Tuesday, July 14, 2009

H1N1 Flu: Newer Perspectives...

2 recent papers in the electronic version of the Medical Journal of Australia give some clearer perspective as to where we are heading with this H1N1 flu.

Understanding Australia’s influenza pandemic policy on the strategic use of the antiviral drug stockpile

Life-threatening respiratory failure from H1N1 influenza 09 (human swine influenza)

Furthermore, WHO has just announced that the H1N1 flu is now unstoppable and is pushing for full vaccination programs to help cope with this pandemic.

Hopefully with many of the largest pharmaceutical companies all striving to devise this specific vaccine, we should have enough to go by, to supply all nations in need and not just the wealthy countries. After testing, it is expected that by year end, we should be able to mass vaccinate the public, at least those at high risks.

H1N1 is ‘unstoppable’, says WHO as it calls for vaccines

"Every country will need to vaccinate citizens against the swine flu virus and must choose who else would get priority after nurses, doctors and technicians," said Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research.

Several reports showed the new virus attacks people differently than seasonal flu — affecting younger people, the severely obese and seemingly healthy adults, and causing disease deep in the lungs.

Interesting research by Dr. Yoshihiro Kawaoka suggests that this new H1N1 strain does not stay in the nose and throat, as do most seasonal viruses. Instead, the H1N1 virus replicates significantly better in the lungs. Other studies have also shown it can cause gastrointestinal effects (from one-fourth to half the cases so far), and that it targets people not usually thought of as being at high risk.

“Obesity has been observed to be one of the risk factors for more severe reaction to H1N1” — something never before seen, Kieny added. It is not clear if obese people may have undiagnosed health problems that make them susceptible, or if obesity in and of itself is a risk.

Last Friday, the US Centres for Disease Control and Prevention and the University of Michigan reported that nine out of 10 patients treated in an intensive care unit there were obese (6 had BMIs >35, and 3, >40). They also had unusual symptoms of blood clots in the lungs and multiple organ failure. None have recovered and three died.

Young children may also be at inreased risk, although it is still unclear if underlying predisposition or illness might have contributed to this. There is a curious possibility that the elderly (those born before 1920) who might have been exposed to earlier H1N1 viruses before may have a protective immunity effect from the current flu pandemic—thus, the very elderly so far appear not at increased risk.

One British doctor who was exposed to to a local transmission of the flu in England has also died, but details are sketchy as of now. Therefore, it behooves the medical fraternity to be very vigilant and cautious when handling cold or flu patients—we do not want to be at the receiving end of something so chancy and catastrophic!

Above is a frightening photograph of someone with a cold coughing and a thick cloud of cold virus being released and widely dispersed. A technique called Schlieren photography was used by Professor Gary Settles to show how a cough can spread the cold virus through the air.


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