Emergency Measures for H5N1 Influenza Pandemic
The ongoing pandemic of the extremely contagious H5N1 version of the avian influenza virus has a fatality rate of about fifty eight percent. It is presenting itself as quite relentless in much of southeast Asia, specifically in Thailand and Vietnam. It does seem to be an inefficient virus there has been some confirmation of person to person contact in the transmission of the virus. If unchecked it could become a potentially disastrous pandemic because of mutating viral antigens meaning a very contagious strain of H5N1 could develop. The last century saw several deadly pandemics in 1918 – 1919, 1957 – 1958, and 1968 -1969 which were virulent enough to claim an estimated thirty million, four million and seven hundred fifty thousand fatalities in that order.
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.