Global flu pandemic declared (swine flu) - August 2009

On June 11th the World Health Organization declared the first global flu epidemic in 41 years and moved the world to phase 6, the agency's highest alert level. ‘The world is moving into the early days of its first influenza pandemic in the 21st century," said Head of WHO Margaret Chan, "the virus is now unstoppable." She was quick to stress that it did not mean the virus was causing more deaths or had increased in severity, but the omens are worrying. Flu epidemics normally emerge late in the year, and those few which – like swine flu – start in the spring, have historically been much more serious. The so-called ‘Spanish flu’ started in the spring, with the first known case (thought to be an US army cook called Albert Gitchell) occurring in March of 1918. Initially a mild disease, by the autumn it had become something much worse; over the next year and a half it went on to kill vast numbers of people .

Estimates of the total death count vary considerably, from 1% of the world’s population to as much as 3% (Johnson & Mueller ’02, Ansart et al ‘09). Extrapolations to today’s larger global population are, therefore, equally fuzzy. Some suggest a total of 62 million deaths (Murray et al ’06). My own belief is that given the weakness of our innate immune systems today, caused by our over-sanitised food chain and evidenced by our abnormally high incidence of allergy (ie Baran et al ‘07), the death toll could be very much higher.

 

The WHO has not recommended that any national borders be closed or that restrictions on the movement of people and goods are currently necessary, because these precautions are effectively redundant. Instead, we must take medical precautions. Unfortunately, to our drugs-obsessed Department of Health, that means vaccinations and Tamiflu.

 

I would never like to imply that our D of H could ever get it wrong, but here they have made a series of potentially catastrophic errors. Vaccinations can only be made up after the antigenic strain of the virus has been identified – it takes 4 months or so to get vaccine production up to speed – but the flu virus is genetically very unstable. By the time we have made vaccine for one strain the next viral wave will be just about to hit us. We will always be one step behind – or as our Yankee friends put it, a day late and a dollar short.

 

Tamiflu is just a bad joke, albeit a very profitable one. Senior people I have spoken to admit that Tamiflu is being purchased and stockpiled primarily so that our political masters can tell us they’re ‘doing something’. They don’t expect it to be effective, and neither do I. Remember the problems with antibiotic resistance? The same thing happens with anti-virals, only even more rapidly.

 

The two main anti-viral drugs Zanivir (Relenza) and Oseltamivir (Tamiflu) were launched in US in 2000. Experimental resistance was demonstrated in 2001 (Gubareva et al ’01). Clinical resistance emerged a couple of years later (ie Carr et al ’02, Hurt et al ‘04) and subsequently spread widely and rapidly (Gooskens et al ‘09, Vicente et al ’09).

 

Once Tamiflu started being used to treat H5N1 (bird flu) in 2003/4, resistant strains of the virus cropped up within months (Le et al ‘05). Tamiflu-resistant strains of swine flu virus have emerged ALREADY (Cheng et al ’09, Hurt et al ‘09). It looks increasingly likely that the anti-viral drugs will be little more than an expensive distraction.

 

There is an alternative, namely 1-3, 1-6 beta glucan, a natural ingredient extracted from baker’s yeast. This compound enhances the innate immune system, and has been shown to protect against influenza virus in rats (Irinoda et al ’92, Biothera ‘04) and in pigs (Jung et al ’05). It is not known if the beta glucan can protect against all flu viruses, but we do know that it is effective against pathogens that activate an innate immune mechanism, whereby they bind complement. Critically, the H1N1 virus binds complement (Beebe et al ’83, Jayasekera et al ’07).

  References

Ansart S, Pelat C, Boelle PY, Carrat F, Flahault A, Valleron AJ. Mortality burden of the 1918-1919 influenza pandemic in Europe. Influenza Other Respi Viruses. 2009 May;3(3):99-106.

 

Baran J, Allendorf DJ, Hong F, Ross GD. Oral beta-glucan adjuvant therapy converts nonprotective Th2 response to protective Th1 cell-mediated immune response in mammary tumor-bearing mice. Folia Histochem Cytobiol. 2007;45(2):107-14.

 

Beebe DP, Schreiber RD, Cooper NR. 1983. Neutralization of influenza virus by normal human sera: mechanisms involving antibody and complement. J. Immunol. 130:1317-1322

 

Biothera 2004. Data on file.

 

Carr J, Ives J, Kelly L, Lambkin R, Oxford J, Mendel D, Tai L, Roberts N. Influenza virus carrying neuraminidase with reduced sensitivity to oseltamivir carboxylate has altered properties in vitro and is compromised for infectivity and replicative ability in vivo. Antiviral Res. 2002 May;54(2):79-88.

 

Cheng PK, Leung TW, Ho EC, Leung PC, Ng AY, Lai MY, Lim WW. Oseltamivir- and amantadine-resistant influenza viruses A (H1N1). Emerg Infect Dis. 2009 Jun;15(6):966-8.

 

Gooskens J, Jonges M, Claas EC, Meijer A, Kroes AC. Prolonged influenza virus infection during lymphocytopenia and frequent detection of drug-resistant viruses. J Infect Dis. 2009 May 15;199(10):1435-41.

 

Gubareva LV, Kaiser L, Matrosovich MN, Soo-Hoo Y, Hayden FG. Selection of influenza virus mutants in experimentally infected volunteers treated with oseltamivir. J Infect Dis. 2001 Feb 15;183(4):523-31.

 

Hurt AC, Barr IG, Hartel G, Hampson AW. Susceptibility of human influenza viruses from Australasia and South East Asia to the neuraminidase inhibitors zanamivir and oseltamivir. Antiviral Res. 2004 Apr;62(1):37-45.

 

Hurt AC, Ernest J, Deng YM, Iannello P, Besselaar TG, Birch C, Buchy P, Chittaganpitch M, Chiu SC, Dwyer D, Guigon A, Harrower B, Kei IP, Kok T, Lin C, McPhie K, Mohd A, Olveda R, Panayotou T, Rawlinson W, Scott L, Smith D, D'Souza H, Komadina N, Shaw R, Kelso A, Barr IG. Emergence and spread of oseltamivir-resistant A(H1N1) influenza viruses in Oceania, South East Asia and South Africa. Antiviral Res. 2009 Jul;83(1):90-3.

 

Irinoda K, Masihi KN, Chihara G, Kaneko Y, Katori T. Stimulation of microbicidal host defence mechanisms against aerosol influenza virus infection by lentinan. Int J Immunopharmacol. 1992 Aug;14(6):971-7.

 

Jayasekera JP, Moseman EA, Carroll MC. Natural Antibody and Complement Mediate Neutralization of Influenza Virus in the Absence of Prior Immunity. Journal of Virology, April 2007, p. 3487-3494, Vol. 81, No. 7

 

Johnson NPMueller J. Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic. Bull Hist Med. 2002 Spring;76(1):105-15

 

Jung K, Ha Y, Ha SK, Han DU, Kim DW, Moon WK, Chae C. Antiviral effect of Saccharomyces cerevisiae beta-glucan to swine influenza virus by increased production of interferon-gamma and nitric oxide. J Vet Med B Infect Dis Vet Public Health. 2004 Mar;51(2):72-6.

 

Le QM, Kiso M, Someya K, Sakai YT, Nguyen TH, Nguyen KH, Pham ND, Ngyen HH, Yamada S, Muramoto Y, Horimoto T, Takada A, Goto H, Suzuki T, Suzuki Y, Kawaoka Y. Avian flu: isolation of drug-resistant H5N1 virus. Nature. 2005 Oct 20;437(7062):1108

 

Murray CJLopez ADChin BFeehan DHill KH. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis. Lancet. 2006 Dec 23;368(9554):2211-8.

 

Vicente D, Cilla G, Montes M, Mendiola J, Pérez-Trallero E. Rapid spread of drug-resistant influenza A viruses in the Basque Country, northern Spain, 2000-1 to 2008-9. Euro Surveill. 2009 May 21;14(20)