Pandemic News/Awareness.

indigo girl · Jun 21, 2007

Why were they thinking that this virus was just going to go away?

http://www.recombinomics.com/News/06200702/Czech_BF.html

Positive diagnosis in the Czech Republic, H5N1 confirmed:

http://afludiary.blogspot.com/2007/06/czech-republic-confirms-h5n1.html

http://www.flutrackers.com/forum/showpost.php?p=86942&postcount=7

indigo girl · Jun 21, 2007

Infected money, who knew?

http://afludiary.blogspot.com/2007/06/infected-money

-nothing-to-sneeze-at.html

I remember reading in John Barry's The Great Influenza,

that people would drop their coins into a jar of disinfectant outside

of the little grocery store, and the store owners would pass goods

out to them with as little contact as possible. They made no mention

of paper money.

indigo girl · Jun 21, 2007

Reprinted with permission from the authors at Effect Measure

The Editors of Effect Measure are senior public health scientists

and practitioners. Paul Revere was a member of the first local

Board of Health in the United States (Boston, 1799). The Editors

sign their posts "Revere" to recognize the public service of a

professional forerunner better known for other things.

New drugs for flu. But what about some old ones?

Category: Antivirals * Big Pharma * Bird flu

Posted on: June 21, 2007 7:00 AM, by revere

The prospect of a influenza pandemic has concentrated the

minds of vaccine makers. There has been a lot of new

research and development on newer, faster and cheaper ways

to make flu vaccines. The antiviral field hasn't been quite as

active, although now things seem to be picking up. Until now the

antivirals (all four of them!) have been in two main classes, the

old M2 inhibitors (adamantanes) and the newer neuraminidase

inhibitors (oseltamivir, zanamivir; and waiting in the wings,

peramivir). Now we are hearing about new drug targets:

One of the promising things about the work is that the drugs

and drug targets that are in the pipeline would diversify the

number of classes of flu drugs if they are successfully brought

to market. That, in turn, would lower the risk posed by drug

resistance.

[snip]

Later this week, scientists will present an update on work to

bring to market a new drug, provisionally called T705, which

targets the polymerase protein. [Dr. Frederick Hayden of WHO]

said Phase 2 clinical trials will begin in Japan later this year.

[snip]

Dr. Robert Krug, of the Institute for Cellular and Molecular

Biology at the University of Texas at Austin, reported on finding

a drug target on the non-structural protein of the virus. A drug

target is a site on a protein created by the virus that could be

neutralized by the right chemical molecule.

Krug reported that his lab had screened molecules that

might be used against the target, and have come up with a

good "hit." But he cautioned that even if the work goes well,

it could be five years

before a drug could be developed, tested and marketed.

The non-structural or NS1 protein of influenza makes an

attractive target for a drug because it does not change from

virus to virus, unlike other parts of flu viruses.

(Helen Branswell, Canadian Press)

New classes of drugs mean there are more options if

a virus manages to escape by developing resistance. They

also may work better or be useful in combination with a drug

using another mechanism. It could also be that none of the new

drugs will be of any help in managing or slowing a pandemic but

still find an important use in treating individual cases.

While we are talking about new drugs, however, it

is somewhat disappointing not to see more information on

the utility of a class of old drugs, the statins (see here,

here and here). Statins are cheap, plentiful and have a fairly

good safety profile.

The statins are used for their cholesterol lowering feature but

seem to have other effects as well. Now a paper on another

cholesterol lowering drug, gemfibrozil, is also showing an ability

to protect against the lethal effects of influenza infection

(Budd et al., Antimicrob Agents Chemother. 2007 Jun 11). Survival

against H2N2 in mice increased from 26% to 52% after an

intraperitonealinjection of gemfibrozil 4 to 10 days

after intranasal inoculation with the virus. Maybe we should

be looking at the cholesterol connection a little closer?

The new drugs under development will have to go through an

intense process of safety and efficacy testing. Meanwhile we

also have drugs like the statins and gemfibrozil that are available

and approved and could be brought into service immediately in

the event of a pandemic. No big bucks here. These are drugs off

patent and not hugely profitable.

But wouldn't it be useful to be investigating their utility a little

more avidly? Or am I missing something?

sediaz · Jun 21, 2007

Dear Indigo,

I'm a fourth semester nursing student and am taking my Trends in Nursing class. We have to do a presentation and I decided to focus on the respirators that nurses would be wearing while caring for patients in respiratory distress during a Pandemic. I've been reading the posts here and visiting the sites that you reference.

Thank you for making me aware that this Pandemic is for real. I hope to become involved in helping my hospital/community prepare for thie inevitablity of this.

indigo girl · Jun 21, 2007

Dear Indigo,
I'm a fourth semester nursing student and am taking my Trends in Nursing class. We have to do a presentation and I decided to focus on the respirators that nurses would be wearing while caring for patients in respiratory distress during a Pandemic. I've been reading the posts here and visiting the sites that you reference.
Thank you for making me aware that this Pandemic is for real. I hope to become involved in helping my hospital/community prepare for thie inevitablity of this.

Sediaz, just remember, that it hasn't happened yet, though the threat is real.

Here is a link to get you started:

http://www.flutrackers.com/forum/forumdisplay.php?f=1175

indigo girl · Jun 22, 2007

Tamiflu resistance in Idonesia? Considering how often it used there, should we be

surprised if this turns out to be true?

http://afludiary.blogspot.com/2007/06/tamiflu-resistance-in-indonesia.html

TORONTO (CP) - An Australian researcher says H5N1 avian flu viruses from Indonesia
are markedly less susceptible to the antiviral drug Tamiflu than a previous line of the H5N1
family of viruses.
Jennifer McKimm-Breschkin says laboratory testing shows the viruses from Indonesia
are 20 to 30 times less susceptible to the drug as compared to H5N1 viruses that circulated
in Cambodia a couple of years ago.
McKimm-Breschkin, who's attending a conference on infectious diseases in Toronto, says the findings are not good news.
And she says they may help to explain the high death toll from H5N1 in Indonesia, where 80
of 100 patients have died of the disease.

indigo girl · Jun 23, 2007

Indonesia, another positive human case in a 3 year old girl. She seems to be stable:

http://afludiary.blogspot.com/2007/06/indonesia-reports-another-positive-case.html

The African nation of Togo is now positive for H5N1 confirmed cases of poultry:

http://afludiary.blogspot.com/2007/06/togo-confirms-bird-flu-outbreak.html

indigo girl · Jun 23, 2007

Scientifically.......the most disturbing part of this issue to me is the possible effects on school-aged kids / teenagers. The cytokine (sp?) storm concerns me..........and I wonder if you could explain it a bit more and especially why, in light if it being an inflammatory response, the use of steroids is not recommended. It seems it would decrease inflammation and inhibit the immune response that is too extreme. Do you have any more information on that?
Finally......what are the alternative-med type people recommending? (Immune enhancers / anti-virals / anti-inflammatories /anything?)

Here is some info on the cytokine storm from previous posts:

http://www.cytokinestorm.com/

http://scienceblogs.com/effectmeasure/2006/10/a_cautionary_tale_about_cytoki.php

I can not tell you why steroids are not effective. I think that we both know that of course, they have been tried in these cases.

Interestingly, that link to Effect Measure describing a drug trial that put the volunteers into a cytokine storm, has been shown to nurses familiar with one of the pediatric flu cases in this country. They felt that it was very similiar to what happened. And, the parents of the 15 yr old Connecticut

girl that died in April 2007, have come on line at a flu forum and said that they believe their child died of a cytokine storm event. They had independently researched this information, and posted the same link on cytokine storm that I posted above the Effect Measure link.

Most any link to the flu forums in these panflu threads will take you to info on various tx modalities which you can discuss with your healthcare provider. Here is one place to start:

http://www.flutrackers.com/forum/forumdisplay.php?f=164

Also in the last few pages of this thread there is an essay from Effect Measure discussing the use of statins as a possibility instead of the very scarce antivirals.

I hope that you will find this information useful. I just realized that I had not fully answered your questions. If there is anything else, please ask.

Update

I just found this earlier post about the WHO warning against the use of steroids with these

patients:

https://allnurses.com/forums/2170010-post259.html

indigo girl · Jun 23, 2007

Egypt

There is another pediatric case of avian flu, a 4 yr old boy, again in the southern part of the country in the summer which as we have noted is unusual:

http://www.flutrackers.com/forum/showpost.php?p=87500&postcount=9

The new case came from the southern Qena province, according to a statement from the Egyptian health ministry carried by MENA. The little boy was admitted to the hospital two days ago, it added.
"Initial investigation into the source of his infection indicate exposure to dead birds," the statement reported, saying the boy was receiving treatment and was in stable condition.
The country lies on a main route for migratory birds, which are believed to have brought the disease.

indigo girl · Jun 24, 2007

Germany

Does anyone still think that bird flu is an Asian disease that does not

occur in civilized countries?

Germany is now reporting H5N1 in their waterfowl. Please note

the warning to keep dogs leashed and away. The same should be

said for cats:

http://afludiary.blogspot.com/2007/06/germany-reports-h5n1-in-wild-birds.html

Authorities posted caution signs around two Bavarian lakes on
Saturday after seven dead birds tested positive for the H5N1 bird flu
virus, the first cases reported in Germany this year.
Nuremberg city authorities warned people to keep their dogs
leashed and stay away from waterfowl after five swans, one duck
and one goose all tested positive for H5N1.

indigo girl · Jun 24, 2007

An atypical presentation of H5N1 may have occurred in the most recent case in

Indonesia, case #101. This is of some concern if this is correct. Imagine asymptomatic carriers only identified by fever.

Has this happened before? No way to know:

http://afludiary.blogspot.com/2007/06/atypical-presentations-of-h5n1.html

Bangaladesh, where avian flu is continuing its spread:

http://www.flutrackers.com/forum/showpost.php?p=87611&postcount=3

gr8greens · Jun 26, 2007

An atypical presentation of H5N1 may have occurred in the most recent case in
Indonesia, case #101. This is of some concern if this is correct. Imagine asymptomatic carriers only identified by fever.
Has this happened before? No way to know:
http://afludiary.blogspot.com/2007/06/atypical-presentations-of-h5n1.html
Bangaladesh, where avian flu is continuing its spread:
http://www.flutrackers.com/forum/showpost.php?p=87611&postcount=3

Geeez, that's scarey........H5N1 sx that only include a fever w/o respiratory sx? .

Thanks so much for keeping us informed, Indigo.