The pandemic flu strain, which has not yet appeared, will likely be a mix of bird flu, anthrax, rabies, dengue fever, and/or whatever - "the perfect
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota warns, "This is going to
What remains unknown
is when, exactly, "this" will happen and what, exactly, "this" will be - that is, what strain or microbial hybrid will
emerge to cause a pandemic.
Even so says Osterholm, it is unacceptable for society to do nothing.
Pandemic inevitable; local planning
and leadership critical, health expert says
The Vaccine Problem
...Michael Osterholm, an expert on public-health preparedness, offered a stark analysis of the threat of pandemic influenza. ..."This is going to
happen." In a globalized, just-in-time economy with no surge capacity, local preparation and leadership will be critical to survival. "Community
planning is not an option," he said. ..."If there is a silver lining to many of the terrorist events, when they happen we go into a recovery phase
within minutes," Osterholm said. "They blow up and then they're done. That's a horrible thing, but it's tremendously advantageous. Imagine
something that unfolds over a matter of months."
According to a September report issued by the World Health Organization, the H5N1 virus has a 65 percent mortality rate, compared to 2.5 percent for
the 1918 virus. In the event of a pandemic, however, "this [rate] will probably attenuate because you will die before you can pass it on," Osterholm
said. If a pandemic occurs in the near future, vaccines and antiviral medicines will have limited impact due to delays in developing effective drugs
and limited manufacturing capacity. Steps such as quarantine and infection control also will have little effect, he said.
...Despite the grim forecast, Osterholm said it is unacceptable for society to do nothing. Even if a 1918-like scenario unfolds, most of the world's
population will survive. "If local was ever important, it's important now," he said. "What happens in Palo Alto is going to be more important than
what happens in the Bay Area. Business continuity planning is not optional—as goes business, so goes our society. If we can't get food, heating oil
and medicines to our population, we are in trouble. Hope and despair are not strategies—that's a common place to go. We'll get through it, but,
ultimately, it's going to depend on how we prepare and the leadership during that time."
Scientists warn that the five known H5N1 bird flu strains are different enough that each require their own vaccine. New vaccines will need to be
developed for new strains as they evolve - including one for the feared yet-to-appear pandemic strain.
At the same time, the world's vaccine production capacity simply cannot and will not meet global requirements. The fallback position involves public
education - with a focus on "simple hygiene" like frequent handwashing.
Vaccines for all H5N1 flu strains crucial -experts
What Can Be Done
The H5N1 bird flu virus has undergone many changes since making its first known jump into humans in 1997 and vaccines must be manufactured to fight
its major strains, experts said on Monday. ..."What's worrying is there were more (human) cases in 2006 than 2004 and 2005. The problem is still
with us," Robert Webster of the St Jude Children's Research Hospital in the United States told Reuters ...Webster said several H5N1 strains had
become widespread and different enough to cause unease among experts, and no one would dare assume that any one vaccine would be able to protect
against other H5N1 strains.
Derek Smith of Cambridge University in Britain said there have been at least five major changes to the H5N1 virus since it was first discovered in
1959. ...These five strains were found in Hong Kong in 1997, Vietnam in 2004, Eurasia-Africa in 2005-2006, Indonesia in 2005 and Anhui province in
China in 2005. ..."It's not clear what is driving this antigenic evolution," Smith, research associate at Cambridge's zoology department, told the
Several companies around the world are in a race to develop vaccines against the virus, although many experts think they might not confer protection
against an eventual pandemic strain... ...In the event of a pandemic, there simply would not be vaccines or drugs for poorer nations. ...More time
and resources should be spent instead on researching about, and promoting, simple hygiene measures "that might be beneficial to the majority of the
world at very low cost", he said, citing the use of surgical masks, alcohol sprays and regular hand-washing.
The cities that fared best during the 1918 pandemic were the ones that "instituted "social distancing" at least two weeks before
peaked in their communities." So says a new unpublished study being called "a Manhattan Project of history," where researchers reviewed health
records, newspaper clippings and other documents from 45 cities about the 1918 pandemic.
"Social distancing" strategies "involve reducing contact with other people including closing schools and cancelling public gatherings; planning for
liberal work leave policies and teleworking strategies; voluntary isolation of cases and voluntary quarantine of household contacts."
Study Shows What Helped During 1918 Flu
Tamiflu IS Better than Nothing
Government health officials tried to build their case for school closings and similar steps during a flu pandemic by showcasing new research Monday
that suggests such measures seemed to work during the deadly Spanish flu of 1918. ...Researchers found that cities like St. Louis, which instituted
"social distancing" at least two weeks before flu cases peaked in their communities, had flu-related death rates less than half that of
Philadelphia, which didn't act until later.
The whirlwind historical research project ...involves a team of researchers from the University of Michigan and the U.S. Centers for Disease Control
and Prevention, who combed through health records, newspaper clippings and other documents from 45 cities. ..."This is a Manhattan Project of
history," said Michigan's Dr. Howard Markel, one of the lead researchers, in a presentation at a pandemic flu planning meeting of health officials
Another finding: The more social distancing measures were used and the longer they were in place, the less severe was the pandemic's effect on a
particular city. Wearing masks in public, restricting door-to-door sales, canceling church and quarantining sick people were among the layers of
measures that appeared beneficial. ...But the researchers acknowledged they've only just begun their analysis, and haven't teased out which measures
were most effective. And they stopped short of saying those steps were the clear-cut reason some cities had lower death rates.
CDC Meeting Explores Community Strategies to Reduce Impact of Pandemic Influenza
The impact of pandemic influenza extends well beyond health and medical communities into many segments of society. Developing a pandemic influenza
vaccine could take several months, and community prevention strategies are public health measures that don't involve vaccines or medications (also
called non-pharmaceutical interventions) may serve as a first line of defense to help delay or reduce the spread of disease.
For pandemic influenza, examples include social distancing strategies that involve reducing contact with other people including closing schools and
cancelling public gatherings; planning for liberal work leave policies and teleworking strategies; voluntary isolation of cases and voluntary
quarantine of household contacts.
Virologist Menno de Jong, head of virology at the Hospital for Tropical Diseases in Ho Chi Minh City in Vietnam was the first bird flu expert to
question Tamiflu's effectiveness publicly. See: Report: Tamiflu "Useless" Against H5N1 Bird Flu
and More About Tamiflu
Now, de Jong is telling doctors NOT to give up on patients with advanced bird flu, and to use whatever anti-virals they have available because they
help. Good advice, imo.
Don't give up on advanced human bird flu cases -expert
An expert who treated numerous bird flu victims in Vietnam has urged doctors not to lose hope with patients who are admitted late to hospital as there
is still a good chance that they can survive. ..."If you can decrease the viral load (with drugs), you can have a good outcome. Even those who are
treated late had good results," he told the conference.
...de Jong, head of virology at the Hospital for Tropical Diseases in Ho Chi Minh City in Vietnam, said Tamiflu could still be used to fight bird flu
many days after the onset of symptoms because the avian virus would still be multiplying. ...De Jong agreed with many experts that an early start to
treatment was still best ..."You have to get very effective treatment as early as possible because you will prevent direct viral damage (to lung and
other tissues)," de Jong said.
...Early treatment could also prevent what is known as the "cytokine storm response", when a human's immune system launches such a heavy
counter-attack that it destroys not only the invading avian flu virus, but the person's own surrounding tissues as well...
[edit on 13-12-2006 by soficrow]