, reduces influenza mortality in experimentally infected mice.
All of these agents - statins, fibrates, chloroquine and resveratrol (and several other agents) - are produced as generic medications in developing countries. They are inexpensive, could be stockpiled and would be available on the first pandemic day. Given the lack of realistic alternatives for "have not" countries, we cannot afford not to undertake the research needed to determine whether these and other generic agents could mitigate the effects of the next pandemic. Otherwise, we might face an unprecedented global public health crisis.
References
1. Fedson DS, Dunnill P. From scarcity to abundance: pandemic vaccines and other agents for “have not” countries. J Public Health Policy 2007; 28: 322-40.
2. Fedson DS. Pandemic influenza: a potential role for statins in treatment and prophylaxis. Clin Infect Dis 2006: 43: 199-205.
3. Fedson DS. Confronting an influenza pandemic with inexpensive generic agents: can it be done? Lancet Infect Dis 2008, to be published.
Posted by: David S. Fedson | March 25, 2008 06:54 PM