Publications
The Bottom Line - A Medical Viewpoint
by Dr. James Young, Medical Director Pandemic 101 (reprinted from the Pandemic News Network). In Canadian Centre for Emergency Preparedness (CCEP) Newsletter for May, 2008 at http://www.graphicmail.com/cceparchive
The Bottom Line - A Medical Viewpoint
by Dr. James Young, Medical Director Pandemic 101 (reprinted from the Pandemic News Network)
Pandemic flu and avian flu have largely been out of the popular press this past winter and it would be easy to think that an influenza pandemic is no longer a serious threat. But as regular readers of the Pandemic News Network know, there is actually a lot happening.
The full article:
http://www.ccep.ca/news/young.html
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The Bottom Line
A Medical Viewpoint
By: Dr. James Young
Pandemic flu and avian flu have largely been out of the popular press this past
winter and it would be easy to think that an influenza pandemic is no longer a serious
threat. But as regular readers of the Pandemic News Network know, there is
actually a lot happening.
Avian Flu outbreaks continue worldwide with serious outbreaks in South Korea,
India and Bangladesh. For example the South Korean government has recently
confirmed 43 cases of the H5N1 bird flu virus resulting in the cull of 8-9
million birds. There had also been outbreaks of bird flu in South Korea in 2003
and 2006 and both those outbreaks resulted in human illness. The difference in
this outbreak is that it appears that the H5N1 virus has mutated again and this
mutation may make it non transmissible to humans. This mutation is also
different from the strain commonly found in Indonesia and Vietnam. This is good
news for humans but not any improvement if you're a chicken. In fact humans
should not be particularly pleased either. What the mutation reminds us is that
these viruses constantly continue to mutate and sooner or later this process
will result in a new virus that can be transmitted human-to-human resulting in
a pandemic. This is exactly what happened in SARS but this time the
consequences could be much worse.
The lack of a pandemic over the past year has allowed planning to progress on
pandemic management although complacency is becoming an enemy. Planning always
should include progression. An example of this is the planning for antivirals. Medical advisors have always felt that antivirals potentially can play an important role in a
pandemic particularly until a vaccine is developed. They have also warned that
drug resistance could develop. Recent studies of a mutated bird flu strain have
suggested some possible resistance to tamiflu while
the strain remained susceptible to relenza. It is
important to note that this is experimental work and relates to a specific
mutation. We do not know what the pandemic virus will look like so
therefore this result may not be valid in that situation. What the experiment
does teach us is that we must not be overly reliant on antivirals
and assume they are a total solution to a pandemic. Antivirals
should be stockpiled but cannot replace other public health measures and
planning. This experiment should also teach us that the antiviral stockpile
proportion might need to be adjusted. Worries about resistance and possible
allergy have changed the thinking about an ideal stockpile. A few years ago we
aimed for a 90-10 mix of tamiflu and relenza. Now the thinking is that the proportion should be
more like 75 to 80 per cent tamiflu and 20 to 25 per
cent relenza.
The time before the next pandemic needs to be used for business continuity
planning, training, exercises and the purchase of supplies such as antivirals and hand cleaning lotions. Ignoring the
possibility of a pandemic will not make it go away.
Dr. James Young
Medical Director Pandemic 101
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