Swine-Flu - A Threat for Asthmatics?

EAACI, the largest European organisation in the field of allergy, immunology and asthma, today hosted a specialist forum on “Swine-flu - a threat for asthmatics? What people with asthma should know” at its new premises on Genferstrasse 21 in Zurich. Dr. Thomas Heiniger, Cantonal Councillor and Head of the Department of Health of Zurich, extended a warm welcome to the EAACI’s new Executive Director Silvia Schaller, along with a top-class international delegation from the field of immunology and asthma.

One out of three Europeans suffers from allergies or asthma. For a person with asthma, a virus infection can be life-threatening. The swine-flu presents a similar risk. The potential complications are heavily dependent on the underlying health of the patient. Among those at risk from serious life-threatening symptoms and even death are patients with pre-existing respiratory illnesses and also asthmatics. “One of the differences between the H1N1 swine-flu virus and the seasonal flu is that younger people become more frequently unwell than they do with the seasonal flu. Younger asthma patients should therefore take special care to keep their asthma under control,” states Professor Nikos Papadopoulos from the University of Athens.

What asthmatics should know about swine-flu

People with asthma are advised to take special note of general preventive measures such as hand hygiene or a change in greeting habits, and also to take special care of their health. If flu symptoms are suspected - aching joints, high fever, coughing, and headaches - asthmatics should consult their doctors immediately. “If asthma gets out of control, there is a risk of severe and possibly even life-threatening attacks during a flu epidemic. Influenza is not the most frequent cause of asthma attacks. However it can be an important trigger of such severe symptoms,” says Professor Papadopoulos.

Does a flu vaccination make sense for asthmatics?

Severe asthmatics are a risk group and vaccination against swine-flu is recommended. It can be assumed that the vaccine is very similar to previous flu vaccines, and that vaccination would be the lesser evil for asthmatics. “Is a commonly held misbelief that flu vaccination causes illness in asthmatics”, says Professor Papadopoulos. “This misbelief is due to the fact that vaccinations are normally given at times of year with high rates of flu-like illnesses from other viruses. When the symptoms then occur, they are falsely attributed to the vaccination.”

Zurich - a new centre for allergology and immunology

EAACI, the European Academy of Allergy and Clinical Immunology, which is represented in 107 countries, has recently moved its headquarters to Zurich. From here, effectively at the heart of Europe, the European association wishes to promote scientific and educational projects in the field of allergy, immunology and asthma.

“As the world’s No. 1 location for science and technology, this is a further milestone for the Canton of Zurich,” says Dr. Heiniger with pride. EAACI is making a big investment in the future.

“We aim to provide the most efficient platform for scientific communication and education in the field of allergy and immunology, striving to ultimately ease patients’ lives,” says EAACI President Professor Jan Lötvall. EAACI has already made a name for itself by organising the largest annual European congress for allergologists and immunologists and bringing together a broad range of specialists. The EAACI 2010 Congress will take place from 5th to the 9th June in London. Approximately 8′000 participants from all over Europe are expected.

About EAACI

EAACI - The European Academy of Allergy and Clinical Immunology is a non-profit organisation active in the field of allergic and immunologic diseases such as asthma, rhinitis, eczema, occupational allergy, food and drug allergy and anaphylaxis. EAACI was founded in 1956 in Florence and has become the largest medical association in Europe in the field of allergy and clinical immunology. It includes 5′500 individual members from 107 countries, as well as 40 National Allergy Societies.

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One-dose drug to fight flu

A New antiviral drug requiring only one dose is close to reaching the market, after Australian developer Biota announced successful trials in Asia.

The drug - laninamivir - is a potential successor to the firm's Relenza, which along with Tamiflu is taken for swine flu.

The new drug can be taken once to treat flu, or weekly as a preventative. The alternative drugs must be taken every day.

Biota managing director Peter Cook said commercial availability was ''within sight'', after trials in Japan, Taiwan, Hong Kong and Korea proved it safe and effective. Trials on adults and children found a single dose worked just as well to rid patients of the flu as taking Tamiflu twice a day for five days.

In children, the drug got rid of the illness more quickly than the Tamiflu regimen.

Biota's partner Daiichi Sankyo will apply to Japanese authorities to manufacture and market the drug next year.

However, before Biota can get market approval in the US and Australia, it must complete more trials that compare its performance with a placebo.

Mr Cook said the single dose meant national stockpiles against flu pandemics would be easier to build - and it could ensure patients completed a course of antivirals. He said it was effective against seasonal, avian and swine flu strains.

Increasing the range of antiviral drugs would slow the spread of resistant strains of influenza. Several strains of seasonal flu have already proven resistant to Tamiflu, and there are early signs in laboratory tests of some resistance to Relenza.

Like Relenza, the new drug is taken with an inhaler device, which restricts its use in children. Like Relenza and Tamiflu, the new drug works by preventing the spread of viruses from the lungs to elsewhere in the body.

Source : www.theage.com.au

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Thai drug maker guarantees vaccine safety amid A/H1N1 flu outbreak in Asia-Pacific region

As the A/H1N1 flu continued to plague the Asia-Pacific region, Thailand's state-run drug manufacturer guaranteed the safety of its vaccine for A/H1N1 flu, amid growing concerns there would be limited time to test it.

Bangkok Post online Friday quoted Government Pharmaceutical Organization (GPO) chairman Vichai Chokewiwat as saying that the nasal-spray vaccine against the new flu virus would meet global standards with the close supervision of the World Health Organization (WHO).

The WHO-sponsored production of the vaccine will begin next month after the GPO's receipt of the seed virus and 350 eggs from Germany to grow the vaccine.

"If things go as planned, we will have the Thai-made spray vaccine by the end of this year," he said, adding that Bangkok will sell 10 percent of the total production of 10 million doses to the WHO at a low price.

Vichai made the assurance amid growing concerns about the safety and effectiveness of the vaccine due to its rushed production.

According to Vichai, the vaccine development team plans to conduct trials on 430 volunteers of different age groups.

The clinical test on humans, which takes 120 days, will be closely supervised by the Public Health Ministry's Ethical Review Committee for Research in Human Subjects.

The newly made vaccines will also be submitted for the Food and Drugs Administration's approval before being introduced to the public.

The government will provide the vaccine to about five million people for free.

In Hong Kong SAR, 88 new cases of influenza A/H1N1 were confirmed, bringing the total number of confirmed cases to 1,640 in the city.

The new cases involve 43 males and 45 females, aged between 5 and 64 years, said the department. The newly confirmed cases included an outbreak of six people from a residential workshop for the physically and mentally disabled in Eastern District, including four workshop attendees, two residents and a staff member.

The neighboring Macao SAR also reported eight new cases Friday, bringing the total number of such cases to 102, passing the 100 threshold.

Some 20 patients who tested positive for the A/H1N1 flu virus were still receiving medical treatments at local hospitals, while 80 patients have recovered and have been discharged from the hospitals.

Myanmar's flu tally rose to four when a 22-year-old woman has been confirmed with the infection, the official newspaper New Light of Myanmar reported Friday.

The authorities continue to take preventive measures against the possible spread of the global human flu pandemic, advising all private clinics in the country to report or transfer all flu-suspected patients, who returned from abroad, to local state-run hospitals or health departments for increased surveillance.

The Vietnamese Ministry of Health confirmed 18 more influenza A/H1N1 cases, bringing the country's tally to 338.

The ministry said there is a high possibility of the spread of flu A/H1N1 virus in schools and communities in the coming time. Therefore, it urged people coming to Vietnam from affected areas to observe self-quarantine and limit their contacts with other people within seven days from the time of entering the country.

Cambodia confirmed new flu cases on foreign tourists Friday.

A four-member American family (a man and three women) were confirmed the positive test of A /H1N1 flu in Cambodia.

A 22 year-old Irish man was also confirmed positive in the test of A/H1N1 virus in Cambodia, a Cambodian health official said late Friday.

"We always found the most case on the foreign travelers into the country, and we are still investigating the case for local people because foreign travelers walked many places in the country," he said. "They have rights to walk anywhere they like but when they were confirmed the positive test of the flu. They need to be treated," he stressed.

Source : news.xinhuanet.com

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Obesity emerges as new risk factor for severe flu

People who are obese but otherwise healthy may be at special risk of severe complications and death from the new H1N1 swine flu virus, U.S. researchers reported on Friday.

They described the cases of 10 patients at a Michigan hospital who were so ill they had to be put on ventilators. Three died. Nine of the 10 were obese, seven were severely obese, including two of the three who died.

The study, published in advance in the Centers for Disease Control and Prevention's weekly report on death and disease, also suggests doctors can safely double the usual dose of oseltamivir, Roche AG's antiviral drug sold under the Tamiflu brand name.

"What this suggests is that there can be severe complications associated with this virus infection, especially in severely obese patients," said CDC virus expert Dr. Tim Uyeki.

"And five of these patients had ... evidence of blood clots in the lungs. This has not been previously known to occur in patients with severe influenza virus infections," Uyeki said in a telephone interview.

Dr. Lena Napolitano of the University of Michigan Medical Center and colleagues studied the cases of 10 patients admitted to the university's intensive care unit with severe acute respiratory distress syndrome caused by infection with H1N1.

"Of the 10 patients, nine were obese (body mass index more than 30), including seven who were extremely obese (BMI more than 40)," they wrote in their report.

Their study was not designed to see if obesity or anything else poses a special risk factor for flu. But the researchers were surprised to see that seven of the 10 patients were extremely obese.

Multiple Organ Failure

Nine had multiple organ failure, which can be seen in influenza, but five had blood clots in the lungs, and six had kidney failure.

None has fully recovered, the researchers said.

The H1N1 swine flu virus first emerged in Mexico in March and was spreading out of control in the United States by the time it was identified at the end of April. The World Health Organization declared a pandemic in June.

While it is causing moderate illness, all influenza viruses can be deadly and this one is no exception. It has killed close to 500 people globally, more than 200 in the United States alone.

However, the new virus has a slightly different pattern from seasonal flu -- it spreads in the summer months, attacks young adults and older children, and may affect the body slightly differently.

As with H5N1 avian influenza, which only rarely attacks people, patients seem to survive better if they get extra-high doses of Tamiflu for longer than the usual 10-day treatment course, Uyeki said.

"We don't know if it is necessary for a higher dose of the drug to be given to patients who are obese," he said.

"The high prevalence of obesity in this case series is striking," the CDC's commentary accompany the report reads.

"Whether obesity is an independent risk factor for severe complications of novel influenza A (H1N1) virus infection is unknown. Obesity has not been identified previously as a risk factor for severe complications of seasonal influenza."

Source : www.reuters.com

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Understanding Swine Flu

By Henry I. Miller

The extent and impact of the swine flu epidemic, which appears to have originated in Mexico and spread rapidly to a dozen countries and parts of the U.S., is still unknown. The epidemiology of such disease outbreaks is rather like a jigsaw puzzle, and we are now at the stage where the picture is intriguing even if we're not sure what we're seeing.

We do know the number of cases in Mexico exceeds 1,995, there have been at least 149 deaths, and there have been 20 cases in five U.S. states (with no fatalities as yet). And that the outbreak causes us to confront complex issues that encompass medicine, epidemiology, virology and even politics and ethics.

These events demonstrate that good surveillance is needed in order to detect early on that a new infectious agent, transmissible between humans, has emerged. Unfortunately, conditions in many countries are conducive to the emergence of such new infectious agents, especially flu viruses, which mutate rapidly and inventively. Intensive animal husbandry procedures that place poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty and grossly inadequate public-health infrastructure of all kinds -- all of which exist in Mexico, as well as much of Asia and Africa -- make it unlikely that a pandemic can be prevented or contained at the source.

In theory, a flu pandemic might be contained in its early stages by performing "ring prophylaxis" -- aggressively using antiflu drugs, vaccines and quarantines to isolate relatively small outbreaks of the new infectious agent. Addressing H5N1 avian flu in 2005, Johns Hopkins University virologist Donald S. Burke said, "it may be possible to identify a human outbreak at the earliest stage, while there are fewer than 100 cases, and deploy international resources -- such as a WHO [World Health Organization] stockpile of antiviral drugs -- to rapidly quench it. This 'tipping point' strategy is highly cost-effective."

But a strategy can be "cost-effective" only if it is feasible. Early ring prophylaxis might work in Minneapolis, Toronto, Singapore or Zurich. In places such as Indonesia, China and Mexico, however, the expertise, coordination, discipline and infrastructure are lacking. Moreover, there is no vaccine available to prevent infection of humans by the new H1N1 swine flu (or by H5N1 avian flu, for that matter).

The rapid and constant movement of goods and people around the world makes early containment virtually impossible. We saw this with the SARS (Severe Acute Respiratory Syndrome) epidemic in 2003: Within a matter of weeks, the disease spread rapidly from southern China to infect individuals in some 37 countries, killing about 800.

In the current swine flu outbreak, New York City high-school students apparently brought the virus back from Mexico and infected their classmates. All six cases so far reported in Canada were connected directly or indirectly with travel to Mexico.

Flu viruses can be directly transmitted (via droplets from sneezing or coughing) from pigs to people, and vice versa. These cross-species infections occur most commonly when people are in close proximity to large numbers of pigs, such as in barns, livestock exhibits at fairs, and slaughterhouses. And, of course, flu is transmissible from human to human, either directly or via contaminated surfaces.

Pigs are uniquely susceptible to infection with flu viruses of mammalian and avian origin. This is of concern for a couple of reasons. First, pigs can serve as intermediaries in the transmission of flu viruses from birds to people. And when avian viruses infect pigs, they adapt and become more efficient at infecting mammals -- which makes them more easily transmitted and dangerous to humans.

Second, pigs can serve as hosts in which two (or more) influenza viruses infecting an animal simultaneously can undergo "genetic reassortment," a process in which pieces of viral RNA (the virus's genetic material, similar to DNA) are shuffled and exchanged, creating a new organism. The influenza viruses responsible for the world-wide 1957 and 1968 flu pandemics -- which killed about 70,000 and 34,000, respectively, in the U.S. -- were such viruses, containing genes from both human and avian viruses.

Experience shows that attempts to stem the spread of an outbreak may actually exacerbate it. In 2006, China's chaotic effort to vaccinate 14 billion chickens to control avian flu was compromised by counterfeit vaccines and the absence of protective gear for vaccination teams. This likely spread contagion by vaccinators who carried infected fecal material on their shoes from one farm to another.

The situation in Mexico resembles the scenario we might expect for an outbreak of a major human-to-human pandemic in its earliest stages: a large number of illnesses among social and family contacts of victims; infection of health-care workers and patients in hospitals where the victims are treated; and the rapid spread of confirmed cases from an initial region to other countries as people infected by the virus travel while it is incubating, but before they become seriously ill.

Because they have been stockpiled for use in the event of an avian flu pandemic, large amounts of the antiflu drugs Tamiflu and Relenza are available. However, they must be administered during the first couple of days after symptoms begin to be an effective treatment. They can also prevent the onset of the disease if administered in adequate doses prior to exposure. The danger of using antiflu drugs in poor countries with inadequate public-health facilities such as Mexico is that they may be administered improperly and in suboptimal doses, which would promote viral resistance and intensify an outbreak.

If the swine flu outbreak becomes a pandemic with a high rate of severe complications (such as pneumonia) and death, we will need to be smart, nimble and flexible. That will involve triage on many levels -- including decisions about which patients are likely to benefit from scarce commodities such as drugs and ventilators -- as well as "social engineering" determinations about issues such as mandatory quarantine, the canceling of public events, shutting airports and closing our southern border. Let's hope it doesn't come to that.

Dr. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution. He is a former flu researcher and was an official at the National Institutes of Health and the Food and Drug Administration from 1977 to 1994.

Source : online.wsj.com

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FDA allows uncleared uses of flu drugs, tests

The U.S. Food and Drug Administration authorized emergency uses of the flu drugs Tamiflu and Relenza on Monday and a diagnostic test to help get a grip on a new strain of swine flu, the agency said on Monday.

The U.S. government's declaration on Sunday that the swine flu is a public health emergency freed the FDA to take such action, the agency said in a statement.

The FDA will now have the authority to allow public health and medical personnel to prescribe Relenza, GlaxoSmithKline's inhaled flu drug also known as zanamivir, and Roche AG's Tamiflu, a pill also known as oseltamivir, for unapproved uses.

Tamiflu, approved for treating and preventing the flu in people over a year old, can now be used in children under 1 year. Doctors can also change the recommended dosage for children older than 1 year under the emergency use authorization.

The FDA also gave more healthcare workers authority to distribute Tamiflu and Relenza, including some public health officials and volunteers.

More than 40 people have been sickened by the new flu strain in the United States.

The rRT-PCR Swine Flu Panel diagnostic test was authorized for testing samples from flu patients to determine if they have the new strain.

A positive finding will presumptively conclude that the patient has the new, previously unseen strain of H1N1 swine flu. But a negative result will not be considered conclusive that a patient does not have the virus, the agency said.

Source : www.reuters.com

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