The growing threat of bird-flu

Written by MICANS, MS, PharmB, Philip A

IAS is doing its best to provide supplies of Tamiflu to as many people as possible. Unfortunately demand is far outstripping supply, so as soon as stock arrives they are sold. We are therefore presenting this article as some further background to the problem and also outlining other key anti-flu drugs that are being used for this purpose. Furthermore, we still recommend that people boost their own immunity now with Biostim and DHEA and have Silver Protein products on hand. In addition, we also have the following general purpose anti-biotics available: Ciproxin, Doxycycline, Penicillin, Roxithromycine and Tetracycline.

It is generally accepted that some prescription flu drugs could provide lifesaving protection against bird flu, particularly if the virus mutates into a human transmitted form. However, experts are warning that supplies will quickly run out, especially as government agencies around the world try to stockpile the medicines.

Currently it is clear that a pandemic will overwhelm most countries health systems, as such, many private individuals/ families are doing their best to stockpile enough protection for themselves.

Experts say the flu drugs could shorten illness and prevent lethal complications for flu victims, as well as keep healthy people from catching it.

Physicians appear to prefer the brand made by Roche, called Tamiflu, as it may be more practical, (due to its shelf life and oral capsule form). However, right now, worldwide supplies are “very thin on the ground”, mainly because the drugs are not widely used to treat ordinary flu. “This needs to be in the national stockpile, just as much as Ciproxin and smallpox vaccine,” said Dr. Arnold Monto, a flu expert at the University of Michigan, who went on to add, a bird flu pandemic “could have as much of an impact as a manmade terrorist attack.”

Roche’s Tamiflu, is a pill that was introduced in 1999, and is one of only two drugs called neuraminidase inhibitors that appear to be effective against all kinds of flu, including the bird flu circulating in Asia and parts of Europe. The other drug is GlaxoSmithKline’s Relenza, which requires an inhaler so it is more rarely used, however given that the demand for Tamiflu is so great that obtaining it is becoming very difficult, Relenza is an excellent second choice.

The problem is that most drug companies only make as much products as is needed for a typical flu season and do not take into account an emergency. Terence Hurley, a Roche spokesman said; “If there was a large outbreak like a pandemic, it would take at least several months to produce additional product on top of what’s already available.”

He also commented that the company had received no orders for stockpiling large amounts, but was however in “preliminary discussions” with the U.S. Department of Health. Furthermore, the World Health Organization is also working on stockpiling plans with several European countries.

Tamiflu and Relenza are more expensive than the more widely available category of flu drugs called M2 inhibitors. These include the generic medicines Rimantadine and Amantadine. When the current variety of bird flu first spread from chickens to people in Hong Kong in 1997, it was treated with the M2 drugs. But since then it has mutated and become resistant to those medicines, a discovery that Dr. Frederick Hayden of the University of Virginia called “very disquieting.”

“That means that a whole class of drugs really would not be so useful for treatment or protection,” Hayden said. However, just how the flu drugs might be used has been widely discussed and debated among flu experts, who agree that they all could be especially critical in the early months of an outbreak.

“I think they would definitely have a major role in the first wave of any new pandemic strain and would perhaps provide time for the development of a vaccine,” says Dr. Paul Glezen of Baylor College of Medicine in Houston.

Typically, a flu vaccine takes at least six months to develop, but a bird flu shot is likely to be even more difficult, because it requires genetic engineering techniques that have never been used in human vaccines. The bird flu virus has the potential to spread around the world in weeks and would also be very difficult to contain by isolating victims, (as was done with SARS) since flu itself is more contagious.

Currently, bird flu is widespread among poultry in many Asian countries. A few dozen cases have been documented in people, but there is no sign yet of a person-to-person contamination. The fear is that someone already infected with the human flu will also catch bird flu. The two viruses could then swap genes inside the victim’s body, producing a very contagious new virus for which people may have little or no immunity.

Meanwhile, the experts agree that the supply of the principle flu drugs is the single biggest concern. “If there really was an explosive worldwide epidemic, we would have shortages of the drugs,” says Dr. John Treanor of the University of Rochester. “If taken by healthy people, Tamiflu could probably significantly reduce the chance of catching the flu. People would need to take it daily for at least six weeks, until the wave of disease passed. “

The drug’s main benefit, though, would be in treating the sick. Some propose giving it to everyone who gets sick in the first days of an outbreak. That would make them less likely to infect others, and therefore would be likely to slow the epidemic.

If taken soon after symptoms start, Tamiflu and Relenza can shorten a bout of ordinary flu by several days, and people often start feeling better within hours. But how well it would work against a mutant bird flu is unknown.

No one knows how many would get sick in a bird flu pandemic, or even whether a new virus would truly spread as easily in humans as it does in birds. However, it is estimated that 30 percent to 40 percent of the population gets infected in a flu pandemic. In the worst pandemic on record, the 1918-19 Spanish flu, an estimated 40 to 50 million people died. Today, the world population is almost four times larger than it was then.