There are many flu viruses in the avian populations but the H5N1 infection is the most worrisome for health service officials for a couple reasons.

One, H5N1 infection has been responsible for the highest number of recorded cases of extremely virulent illness as well as the highest mortality rate. On three occasions it has jumped species to infect humans most recently in 2004 and our current trouble, but also in Hong Kong in 1997 when there were 18 infections and one third of them fatalities and also Hong Kong in 2003 with 2 cases and one death.

Two, and even more disconcerting is that the current H5N1 virus runs the risk of mutating, if enough chances are presented to it, into an infection of pandemic proportions. Thus far the H5N1 virus has displayed all the rudimentary qualities it needs to initiate a pandemic except one critical component, the capacity to be effectually transmitted from human to human. While currently the H1N1 virus is at the critical pandemic level, the potential for a pandemic to develop from a mutated human version of H5N1 virus must not be ignored.

The H5N1 virus can suddenly begin infecting people in two ways. The first is in an exchange process between viruses. The genetic matter is passed between a human and bird flu virus while there is a mutual infection of the two viruses with a person or a pig. This trade of material or shuffling process could mean the mutated result is a very dangerous and highly infectious pandemic virus and would be introduced into society by a rash of human cases and a rapid spread.

Another method would be slower but no less perilous, adaptive mutation is caused by the virus attaching to human cells in a steady manner through successive human infections and the virus becomes more capricious and pernicious as it gathers momentum forming small groups of human illness where there is confirmation of person to person contact. This second version of events would at least, if discovered early enough, give authorities some valuable time to respond.

In the Hong Kong H5N1 influenza spate of 1997, there were eighteen cases of illness which happened to take place when there was an outbreak of a far more severe and contagious bird flu by a virtually matching strain of the virus occurring on poultry farms and in public poultry markets. Intense follow up studies with familial and personal contacts of the patients, health care personnel, and those who culled flocks of birds determined there was little confirmation, in not any at all to confirm the spread between humans. In three days time, the culling of all poultry in Hong Kong ensured there was no further human infections. This at the expense of a million and a half birds that world medical officials credit with preventing a pandemic of avian influenza.

Everything up until now points to humans making contact with infected or dead birds as the primary source of illness in humans from H5N1 virus. People at risk are those who butcher, pluck feathers, initiate the bird kill process and those who process poultry meat for consumption when handling infected bird carcasses. Some individuals came into contact with chicken feces specifically using a poultry free range as a playground for kids and subsequently became ill. Experts also believe that swimming in water that contained dead bird cadavers or where infected birds could have contaminated with their droppings is potentially a further cause of some infections.

Not all cases of initial virus exposure could be indentified making authorities consider the possibility that some undiscovered infectivity factor with the virus may be the cause of certain cases. Some thoughts about what this cause may be area possible connection with feral birds such as pigeons or perhaps employing bird droppings as a form of fertilizer. For the time being H5N1 avian influenza is primarily a bird illness. The obstacle of single species strains of flu is noteworthy since the virus does not transfer from birds to humans without difficulty.

Notwithstanding the fact that there have been millions upon millions of diseased poultry in huge areas since the year 2003 there have only been less than a couple hundred cases of clinically diagnosed human H5N1 infection. There must be a reason, as yet not understood, why many of these infections occurred out in the country or semi rural locations where families and farmers maintain smaller stocks of poultry. It is also an anomaly that there are fewer infections in those groups that would ordinarily be considered at greater risk such as industrial poultry personnel, live poultry market vendors, those who cull flocks, veterinarians, health care workers who aid the patients that are ill, many not having the proper safety gear to do so without leaving them vulnerable.

There is also a lack of data or understanding of why kids who were in good health and medically fit young adults seemed to get ill. Health officials need to quickly discover logical reasons for this type of exposure. Are there certain behaviors involved? Perhaps there are immunity or genetic circumstances that seem to leave these groups vulnerable to infection?

Evaluating Potential infections in People

Examining many of the verified human infected with H5N1 virus, those in Asian nations and in Turkey, showed that direct contact with diseased avian species as presumably the primary reason for exposure. When reviewing likely infections, medical personnel should be inclined to look at those people displaying signs of influenza symptoms such as respiratory illness, hyperthermia etc. and those persons with a close proximity to birds. Particular attention should be paid to those presenting with these symptoms who reside in locations of verified outbreaks of the contagious H5N1 bird flu are active. If those presenting symptoms are from an environment where avian fecal matter may have caused contamination then than perhaps this would be a secondary consideration for exposure.

To this point, human infections of H5N1 virus are not all the responsibility of contact with diseased carcasses or tame bird stock that look like they are ill. In 2005 reports showed that domicile ducks could emit large amounts of high contagion virus but display none of the illness symptoms. There was no threat to people who ate poultry from these countries provided they cooked their poultry well and those people did not take part in prepping the food.

Since there is not a sign of any person to person spread of this virus anywhere, there is no discernable hazard for anyone travelling to these countries where outbreaks occur provided obvious precautions are taken such as staying away from open air poultry markets, farms or any other location where diseased bird contact is imminent or has occurred in the past.

How Clinical Symptoms Present

When a patient with H5N1 influenza becomes ill the infection is usually quite aggressive during its path, with patients displaying a fast decline with an elevated mortality. As with most new diseases, H5N1 influenza has a long learning curve for health officials. Health services data compiled in 1997 along with the latest epidemic are only now starting to illustrate the clinical characteristics of the infection yet there is so much left to study. Making matters worse is the fact that the virus has a habit of mutating quickly meaning its unpredictable nature makes disease mapping that much more frustrating for researchers.

The infection development phase for H5N1 avian flu is probably longer than the more common seasonal influenza which stand around two or three days. Any current information regarding disease incubation shows a range of two days to eight and quite probable extending to a length of seventeen days. But the Likelihood of numerous exposures to the H5N1 virus means accurately calculating a disease development period quite difficult. The WHO is currently saying clinicians should use a seven day gestation period in order to conduct examinations at ground zero for illness and when observing patient acquaintances.

The illness presents itself through elevated temperature, higher than 38° Celsius with influenza type indicators. Vomiting and diarrhea, stomach pain, chest pain and gum and nosebleeds have been cited as pre symptomatic signs with certain patients. Watery diarrhea with no blood seems more common in H5N1 than in the season variety of flu. The range of illness symptoms may be wider still. Verified patient illnesses have not all included respiratory problems.

Several Vietnamese persons infected the diagnosis was severe encephalitis: neither of these people showed any respiratory distress when they presented. Another infection in Thailand had the patient presenting with hyperthermia and diarrhea but no lung/breathing distress. In all three of these infected patients they had been in direct contact with diseased poultry.

A characteristic observed in a number of illnesses was the development of indicators in the lower respiratory tract in the beginning stages of the illness. Many patients display these lower respiratory symptoms when initially looking for treatment. Based on current knowledge, breathing irregularities begin to manifest about day five of the onset of illness. Respiratory trouble, hoarseness in the voice, and a discernable crackly noise while inhaling are most likely observed. Phlegm production is erratic and occasionally tainted with blood. Lately there have been bloody respiratory secretions seen in Turkey. Nearly all patients wind up with pneumonia.

Throughout the Hong Kong influenza illness spurt, the severely sick people showed primary viral pneumonia that antibiotics couldn’t help. Inadequate information about patients in the current outbreak show the signs of primary viral pneumonia in H5N1 that usually fail to show signs of bacterial supra-infection when determining diagnosis. Turkey medical officials have documented pneumonia as a consistent characteristic in more harsh cases, and the same as other patients, these people did not respond to being treated with antibiotics.

Those patients with H5N1 Influenza suffer a quick decline in their illness. There was a six day time period from the beginning of the flu to respiratory distress in Thai patients with an overall spectrum of four to thirteen days. Severe Turkish H5N1 illnesses the respiratory decline was three to five day after initial symptoms appeared according to medical experts. Something else which appears all too common is the irregular function of multiple organs. General laboratory anomalies, consisted of leukopenia (chiefly lymphopenia), mild-to-moderate thrombocytopenia, prominent aminotransferases, and with several occasions of disseminated intravascular coagulation.

There is some confirmation that particular antiviral medications, especially Oseltamivir or generic Tamiflu as it is known commercially, as they decrease the ability of the virus to reproduce thus improving the odds of survivability. They must be taken inside a forty eight hour window from the start of symptoms to be effectual. Data collected from the Turkish outbreak suggests that the majority of those with the virus were diagnosed and treated well into their course with the illness. It is because of this information that the use of Oseltamivir as a treatment is somewhat incomplete.

Oseltamivir or Tamiflu and other antiviral medications where produced as forms of treatment and as prophylaxis methods for seasonal variations of influenza, known to be a less severe version of flu as well as having a longer virus reproduction process in the body. The options for treatment courses and dosage quantities are still in a state of fluidity for oseltamivir – tamiflu therapeutic treatment of H5N1 influenza as it is with child illness of the virus. The WHO is continually monitoring and reviewing these antiviral practices as they require vital revision.

When a case of H5N1 influenza is suspected, generic tamiflu needs to be prescribed and taken as quickly as possible, preferably within forty eight hours from becoming symptomatic in order to optimize the value of the medication. Given the virulence of the current strain and the length of time of replication process, mortality rate etc. it would behoove the primary physician to begin treatment with generic Tamiflu also in those patients who are well into the illnesses course.

The existing suggested dosages for generic tamiflu for influenza virus treatments can be located on the Manufacturer – Roche’s website under product information. Currently the optional dose for generic tamiflu for influenza therapy is 150 mgs daily for children thirteen years and over and also adults, administered twice daily at 75 mg each for a course of five days minimum. There is no record of Tamiflu treatment for kids under one year old. The WHO health experts are looking into issuing treatment dosages and recommendations for children under the age of one year.

Since H5N1 viral reproduction periods could be extended, clinical personnel should reflect on increasing the tamiflu course treatment from five days up to seven or ten days in patients who are not responding to average treatment courses. When a patient displays severe H5N1 infection, they may want to raise the suggested daily dosage or length of treatment time. Clinicians also need to remember that Tamiflu dosages higher than 300 mg per day can be responsible for an increase in adverse effects . These same clinicians may want to consider administering serial clinical samples for future examination so viral loads can be monitored, an assessment can be made on medication susceptibility and levels of tamiflu can be reviewed. But, these samples should only be ingested where suitable procedures for infection control are available.

When a patient with H5N1 is suffering from a severe form of the illness and hampered by gastrointestinal symptoms, the absorption of Oseltamivir – Tamiflu could be hindered. Clinicians need to be cognizant of this prospect when treating patients such as these.

Bird Flu

The recorded cases of H5N1 have been dropping in previous years but the H5N1 strain is known to vary in intensity year to year, though the drop is an indicator that efforts to manage the virus have been somewhat successful in domestic poultry birds. There has been better observation of the disease globally and China has instigated a huge poultry inoculation endeavor but China has experienced a cluster of illness from bird flu that felled eight people in one month. Six of those cases were in areas with no reports of outbreaks in their poultry stocks.

Influenza H5N1 is still difficult for humans to contract, it has still claimed two hundred fifty four victims around the world since 2003. Health scientists have been sounding the alarm for a while now that if H5N1 wasn’t under control in the avian population it could well mutate into a modified strain that would infect humans and cause the spread to activate the strain into a pandemic.

The peril is that after years of controlling this H5N1 strain and keeping it from becoming a more serious threat to humans there could be slippage in vigilance due to economic stress and general flu fatigue. After years of pandemic preparedness operations and a recession, would there be a call for financial curbs on funding? A number of less resourceful nations could be the impetus for this to happen.

The World Health Organization still thinks a flu pandemic from H5N1 virus is only a matter of time, there is no IF in the equation. The international community must keep a vigilant eye not only for modification of the H5N1 virus but also for other influenza strains in addition to what has already been identified. We are already a world under threat from a pandemic of H1N1 influenza and if these two viruses were to somehow mutate from mutual contact the result could be catastrophic.

Bird Flu Symptoms And Treatment Protocols

People who contract the H5N1 illness will present with hyperthermia or fever, sore throat, cough, severe respiratory distress and viral pneumonia. People of all ages can be infected and can be in various situations with their health. Today there are tests that can be performed quickly in order to diagnose a particular influenza strain. Antiviral medications like Generic Tamiflu or Oseltamivir are considered effective for treating and preventing the influenza A strains of the virus and this is good since when a new strain of flu develops it can take a good number of months to produce a viable vaccine.

The WHO is recording and posting regular updates concerning any new human infections of H5N1 Bird flu. They must gather information as to how the person was exposed to the virus whether by wild or domestic birds and which species of bird they made contact with. It’s critical to inform the public not to keep wild birds with domestic flocks, not to allow free ranging poultry, to keep the public away from wild birds, or keep in captivity any wild birds’ period and this must be done to aid in preventing a global pandemic. The public must continually wash their hands after coming in contact with poultry stocks or subsequent to handling chicken meat, cooking poultry well and keep domestic bird species separate from each other.

Bird Flu

The risk would be calculated but how do you respond when there is no way to forecast when it will get severe and yet the cost of doing nothing could be ominous. It is an impossibility to know in advance when a bird flu pandemic will happen and so forecasting a crisis is difficult and the possibilities are vast. What is certain is that the next great pandemic is nearing its due date if not having surpassed it.

The twentieth century bore witness to three deadly pandemics. The Spanish influenza in 1918 -1919 in which some estimates claim nearly fifty million people perished. The Asian influenza of 1957 -1958 with approximately one million fatalities and the 1968 – 1969 Hong Kong influenza took anywhere from one million to four million lives. Estimates vary widely as a testament to the lack of record keeping and resources during a major worldwide health crisis.

All three of these outbreaks are believed to have had their origins in avian species. There are fifteen known bird flu virus sub variations and H5N1 is specifically anxiety producing. This strain of avian flu has slammed domestic bird sectors in eight nations, of these three of them, Cambodia, Thailand and Vietnam, have reportedly had altogether seventy nine human infections and more than fifty percent of these illnesses were deadly.

Never has there been such destructive fallout to so many nations by the H5N1 bird influenza virus at once causing anxiety to populations and economies to suffer so greatly in both farms and residences as well as industrialized poultry producers. The H5N1 Bird flu strain has displayed two frightening characteristics thus far, the ability to spread infection quickly and to cause harsh disease in humans. What it has not yet shown is the capability to spread human to human. If and when this third indicator appears it would be considered the beginning of a pandemic and would certainly prompt an international reaction from The World Health Organization and the initiation of emergency preparedness plans for an influenza pandemic.

The worry right now is that this H5N1 bird flu virus could mutate, it has a history of doing just that, developing the means to spread more easily from person to person contact. Experts wonder if this mutation or change could occur from adjusting to the infected masses or via an inherent modification with a known human influenza virus. Currently the infection is spread through direct human exposure with contagious domestic poultry.

The WHO has stated that there is no confirmed link of any continued person to person diffusion instead there were limited infection sequences that remain quite typical in bird flu virus not yet tailored to people. It is understood by authorities that each specific cluster of infected persons could be an indicator of an oncoming pandemic, meaning each case needs to be examined promptly.

Expert clinicians concur the unparalleled scope and transmission of H5N1 bird flu has increased the chances of a serious influenza pandemic reoccurring, their human mortality approximations are anywhere from two million to fifty million globally. Because of international travel being so common and the massive amount of trade between countries there is little that can be done to inhibit the spread of the virus worldwide.

When SARS [severe acute respiratory syndrome] was a problem a few years ago, infected persons were able to be identified and quarantine measures taken at airports. H5N1 Infected persons during a pandemic are going to be able to infect anyone they come in contact with before symptoms even start to present. This is a real concern for the medical and health services since infected travelers won’t be caught at the airports this time.

The WHO is asking all of its member nations to urgently review and revise their influenza pandemic emergency response plans. It is mainly industrialized, more affluent nations that have done these revisions while many others are scrambling to do so. These preparedness plans are based on suggestions made by the WHO to utilize a phased reaction in order to decrease the feared force of any influenza pandemic.

The plan is to produce a vaccine quickly and warehouse antiviral medications such as generic tamiflu or Oseltamivir, which has displayed an effectual response to the H5N1 bird flu virus. Generic Tamiflu will probably be as effective against any upcoming flu strains in the future as well. The WHO has also recommended thirty other pandemic guidelines not related to medical intercession that should prove valuable if we are facing a pandemic.

If we make the assumption that the H5N1 has its roots in the Far East Asian nations we must also assume that we will not be able to stop it from reaching the industrialized western nations of North America and Europe. When it lands here it will hit with a ferocity racking up illnesses and causing havoc with our daily lives. Preplanning for this event horizon will go a long way to decreasing the effect overall on the national communities affected.

The United Kingdom has decided to acquire nearly fifteen million therapeutic courses of anti viral medication Oseltamivir or Generic Tamiflu. This means treatment can be given to one in four Britons who could potentially be infected, this number estimated by the WHO for antiviral stocks on hand. Great Britain is only one of a number of countries that are stockpiling Tamiflu and other antiviral medications. They are also taking part in the research to quickly ramp up production of a vaccine against any future H5N1 pandemic flu outbreak.

Current influenza vaccines won’t give any defense against a future pandemic flu virus. But knowing that a potential mutation will initiate from H5N1 and have little difference genetically, The WHO is urging its members that preventative warehousing of current vaccine may be an option of some protection for wealthier countries to consider. At least it would be available immediately and it may offer a certain amount of help from the human exposed pandemic virus. There is the hope that this could also bring about investment from companies to begin pandemic vaccine development. Vaccine has an expiry date of a couple years so it could in the end just be thrown away but it would be considered cheap insurance in the event of a full blown pandemic health crisis.

Countries like China, France, Canada, Japan, the UK and the United States have made arrangements with manufacturers to produce a sample H5N1 vaccine, but if any new flu strain is drastically modified from the H5N1 virus the vaccine will be deemed ineffective. This on the back of a report from the WHO stating that a vaccine offering protection against the H5N1 as it is now could be nearly as effective against a new variation. Error on the side of caution according to the richer nations.

For the first time many countries are affected outright by the disease and the economic losses alone are overwhelming for farmers, industrial poultry producers and common households in these countries.

Currently the vaccine production is taking place in Australia, North America, Europe and Japan but during a pandemic the need will stretch around the world. There are concerns that less affluent countries seem to get hit the hardest by the influenza pandemic because their people tend to be less fit and undernourished. Poor countries have fewer health service staff and weaker health organizations overall that can’t stand up to the load of a pandemic virus and are lacking an emergency preparedness plan of any significance.

Because of a lack of resources most emergent nations are concentrating on surveillance of the H5N1 disease rather than warehousing antiviral tamiflu and vaccine production. If a pandemic hits these areas they will be extremely susceptible to illness in overwhelming numbers and not have the medicinal resources to anything about it.

The danger faced by humans from H5N1 flu has been second guessed lately. Medical personnel initially approximated the mortality figures at about ninety percent but adjusted that number as additional cases became obvious so the number dropped down to sixty seven percent along with newer confirmation of a lack of symptoms shown in many people so there may well be more cases that go unnoticed making an accurate death toll difficult to predict and possibly much lower than originally considered. It should be mentioned that a lower death tally doesn’t necessarily mean a lesser menace to humans from the H5N1 virus.

With H5N1 it was always suspected that the illness cases to death ratio seemed strangely elevated and the range of illness more general than only severe cases that were being recorded. Still, with lower fatality numbers based on more cases of illness, easier spreading of the flu virus means more people will get infected and hence, more individuals will become fatally ill.

The WHO is still quite certain that a pandemic of H5N1 virus will hit us globally. Regardless of all the unanswered questions surrounding the bird flu virus and its shock to society, preplanning for a pandemic will have a positive effect on the outcome. Lives will be saved, some will be lost, and the economy will still take a beating along with societal structure in general but emergency response organization will be improved and that is at least something positive. Better to be prepared as much as possible regardless of a nations internal capabilities.

Bird Flu

Any chance for a vaccine to combat the H5N1 influenza will probably take a while yet to produce. Should the major pharmaceutical companies start producing immediately after an epidemic occurs, there won’t be enough of the vaccine to offer any kind of adequate provision for the nations that are in dire need – meaning the Asian countries. This means that for the foreseeable future antiviral medications such as oseltamivir –generic tamiflu and zanamivir – relenza and perhaps other older antivirals such as amantadine and rimantadine are going to be the first line of defense.

Drugs such as generic tamiflu and amantadine are referred to as neuraminidase inhibitors which both decrease and shorten the severity of flu symptoms and they can provide prevention measures from influenza as subsequent contact and seasonal prophylaxis medications. Influenza preparedness strategies recommended by the World Health Organization, WHO, and many governments globally as a rule support detection, isolation, primary responder protection, and beginning antiviral treatment therapy for those with the illness and those in contact with them. Most national governments have already begun warehousing at exorbitant costs, huge amounts of generic tamiflu [Oseltamivir] in preparation for a potential epic rash of illness.

in any case, the effectiveness of the neuraminidase inhibitors, even when taken as a prophylaxis in healthy people taken within the forty eight hour window from the beginning of flu symptoms is only small. The utilization of tamiflu in five of ten cases documented in Vietnam did not display any clear medical effectiveness and there was an eighty percent fatality rate found in this effort. Neither tamiflu – oseltamivir nor relenza – zanamivir, were directly evaluated in the restricted study.

Both antiviral medications have related pharmacological properties and both offer comparable effectiveness; zanamivir- relenza appeared to have fewer side effects to manage and a better resistance report. This resistance report would carry much weight in the event of a pandemic. The zanamivir is not being stockpiled in anywhere near the amounts as tamiflu is and this could be because of the potential challenges of administering an inhalant medication for children and intellectually impaired persons. Zanamivir does have some original and practical methods for use in children.

The incidence of bronchial problems and decreased lung utility is not very common, and those suffering with asthmatic conditions and chronic obstructive pulmonary disease or [COPD] are able to abide by the inhalation of the zanamivir – relenza, along with the placebo. Zanamivir has options for dry inhalant devices which are popular among these same patients even in times of problematic situations with their illnesses.

With this in mind, nation governments need to contemplate warehousing zanamivir as an antiviral option along with generic tamiflu as part of their emergency preparedness planning. The antivirals must be dispensed to ill patients and those who have been exposed to them within forty eight hours of becoming symptomatic. The logical position for health officials to take is allowing community health care services and drug store pharmacists to be responsible for getting the antivirals medications into the hands of those who need them in a timely manner rather than counting on potentially overstretched hospital based health providers to do the job.

All nations and their health services sector should include H5N1 study trials in their preparedness planning testing a dual role for tamiflu and zanamivir with prospective new medications and not; specifically testing SIRNA’s and interferon. These are in experimental phases now and hold promise as antivirals. More important is that these studies when conducted in the outset of a pandemic offer valuable data for late stage virus control and patient care. Vaccine producers are located mainly in wealthier industrialized nations and so delays getting the bird flu vaccine into the underprivileged Asian countries that need it. The wise decision would be to initiate some production of neuraminidase inhibitors and vaccine in these areas to rectify these shortages. Questions arise about drug patents during a pandemic that could lead to global crisis.

From a virus control perspective having available tamiflu and zanamivir antivirals stockpiled and or produced in these outbreak countries would aid in controlling the anticipated spread of the illness, nipping it in the bud so to speak. Developers such as Roche for oseltamivir [generic tamiflu] are already licensing out to many overseas countries. India has pharmaceutical companies prepared to begin producing generic tamiflu but cannot obtain government approval to do so. Restrictions and red tape need to be removed in order to take the fight to the virus with as much clinical punch as possible.

Medical study modeling has displayed to researchers that H5N1 influenza is more contagious than severe acute respiratory syndrome [SARS virus] and the preparations and management model for controlling SARS may not be sufficient for a pandemic of influenza, particularly H5N1. If this isn’t looked at and changes aren’t made to these plans the community health services in infected nations will become strained to the maximum in short order. SARS showed that when hospital personnel are under equipped in staff and resources they become discouraged and personnel begin to abandon their posts. Especially when these first responders begin to see their co workers become infected by clinic borne H5N1 contagion and they aren’t treated in an ICU setting. Health care officials at all levels of government must see that they protect their health care providers and show they are being conscientious. These health care professionals on the front line will also be depended on for their skills to handle the repercussions of a pandemic so their continued health should be paramount in the planning stages of a pandemic.

Bird Flu

The Message is clear that women who appear showing influenza type symptoms or illness need to be treated as quickly as possible. There shouldn’t be any waiting for a test result to verify the illness. There has been an update of the advice for preventative prophylactic treatment with antivirals in groups prone to risk [or chemoprophylaxis]. There have also been instructions updates for infant feeding that looks further into using masks and a requirement for a careful stance on stemming viral infection in infants though there is not much information to refer to. The recommendations are fluid based upon what is currently understood about the H1N1 viral spread within America and updates are planned as data becomes available.

The first known human infection with this strain of swine flu [the name was changed by the WHO to Novel influenza A H1N1 due to concerns over pork sales among other reasons] occurred in April 2009. The illness has been severe in pregnant women though the depth and transmission of this strain is under intense examination to better understand its effect on pregnant women and infants.

Though current information is not readily available, harkening back to past epidemics and pandemics is useful and available data for seasonal influenza and the effect on pregnant women is also being used in studies. There were an above average number of influenza linked fatalities in pregnant women throughout the Spanish influenza pandemic of 1918-1919 and the pandemic of Asian flu in 1957-1958. There have been unfavorable pregnancy results reported subsequent to prior influenza pandemics including miscarriage and premature births particularly in those women who contracted pneumonia.

Case studies and epidemiology reports carried out during pandemics past and interpandemic periods concluded that a women’s risk is greater during her pregnancy for complications related to influenza and there are signs of perinatal difficulties and delivery problems.

Women who become infected with the Novel influenza H1N1 strain of the infection it is predicted would have the normal respiratory illness seen in influenza cases presenting symptoms such as sore throat, runny nose, fever and cough. Perhaps accompanied by body aches, headaches, fatigue, diarrhea and vomiting and most pregnant women will proceed with a normal infliction of influenza without complication.

However, certain pregnant women will find the illness hitting harder and faster than others and possibly have secondary infections such as bacterial pneumonia. It’s during these difficult times for the mother that prenatal fetal distress caused by the maternal illness. There are reports of maternal fatalities as well as fetal complication outcomes linked to relentless illness. The ideal scenario would have the pregnant women being tested for influenza at an early symptomatic phase but delays in treatment for testing and awaiting those results are highly inadvisable since antiviral treatment are at their most effectual in the first forty eight hours of from the beginning of symptoms.

Testing will often take several days and may not be available at all for the Novel H1N1 though research is being undertaken vigorously to discover a rapid testing kit with great progress being made.

Primary health care providers need to be aware of the influenza outbreak in local areas of their practice and bypass the testing process in favor of treatment in those women who are pregnant and presenting symptoms of H1N1 influenza A illness.

Treatment and Chemoprophylaxis

Pregnant women who present with influenza like symptoms should undergo the earliest treatment possible with antiviral medications. Health care providers mustn’t wait for test results to come in to determine if influenza exists before starting treatment. Therapy should be initiated as soon as possible once symptoms begin to show for the best chance of success with these medications. The H1N1 influenza that is currently being transmitted has shown sensitivity to the neuraminidase inhibitor antiviral drugs zanamivir [Relenza®] and oseltamivir [Generic Tamiflu] but has built a resistance to adamantane antivirals amantadine [Symmetrel®] plus rimantadine [Flumadine®] .

Generic Tamiflu is an oral medication and the drug is absorbed systemically and the zanamivir is inhaled which lowers the systemic absorption somewhat. Tamiflu and Relenza as treatments and chemoprophylaxis course of therapies are suggested for women who are pregnant and are the same as if for an adult who is inflicted with seasonal influenza. In no way should a pregnancy be measured as a contraindication to tamiflu or Relenza usage. All indicators show pregnant women are more susceptible to harsh complications resulting from a bout with Novel H1N1 influenza A infection. They would benefit from a course of treatment or preventative therapy using Generic Tamiflu or Relenza, the risks outweighed by the antiviral use at this stage of infection in a pregnant women.

There have been some unfavorable reactions in those women who have ingested the antivirals generic tamiflu and Relenza though there has been no link between these adverse effects and actually taking generic tamiflu or relenza in pregnant women. It is recommended that health care providers stay up to date on CDC releases for the further use of generic tamiflu and relenza for H1N1 influenza A infection as the virus’ data is compiled over time so patients can further benefit.

Treatment Recommendations

Pregnant women showing flu like symptoms should have their medicinal therapy initiated before a firm diagnosis is confirmed. Because of its absorption process generic tamiflu is the drug treatment of choice and the treatment course recommended should last five days. There should not be any hold up of treatment while awaiting testing results since antiviral drugs for empirical use for anyone on this regimen need to be started within forty eight hours of the onset of influenza indicators being discovered. This therapy initiative is based on information collected from research conducted during seasonal influenza outbreaks.

This data also showed that there are benefits to those patients who are in hospital receiving the medication even after the forty eight hour time period so the antivirals are to be initiated for all high risk individuals who are symptomatic and in need of care whether or not the forty eight hour onset rule is exceeded, including pregnant women, persons with chronic illness and lowered immunity levels and those who require hospitalization.

Chemoprophylaxis Recommendations

Subsequent contact viral prophylactic use of medications like generic tamiflu and zanamivir should be judged useful for pregnant women who are confirmed or suspected of being infected with the Novel influenza A H1N1 virus. The medication most recommended for disease prevention or as a transmission inhibitor is likely zanamivir because of its partial systemic absorption properties. There could be certain problems associated with zanamivir usage because it is administered as an inhalant which may result in respiratory complications in women at risk of these ailments. Tamiflu then becomes the drug of choice for these patients.

The duration for this preventative treatment course is ten days after exposure to H1N1 virus was finally noticed. Pregnant women in multiple exposure situations to the virus in familial circumstances as an example, need to be monitored closely to determine the actual time period for preventative treatment depending on their medical situation and how it develops.

Hyperthermia [Fever] Treatment

One severe unpleasant symptom that affects influenza sufferers is the related hyperthermia or fever condition in a patient. Research has revealed that hyperthermia in pregnant women specifically in the first three months of pregnancy doubles the odds of having developmental problems with the fetal central nervous system or neural tube defects and could also be responsible for other birth defects and unfavorable birth results. Some research shows that hyperthermia related birth complications may be lessened by medications such as antipyretics or multivitamins such as folic acid which is highly recommended even for naturally progressing pregnancies.

Pregnancy related fever during labor constitutes further risks like developmental complications and neonatal problems such as seizures, cerebral palsy, encephalopathy and even neonatal fatality. Trying to determine the cause of a fevers effects from the fever itself is troubling so treatment of the hyperthermia is the first priority and Acetaminophen seems to be the choice option for fever control during a pregnancy.

The suggested dosages for antiviral drug treatment for novel influenza A H1N1 strain virus infections are as follows:

Tamiflu [Oseltamivir]

Adults should take 75 mg capsule twice daily for five days – 75 mg capsule once daily.

Zanamivir

Adults should inhale two 5 mg doses [10 mg total] twice daily for 5 days – Two 5 mg inhalations [10 mg total] once daily.

Other Ways To Reduce Risk For Pregnant Women

Currently there is not a vaccine available for the prevention of influenza A H1N1 infection though medical researchers are working feverishly to develop a potent anti virus vaccine. Therefore, the risk of getting infected by the influenza virus could be dramatically reduced if certain precautions are taken to decrease the chance of accidental exposure. Individuals should practice the following steps:

• Washing hands frequently for twenty seconds
• Minimize one’s contact with infected individuals
• Making certain those infected with the flu remain house bound [leaving only for medical aid]
• Coughing or sneezing into the elbow crook
• Practice social distancing by keeping at least six feet away from groups or crowded environments and staying away from areas of H1N1 infectious outbreak exposure.
• When required use a mask or respirator in the proper fashion.

Infant Feeding Considerations

Babies who are not being breast fed are at more risk of respiratory infection and are further susceptible to illness and a hospital stay than babies who are being nursed. Those women who remain influenza free should be positively reinforced to start or continue their breast feeding regimen and do so often. Under the proper conditions infants should be receiving their primary nourishment and nutritional enrichment from breast milk and so any bottle supplements should cease so babies can take in as many of their mothers antibodies as possible.

When considering H1N1 influenza and children it is thought that infants are at the most risk of all from H1N1 infection and precious little is known or understood about the infection in tiny infants. Recommendations such as only healthy adults should care for babies including feedings. Again little is known about the transmission of influenza A H1N1 virus through breast milk though reports of virus in the bloodstream for seasonal influenza is uncommon, the passing of infection into mother’s milk is likely just as infrequent an occurrence. If the possibility exists to pump milk from a virus infected mother for bottle supplementation feeding by a healthy family member, this process should be reinforced positively. It should once again be noted that generic tamiflu or relenza are not contraindicated for breast feeding.

Proper hygienic etiquette is crucial to women who are alone caring for infants while infected with influenza H1N1 virus. Ideally when ill there will be someone else available to assist with infant children. Women who are infected should also wear a facemask when feeding babies and caring for them in general to reduce the transmission of the virus.

Parents and caretakers need to be instructed on the proper methods for reducing the spread of infections like influenza A H1N1 virus which can result in respiratory complications and illness.

• Always wash hands and practice cough etiquette
• Use social distancing with children and keep them away from crowds.
• Be careful to control sharing of toys or other personal things which may have been in a child’s mouth and clean with soap and water if these items have been touched orally.
• Keep a supply of disinfectant wipes available for quick cleansing of hands or objects.

Swine Flu

Nearly one thousand virus samples of H1N1 pandemic influenza have been studied by the WHO’s Global Surveillance Network labs to test for antiviral medication resistance. All viruses showed sensitivity to tamiflu and zanamivir. The WHO and its members will carry on with their scrutinizing of tamiflu and relenza and virus resistance of the drugs.

The resistance shown to the medication tamiflu are considered irregular and random cases of resistance. There has been no extensive antiviral resistance displayed by pandemic H1N1 influenza viruses on these drugs in evidence so after assessing the threat potential the WHO has declined to modify their treatment direction and tamiflu remains an important tool in public health preparedness.

Tamiflu

Countries such as the United States, Great Britain among others, who signed contracts with the vaccine producing manufacturers, may be broadsided by those contracts not being honored. Some experts caution that as we enter further into the existing global pandemic, some nation’s governments could find they are facing massive pressure from their populations to safeguard their populace first before shipping the valuable and perhaps limited supplies of H1N1 vaccine abroad.

Countries like England that require all of their vaccine supply to be imported from overseas are vulnerable to broken contracts as is the United States and others who just don’t produce enough of their own vaccine at home. The U.S. now only manufactures 20% of the influenza vaccine that it utilizes and the rest is contracted out of country. One doesn’t have to stretch their imagination to far to understand that in the event of a severe outbreak within a vaccine producing country, governments may be forced politically to hoard the vaccine destined for other countries, regardless of any legal paperwork.

Some experts believe the pressure to forego shipments of vaccine in order to aid in saving their own people would be intense. If they did ship out the vaccine supply as ordered and left their own populace with little or none of their own the result would be chaos. Currently close to seventy percent of the worlds, influenza vaccine is produced in Europe and just a few nations are actually self-reliant in their vaccine stock. There is no easy solution to this potential nightmare scenario since new production facilities can’t open tomorrow. The solution just is not there for more vaccine production.

The World Health Organization [WHO] continues to announce increases in cases of H1N1 flu and the mortality rate continues to rise. The only viable solution for a lack of flu vaccine is to increase stockpiles of antiviral medications such as Tamiflu [Oseletamivir] and Relenza [Zanamivir]. The drugs can meet the demand for treatment and prevention by acting as prophylaxis for citizens who are exposed to illness and also treat influenza patients so illness is less severe. Production of antiviral medication like generic tamiflu has been ramped up substantially since the H1N1 virus reared its ugly head earlier this year after the initial outbreak was tracked to Mexico.

The use of antiviral medications would be a stop gap measure until enough H1N1 vaccine was available for everyone who needed it. To make this scenario even more real is the lack of the expected vaccine yield that was only twenty five to fifty percent of what was expected initially. There is talk that supplies would not be available to countries in need until perhaps the end of the year. The WHO is doing everything it can to see that stockpiles of Tamiflu are getting out to poorer countries and that production is at its peak. They are in contact with the developer and manufacturer oseltamivir – Roche Pharmaceuticals of Switzerland staying abreast of the situation.

Legal experts have spoken out on this situation of broken contracts and non-shipment of vaccine. International law does not have any resolution for contractual situations such as this. It is an unfortunate occurrence that is happening in the core of an epidemiological calamity. The contracts themselves could include a termination clause allowing the contract to be broken if there is an unpredictable situation like a health crisis.

Any nation that is producing influenza vaccine may arbitrarily choose to confiscate all vaccine supplies prior to shipping and place a prohibition order on the export of the vaccine, which would ultimately mean the contract would be broken. Private contracts are not political in the legal sense and are therefore not binding on the parties by international law as if they were two countries.

To this point, the H1N1 influenza virus has been relatively mild to moderate and the seasonal flu kills approximately half a million people every year and the medical experts expect this H1N1 flu to be about as virulent as the regular influenza. If this flu pandemic remains mild than there would be no reason to worry. There were three major pandemics in the last century and the last two in 1957 – 58 and 1968 – 69 found many countries scrambling for available vaccine, this time that is not the case with far more countries brokering deals for guaranteed delivery of vaccine. In the event of a global crisis with this pandemic flu there is no guarantee for any country regardless of how much money and or power they may brandish.

Swine Flu, Tamiflu

The experiment was paid for and sponsored by the National Institute of Allergy and Infectious Disease [NIAID], which is affiliated with the National Institute of Health [NIH]. Health officials are concerned that the bird flu virus might produce the capability to transmit more easily from human to human and become far more deadly taking millions of lives via a flu pandemic. The point is to learn whether antiviral medications have the strength and endurance to treat and act as a prophylaxis for the avian virus since an early phase outbreak would mean few if anyone would be vaccinated. Once a vaccine becomes viable, months would be needed to produce, deliver and administer it.

Scientists who carried out the study administered one of three daily dosage amounts to the H5N1 contagious mice. The maximum amount was adjusted to the weight of the mice and was the equivalent of the expected dose for humans infected with the illness. The protocol for generic tamiflu is to take it for a course of five days, the also tested an eight day course in 50 percent of the mice. the H5N1 virus continued to spread if the medication was ceased after five days. Generic tamiflu reduces the action of the virus in the mice, inhibiting its ability to spread into uninfected cells by stopping the neuraminidase enzyme, the surface protein which enables the virus to move from infected cells to others.

There were 8-0 mice total infected with the H5N1 virus and twenty of those received a placebo drug, thirty were given tamiflu at one of those three dosage levels for a five day span, while thirty got the dose of one of three levels for an eight day period. None of the placebo group of mice lived. Just five of ten mice who were administered the top level five day dose of tamiflu survived. Oseltamivir did aid in suppressing the flu virus in the infected rodents, the virus continued to thrive if the tamiflu was discontinued after day five.
Those mice that were administered the tamiflu over eight days did do better at surviving. One of the ten mice given a low dose survived as did six of ten in the mid level range of dosage and eight out of ten that were administered the highest dosage amount survived. The eight day course of oseltamivir gave added time for the virus to decrease its levels and there was a lesser chance of the avian virus from bouncing back after the tamiflu medication dosing was closed.

On top of testing for the effective response from the tamiflu versus H5N1 flu virus in these rodents, researchers also evaluated the vigorous nature of the current avian virus from Vietnam to a 1997 strain of the same virus that caused the deaths of half a dozen individuals in Hong Kong. Scientists discovered that The recent H5N1 influenza avian virus now working its way around Vietnam is far more virulent than its previous 1997 counterpart. They are suggesting that a longer phase of tamiflu antiviral medication will likely be necessary to defeat the ferociousness of the antigenic version of the H5N1 bird flu virus.

They believe that H5N1 is going through a quickening redevelopment phase that is tenacious. Experts were taken back by the persistence of this strain of bird flu. This initial study will be useful when future research is conducted by offering up a basis for measurement towards treatment and prevention of the avian virus utilizing oseltamivir – tamiflu antiviral medication.

After a spinal tap procedure on a young Vietnamese victim of influenza H5N1 performed in England physicians found traces of H5N1 in the boy’s spinal fluid which indicates this flu virus has the capability to transmit to the brain. More science is required to determine whether higher doses of tamiflu over a longer course can thwart H5N1 from entering the lungs and establishing a grip so it can then spread to the brain. Animal study models using avian flu virus to closely mimic the illness in a person are planned.

The NIAID is a section of the National Institute of Health connected with the United States Department of Health and Human Services and the NIAID is supportive of basic and practical research in order to diagnose, treat and prevent infectious communicable diseases like influenza, among others.

Bird Flu

Because Oseltamivir is the primary drug used to fight a global pandemic of the swine flu, the demand for this medication has grown rapidly over the past several months. Star Anise contains the compound called shikimic acid, which is used to create Oseltamivir. The availability of Star Anise is limited, meaning that the supply of generic tamiflu is constrained as well.

The price of shikimic acid has climbed drastically with the increased demand for Oseltamivir. Originally costing $40 per kilogram, it is now priced at 10 times that amount at over $400 per kilogram.

The manufacturer of Tamiflu, Roche, has been asked by competing companies to allow their production of the drug. However, even if Roche gave in to the mounting pressure and granted permission, the supply of generic tamiflu would be limited to the finite supply of Star Anise, unless an alternative was available.

A professor at Michigan State University has developed an alternate method to create the primary material to create Oseltamivir, called shikimic acid, which does not require Star Anise. Using this method, the professor claims that he can make large amounts of generic tamiflu available and has started his own company to manufacture this drug.

In response to the anticipated demand for generic tamiflu, over 100 companies have applied for licenses from Roche, the manufacturer who holds the patent. Other manufacturers around the world have decided to proceed with manufacturing this drug without waiting for the approval from Roche, although company officials from Roche believe this may be a difficult task to accomplish.

Because the procedure to create Oseltamivir is complex and requires ten different stages, Roche has stated that a new manufacturer of this drug would need a minimum of two or three years to begin production of generic tamiflu. After securing a supply of raw materials, the process needs up to eight months to complete. Some of these stages of production are dangerous, as they require sodium azide, a chemical that is also used to create the explosive component in automobile air bags.

While other drug manufacturers agree that manufacture of Oseltamivir is difficult, they do not feel this is an obstacle they cannot overcome. Cipla, a large Indian drug manufacturer that plans to produce Oseltamivir, currently uses sodium azide in its manufacturing process for two other drugs it produces, AZT (which is used to fight AIDS) and another drug used to combat epilepsy. Within a few months, Cipla plans to have enough Oseltamivir on hand to treat up to 200,000 people.

Headquartered in Basel, Switzerland, Roche will be increasing its production of Tamiflu by eight to ten times its 2003 production levels. The inventor of Tamiflu, Ernie Prisbe, who later licensed its production to Roche, agreed that the production process for Oseltamivir is complex and time consuming. He stated that the manufacture of Oseltamivir requires 12 steps, and each step in the process requires between four and six weeks to complete.

When manufacturing a small quantity of generic tamiflu in a laboratory, the process can be completed in a short period of time. In Taiwan, the National Health Research Institute created Oseltamivir within eighteen days. However, to produce this drug on a mass scale, a much longer time frame is required.

Tamiflu

If an international outbreak occurs and generic tamiflu is required to fight this virus, then Cipla is prepared to export generic tamiflu to meet the demand. As a result, the company’s share prices have risen nearly 7 percent in anticipation of the increased sales of generic tamiflu, in addition to the company’s most recent quarterly profits being higher than expected. Cipla currently supplies generic tamiflu to Indian hospitals that are run by the government at a price of 1,000 rupees for 10 capsules.

However, analysts have cautioned that these additional sales for Cipla may not be realized for some time, as other manufacturers such as Roche and GlaxoSmithKline have a stockpile of anti-flu drugs available. Depending on the severity and length of a global outbreak, these stockpiles may be insufficient to meet the demand and Cipla sales could then be positively affected.

Tamiflu