Medical Care

• Appointments with primary health care providers are expected to rise by one hundred fifty to four hundred percent in an epidemic situation causing much havoc and cost to the health care structure.
• During an influenza pandemic or epidemic health care systems are pushed to the brink by illness complications like sinusitis, bronchitis and pneumonia which increase costs for care substantially not only for outpatient services but from an inpatient point of view. Data compiled in big hospitals located in the United States prove that admitting patients to facilities rises by one hundred to one hundred seventy percent in an influenza pandemic or epidemic.

Industry Health Watch

• Influenza on its own is shown to be responsible for one tenth of all illness related nonattendance from work.
• When those absentees come back to their jobs eighty percent of the adults claimed a reduced performance in their ability to function at work.
• Production losses come in at twelve billion dollars every year in only the United States.

In the past influenza was difficult to treat and options limited to mainly bed rest and doctors orders. Patients would treat symptoms using OTC medication but the virus was always left undisturbed to run rampant until it subsided causing a threat of secondary illness and complications from the primary disease itself.

Many corporations and businesses today will stockpile their own stores of antivirals such as generic tamiflu and relenza in the event of an pandemic or epidemic outbreak of flu. In fact, some countries are looking into the practicality of non medical hoarding of medicines such as tamiflu when global stocks may be insufficient to administer courses of antivirals to those who will be in most need of them during an outbreak. Currently there is nothing stopping a company from warehousing tamiflu for their employee use in the event of influenza outbreak.

Understanding Vaccinations

Vaccination is with doubt the best strategy in the prevention of a full blown pandemic and the administering of vaccine targets high risk sectors of a population such as chronically ill and the elderly. Research has shown us that vaccinations are effectual at levels of seventy to ninety percent with thos percentages dropping off in certain groups such as elderly who have a thirty to forty percent effectiveness. In the case of a new virus variety becomes active after a vaccine is produced and administered, those people who get their vaccination are not protected from the new strain.

The WHO makes a point of organizing a data exchange of information gathered from around the world so experts can determine which strain of virus needs to have a vaccine produced to combat it. Surveillance of influenza cases globally helps make certain the best and most effective vaccine is formulated annually.

Useful Antiviral Drugs

Older antiviral medicines are becoming obsolete because of quickening of resistance to the drugs, they are narrow in their treatment options and some have adverse reactions which are less than favorable. Newer antiviral medications have been developed that are called neuraminidase inhibitors [or NAIs] that challenge the virus at the point of reproduction effectively blocking its growth and these NAIs have displayed successful results.

Two antivirals medications in the NAI class are being produced in mass numbers and distributed worldwide for novel influenza H1N1 virus combat. One is known as Zanamivir [aka relenza] which is administered via a dry powder and inhaling mechanism. The other more popular NAI being shipped and stockpiled globally is Oseltamivir or often referred to as Generic Tamiflu which is an oral medication taken in capsule form or liquid for easy ingestion by children.

These neuraminidase inhibitors work on the surface enzyme of the flu virus called the neuraminidase protein which is blocked, or inhibited and restricts the growth or expansion efforts of the virus. The neuraminidase part of the virus is not exclusive to a single influenza strain but common in all varieties and the drugs action means the virus cannot continue infecting cellular physiology.

Tracking Influenza Outbreaks globally Via Surveillance

When a medical practitioner realizes that a flu virus is active locally they can dramatically increase their rate of diagnosis using certain symptoms to form a diagnosis which means they can better treat the influenza virus. This means when patients are not feeling well they can see their primary health care provider for a checkup and feel pretty certain they know what they have and how to treat it.

The WHO collects information about potential hot spots for influenza outbreaks through its Global Influenza Surveillance Network and reports the pertinent flu virus information globally twice a year. This so individual nations can begin preparing for specific threats from influenza. The contents of the influenza vaccine for the following flu season are developed annually using data provided by this WHO network.

This information must be updated often since flu viruses are continually changing so if the correct influenza strain is not produced the protection factor of the vaccine will drop resulting in more illness and further fatalities. This same WHO influenza surveillance network is used as a world alert system warning when a potentially virulent strain of flu shows pandemic qualities. This network has vastly improved influenza epidemiology since its inception in 1952, when WHO experts concluded a network of labs spanning the globe could assist its international member nations on overall influenza preparedness. The WHO works closely with Pharmaceutical companies and national health systems of its members to provide guidance for testing and development processes.

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The facts are that national warehoused quantities of generic tamiflu are destined for treating infected patients only rather than targeting treatment and prophylactic care. Some nations are now considering plans for stockpiling enough generic tamiflu to aid in treatment as well as providing drug intervention to those who have made contact with individuals who already have the contagion.

This study looked carefully at models of research showing how cost-effective it would be to decrease the transmission of novel influenza A by utilizing generic tamiflu in a preventative prophylactic manner. The research displayed how treating pandemic influenza in this way would not only reduce risk but save money in an effectual manner by lowering the overall impact of an outbreak on society. This study combined with other previously analyzed data showed that using generic tamiflu in a prevention strategy would greatly assist in controlling a virulent infection incidence.

The impact from an influenza outbreak could be reduced even further if the generic tamiflu stockpiles were increased by an unlimited amount. Patients who were treated as soon as they became symptomatic as well as infection prevention when individuals are exposed to infection whether at school or work or via familial contact, could reduce illness rates by more than half by comparison to no intervention at all. The money saved woul amount to about $70,000.00 per one thousand people saving some twenty one billion dollars in the United States on its own!

Including further tactics to combat influenza like closing down schools will decrease the number of fatalities and present health cost benefits to boot. Having a vaccination program in place before an outbreak hits hard would also be vital in flu control depending on how effectual the vaccine was at diminishing illness.

The WHO is strongly advising nations to use generic tamiflu for the prevention of avian influenza for people in contact with infected individuals or even suspected of having the illness and research shows that such a strategy may also be a viable tactic in the event of an H1N1 pandemic outbreak. This is even more practical given that the vaccine could be delayed and insufficient in quantity and initial potency in the first wave of outbreak.

Prophylaxis with antivirals or vaccines

Ideally, vaccination against influenza would be the best method of prevention. In the initial stages of a pandemic however there are usually limited – if any – amounts of vaccine available and that which is used may not have the full matching characteristics to the infectious strain. Production of a vaccine will only be able to start once the correct variety of virus is established. It usually takes months for a vaccine to be developed and so the initial months of a pandemic are vulnerable times. Given these factors the use of antiviral medications such as generic tamiflu and relenza are more important than ever to ease the burgeoning growth of pandemic influenza.

Having a solid plan in place is imperative when the state of global health is so uncertain and knowing an adequate supply of antivirals like generic tamiflu are in place relieves anxiety levels. Generic tamiflu is a known virus inhibitor that has proven effectual aganst varying types of influenza. Having tamiflu stockpiles at adequate levels when an outbreak occurs is crucial to early influenza defense. Health organizations the world over must decide if these generic tamiflu stocks should be used to treat influenza or act as a prophylaxis.

How The Study Worked

The premise of the research study was to look at the possible health results and cost effectiveness on society when using tactical methods of mitigating pandemic influenza on community and populations in America. Using a population of 1,632,000 persons and the average household demographics based on an earlier census, the study looked at no intervening measures with sixteen singular and combined tactical approaches for intervention which included using tamiflu as a prophylaxis after exposure, treating influenza with generic tamiflu as well as prior to vaccination before a pandemic outbreak with fractionally dynamic vaccine; and the closing of schools.

Assumptions were made regarding the amount of tamiflu available studying quantities for twenty five percent of the population through to limitless amounts of generic tamiflu for therapeutic treatment and prophylaxis. The representation also made consideration for the possible effects of both generic tamiflu and vaccines in lowering death rates and the presence of illness in a time of vigorous pandemic. The number of cases of illness was lowered from five hundred cases per one thousand people and no intervening measures to two hundred and thirty bouts of flu per one thousand persons using generic tamiflu as a pre exposure prophylaxis. Fatalities also dropped from 13 per one thousand to 5 per thousand people. The manufacturer of tamiflu [oseltamivir] provided the funding for the comprehensive research.

More About An influenza Pandemic

When a pandemic of influenza takes place it is caused by a new strain of influenza A emerging and the world’s population is left vulnerable because no immunity yet exists and the outcome is concurrent epidemics breaking out around the world resulting in large numbers of fatalities and sickness. The world’s worst pandemics thus far were the Spanish flu A H1N1 in 1918 – 1919 which caused more than thirty million deaths globally, Asian flu A H2N2 in 1957-1958 resulting in one million fatalities around the globe, Hong Kong flu A H3N2 in 1968 which had an outcome of eight hundred thousand people dying in only six weeks around the world.

The World Health Organization believes we are in a pandemic phase now and in under the worst threat in thirty seven years, having met the prerequisites needed to classify novel influenza A H1N1 a Pandemic and avian influenza in south east Asia meeting two of three conditions of a pandemic; a new virus has emerged and it has spread to the human population. H1N1 has met those requisites and capped it off by qualifying under widespread human infection or pervasive human to human transmission.

More About Generic Tamiflu

Generic tamiflu was produced as an overall active antiviral against which acted against any and all influenza varieties by thwarting the action of the neuraminidase [NA] enzyme on the membrane surface of the virus. When the NA enzyme is blocked it can no longer reproduce to additional cells in the human system. It is approved and dispensed as a treatment and preventative medication against influenza in kids above one year old and adults.

A Review Of Pandemics and Epidemics

As influenza viruses go influenza A is the most vigorous and worrisome type having become associated with most epidemics and pandemics over the years.

Influenza epidemics are happening nearly every year but each varies in intensity and depth and pandemics –which are basically global epidemics – happen in ten to forty year time spans and can touch nearly fifty percent of humanity.

In the last one hundred years the most severe influenza pandemic outbreaks were:

• Spanish influenza A H1N1 – 1918 1919 post world war 1 – over thirty million fatalities globally
• Asian influenza A H2N2 – 1957 1958 –one million deaths globally
• Hong Kong Influenza A H3N2 – 1968 1969 – eight hundred thousand global fatalities in six weeks

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The Different Strains Of Influenza

Presently three types of infectious influenza are active. They are referred to as Types A, B, and C Influenza. Type A influenza is the most talked about flu virus these days and is probably thought of as the most volatile as it is dangerous as a potential ignition infection for a great epidemic and it has proven this in the past. Medical experts sit up and take notice when influenza A has become virulent. These A strains infect birds and animals and can be aggressive against human populations as well. On the Basis of surface proteins the flu is separated in to differing sub groups. Two types of surface proteins and known as hem agglutinin and Neuramidase which are designated by the H and N letters correspondingly. The Strain varieties are referred to numerically. This means that H1N1 is a hem agglutinin with 1 as a variety and Neuramidase also with a variety 1 type. Hem agglutinin has sixteen varieties and the Neuramidase has nine varieties.

There are as many versions as combinations in the sixteen to nine ratio. That many strains of viruses of the type A influenza potentially could exist. These are not all dangerous versions of the illness and many are limited to infecting certain animal classes. There are only several of these which could potentially extend to humans. These varieties are the H1N1, H1N2 and H1N3. The H5N1 strain is the most volatile and dangerous of all and infects avian populations, animals and humans alike. It is commonly referred to as the avian strain. Found hosting in water borne birds, ducks are the reservoir for the majority of concern when hosts for this strain are considered. Transmission of the disease from these birds is through their saliva, nasal secretions and feces. Avian influenza exists in two types, one highly infectious and the other not so pathogenic a form.
Influenza B and C are less virulent and symptoms in humans are relatively mild.

These viruses which cause the influenza are beginning to show small signs of change referred to also as drift. The “drift” is what may cause a mutation within the flu virus creating a new combination of the genetic substance and this can make it quite resistant to any medications and the transmission of the mutated virus will become easier from human to human.

How Tamiflu acts

Generic Tamiflu is the medication of choice with primary health care providers when faced with prescribing for influenza. Tamiflu is an inhibitor drug so it will respond in a unique manner than from other medicines. Tamiflu combats the virus infection at its root level inhibiting its growth in the primary phase of expansion. It then begins to travel throughout the body hunting and killing the virus when it presents itself utilizing the antibodies within the patient to aid the process of healing. When starting a course of generic tamiflu it should be initiated in the first forty eight hours of initial onset of the symptoms. Ingested in this way it is really quite effective.

A full course of medication is recommended to last for ten days and should be completed in its entirety. Patients claim to begin feeling better within two days of starting generic tamiflu and the minimum treatment course should be five days or ten capsules in the course. Tamiflu can also be ingested as a chemoprophylaxis if one has been exposed to influenza infection but aren’t presenting symptoms or if influenza like symptoms are indicated but there is no time to await test results. There are now different recommendations for taking generic tamiflu for these different presentations of combating the flu so instructions from a health care professional should be sought. The CDC and WHO are updating protocols for generic tamiflu regularly to continue the best utilization of the medication and reduce the risk of resistance build up.

Generic tamiflu [Oseltamivir] and relenza [zanamivir] are the only current antivirals deemed effective in battling novel influenza H1N1 infection as a direct “curative” or as close as it can come to curing the virulent influenza illnesses.

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Patients who cope with asthma or some form of lung ailment are certainly at higher risk of complications resulting from H1N1 influenza though it behooves them to pay attention to the presentation of symptoms and not to panic if the illness is present. Noticing the symptoms in the initial stages of illness is vital to utilizing antiviral drugs such as generic tamiflu or Oseltamivir that is effectual at combating the current swine flu virus. Tamiflu medication is at its most potent when started at the earliest sign of illness and its effectiveness wanes if taken after a forty eight hour window of the onset of the illness.

If an asthma sufferer notices swine flu symptoms like hyperthermia [fever], lethargy, no appetite, and productive cough treatment action should be initiated. Some patients with the virus experienced runny nose, sore throat, nausea, vomiting and also diarrhea – in about forty percent of cases it affects gastro tract.
If a person begins showing indications of the swine flu virus that person needs to contact their primary health care provider to consult on their symptoms. A physician is ready to recommend if an office appointment is advisable or not. At the same time if a patient begins showing signs of the illness they should avoid contact with family members or any individuals who would normally be in contact with them. They also need to practice virus safe hygiene like washing hands thoroughly since frequent hand cleansing is probably the best way to prevent illness along with social distancing – keeping at least six feet away from others and avoiding groups, especially if you feel symptomatic.

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The avian viruses are divided into two groups, High contagion and low contagion. The majority of avian viruses fall under the low Contagion [or low Pathogenicity] Avian Influenza [LPAI] group, developing mild infections in the diseased birds. Birds will commonly present with disheveled plumage, loss of appetite, a reduced egg production, sneezing, and coughing. Often this class of pathogen will go undiagnosed.

High contagion [or high Pathogenicity] Avian Influenza [HPAI] presents with more harsh symptoms that comprise sudden death, no interest in food and low energy, reduction in egg laying, facial swelling, malformed eggs and diarrhea. The fatality rate for HPAI can be as high as one hundred percent.

What is the H5N1 variation of avian influenza?

Every flu virus falls under one of Influenza A, B, or C based on their structural makeup. Type A is the virus variety that is the cause of fatal pandemics and can infect both humans and animals. The B variety is responsible for local outbreaks of influenza infections. The C type is the one virus version that seems to be the steadiest of all three, displaying just mild symptoms in infected humans. Varieties B and C are normally discovered in humans. Both of types B and C appear more stable than Type A and do not get grouped on the basis of subtypes.

Type A influenza viruses are separated into sub units and are named based on surface proteins Hemagglutinin [HA] and Neuraminidase [NA]. There are in existence sixteen varieties of HA and nine variations of NA which means a full 144 combinations are potentially likely.

Therefore, the H5N1 is a type A virus and its name is derived from HA 5 protein and NA 1 protein found on its outer membrane surface.

How Do Type A Viruses Cause A Pandemic?

Influenza Type A viruses are sub categorized into strains. The strains are constantly evolving into other strains. They possess a unique ability to trade genetic substance with other viruses to fashion novel viruses that make them volatile and tough to defend against. People are required to build up a different immunity [or antibodies] whenever a novel strain appears active.

Viruses are not able to restore the genetic harm done in the trade process, hence a process known as Antigen drift takes effect casing newer strains of virus through small alterations. In the event that this genetic substance from two species such as birds and human Influenza A in come together and mix, a totally new strain is produced. The process is referred to as antigen shift to which humans have no immunity, this results in quickened transmissibility and a serious pandemic can develop.

How Does The Virus Go to Humans From Birds?

Avian influenza viruses are not normally a threat to humans. Birds in migration are responsible for carrying the viruses but remain unaffected by them. These migratory birds then make contact with the domicile variety like poultry stocks and ducks thus transmitting an infection into them. The domestic avian populations can also become infected when they are exposed to tainted surfaces as well. When the virus lodges in these domestic bird populations it can become the foundation for a severe epidemic within those avian populations it infects. Humans contract the illness when they are exposed to these infected birds and their virus or if they come in contact with impure feces ridden areas of avian activity.

When the virus reaches the human host it begins the transformation of antigenic shift, mixing with the genetic substance of the human influenza form producing some unique variation strain of virus that unfortunately humans have no way of combating naturally since they don’t have an immunity to it. These genetic shifts can also happen in a third party species when they are susceptible to each of the bird and human viruses, for example the pig. When a human influenza virus and an avian flu virus meet, their genetic imprint comingle thus producing a new virus that has the potential of infecting people.

What Makes The H5N1 Virus So Harmful?

In 1997, the first cases of H5N1 influenza were noticed in Geese in China’s southern area. Combined, there were infections documented in eighteen people, six of those people became fatalities. From here the disease rapidly moved into Hong Kong, infecting poultry which led to the culling of a million and a half chickens in order to seize the advantage from the H5N1 virus. There was no sign of the virus for several more years when it once again reared up in 2002, once again plaguing Hong Kong. From then until now it has been responsible for killing millions of domestic birds in Asia and human infections have now been recorded.

The specific strain of H5N1 virus has been particularly virulent and the apprehension for human populations is growing. Currently it is no simple feat for a person to become infected with the virus, but those who become infected face a severe battle with the illness. Fifty percent of those humans infected have become fatalities and this number is worrisome to say the least. Everyone who succumbed to the illness was previously in robust health having never been previously infected. What is now more disconcerting to world health officials is the prospect of H5N1 virus mutating via antigenic shift which could produce a form of the virus that is deadly because of human to human exposure. If this were to happen the result could be a pandemic globally that could result in the human mortality rate soaring.

Is It Still Safe To Eat Poultry?

Yes it is quite safe to eat your favorite bird dish provided it is PREPARED WELL AND COOKED THOROUGHLY. H5N1 virus is susceptible to heat and is killed by heat sources of 70° – 100° Celsius, normal cooking heat. It is imperative that none of the poultry meat you eat is uncooked or raw and that goes for eggs as well. Remember to cook your birds well.

What Are The Chances Of A Pandemic Occurring?

On three occasions in the last century the world has been under siege by a bird flu pandemic. The Spanish influenza of 1918 to 1919 killed millions and estimates have been as high as 100 million but probably closer to half that. During that pandemic the United States recorded half a million fatalities. There was the Asian influenza pandemic of 1957 to 1958 which claimed seventy thousand people in the U.S. at the time. The Hong Kong influenza of 1968 to 1969 contributed thirty four thousand deaths.

The odds are high that there will be a pandemic of H5N1 influenza because the attempts to control the rapidly spreading virus have been unsuccessful. Human raised ducks are known to be a haven for the virus, acting as unwitting hosts of the bug without any indications of illness. The virus laden birds then release enormous amounts of the contagion through their fluids and excrement transmitting the virus to other vulnerable birds or humans. Virus detection in outback locations in various nations make it tricky to control the spread.

Health officials have stated that the virus is now meeting two of three conditions for a pandemic to be called. It has begun infecting humans who are susceptible because no immunity exists and also it is contagious and it is sufficiently virulent to make humans seriously ill and cause death.

The only factor keeping the H5N1 virus at non pandemic levels is that it has yet to go through a genetic exchange or antigenic shift causing it to mutate into a more transmittable virus spreading human to human more easily. If this occurs the infection rate for humans will skyrocket bringing about a pandemic condition level globally in quick succession. The world’s first warning that this mutation has occurred will be grouped infections of patients presenting influenza signs that are near in timing and location. This makes it clear that the strain has the power to spread person to person.

Right now there is not a vaccine available to fight a strain of H5N1 bird flu that is infecting humans. Experts are working concurrently in most countries trying to produce a vaccine. S of spring 2008 the WHO was still pressing to launch a worldwide stockpiling of an effective vaccine with some success. Producing enough vaccine for global markets is difficult and so many manufacturers are stepping up research and testing but the demand is high. Maximizing the available vaccine via testing dose efficiency is also being undertaken.

What can Be one To Avert A Pandemic?

It would seem obvious that the disease must be controlled while still transmitting among the avian population. Not an easy task given that bird infections have reached epidemic levels in many Asian nations and it is spreading rapidly.

Health experts know that they need to keep the disease from infecting the human population. Individuals such as poultry workers who are contact with domestic bird populations are instructed to continuously observe the birds for indications of illness and contact the health system officials of ANY sign of infection in their birds and also restrict any exposure to ill birds at all cost. Ducks in particular have become highly infectious carriers of the disease without showing any illness.

In the event of a pandemic the entire world becomes at risk and certain best practices of prevention become important like personal cleanliness. You should also avoid crowds and populace locations and avoid raw eggs and poultry.

Getting a seasonal influenza injection won’t aid in fighting H5N1 but it will keep you healthy from other flu viruses and aid in avoiding further health situations that could complicate H5N1. All high risk groups such as first responders for health care, the elderly, children, chronic respiratory patients, those who must travel to infected countries, those with lowered immune systems and pregnant women should seek an appointment with their physician regarding a vaccine injection.

Are there Treatments available For H5N1 Flu And What are the symptoms?

The same symptoms will present with H5N1 as you would normally have with seasonal influenza. relentless coughing, body aches, sneezing, sore throat and hyperthermia. There is concern of complications like pneumonia, bronchitis, ear and eye infection and upper and lower respiratory problems. There are currently two drugs available, antivirals, which will aid in combating influenza. Oseltamivir or Tamiflu and Zanamivir or Relenza. These two medications can decrease the harshness of the infection and the length of time one is ill. They could prove to be ineffectual if the virus remains in the system for an extended period. The use of Tamiflu – Oseltamivir needs to be administered within a forty eight hour window from the onset of symptoms.

Both Oseltamivir /tamiflu and Zanamivir/ Relenza are in a class of antivirals called Neuraminidase inhibitors and they attack and block the surface proteins of the virus inhibiting or stopping the reproduction of the virus cell to cell. This blocking action halts the virus and patients recuperate.

There is another drug type available known as M2 inhibitors but the viruses have proven able to build a resistance to these medications making them ineffective at halting viral spread. Amantadine and Rimantadine are the names of the drugs. The stopping action of the meds works on the M2 proteins ability to multiply. The M2 inhibitors have been disappointing in their lack of wherewithal when fighting certain viruses but The oseltamivir-tamiflu and zanamivir-relenza medications are still potent in their attack. The drugs act as a treatment or as a prophylaxis in people who have been exposed to illness but are not presenting.

These drugs are currently stockpiled by many countries and require a prescription for use. You should consult a primary physician before taking Tamiflu or relenza since they have shown adverse reactions in some patients i.e. Relenza is an inhaled medication and those with asthma or other breathing ailments have displayed problems.

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Short-term Guidelines were given to assist physicians who are treating babies with influenza-like sickness while mired in a pandemic of H1N1. The approval was based on information garnered during the current public health crisis relating to the H1N1 pandemic situation and the high risk group of infants that remain susceptible from the influenza virus. This called for necessary measures produced by vital conditions.

There is currently limited knowledge that concerns the administering of Tamiflu in patients below one year of age; a critical requirement has come to pass where this part of the citizenry needs to be treated because of the rise in morbidity and mortality due to H1N1 influenza. The Health services communities in the United States as well as Great Britain have also made this recommendation to treat infants with antiviral medicine Tamiflu.

Physicians Wanted Leadership To Show The Way

The modification was a reflection of the necessity to look hard at concerns from primary health care providers who wanted the government to take a leadership role and make the hard decision to treat infants instead of them having to guess at treatment with tamiflu in an off label manner. The decision to finally treat very ill babies with Oseltamivir is a no brainer considering the alternative could be hospitalization, harsh illness courses and even death from H1N1 influenza infection. Weighed against not treating infants with a medication – Tamiflu – which has an excellent safety record when administered in proper dosages to adults and younger kids.

Health officials also stated that responsible family members or caretakers of these children should be notified that the medication is being administered under special circumstances. The medication can be used when an assumed infection of H1N1 influenza is verified with a quick and affirmative test outcome. In addition, if a child presents with hyperthermia and no other reason can be found, a past exposure to an infected person, likewise if there is a fever and breathing is distressed. The course of action calls for administering Tamiflu using dosages according to the child’s age and weight.

Zanamivir or [Relenza] is also approved in kids seven years of age or older. Though a case of Tamiflu resistance was confirmed in the past week in Canada, the drug had been administered as a prophylaxis to avoid illness. This individual only suffered mild sickness and completely improved. There was no indication that the resistant strain was transmitted.

Canadian health experts also recruited twelve ICU departments in various provinces to examine the cause of why certain H1N1 virus sufferers appear to get hit harder from the infection than some others do. They will also study the function of risk factors with rigorous illness like age, gender, weight, and immune deficiency. Also, research will be done to figure out the length of time that the seriously sick patients continue to be contagious and the best practices for dealing with severity in the illness.

Concerns And Unfavorable Effects in Children Taking Tamiflu?

When oseltamivir was researched during clinical trials for use in kids with influenza, the ones taking tamiflu had comparable adverse reactions as those kids not taking the tamiflu. There were no grim side effects recorded. The most frequent adverse reactions in treatment and preventive measure trials were nausea and vomiting. The clinical trials recorded an incidence of some children quitting their tamiflu because of the previously mentioned side effects.

A safety appraisal showed a few adverse incidents were recorded with the use of tamiflu on children sixteen years old and younger. The reports were mainly to do with unique neurological or psychiatric occurrences like delirium, delusion, confusion, strange behavior, encephalitis and seizures. These results were nearly all reported from Japan who were administered tamiflu using Japanese guidelines, which were similar though not equal to those in America.

There were twelve recorded fatalities in child patients since tamiflu was granted approval. Mortality figures were all documented as being child patients from Japan. Certain cases were clouded regarding tamiflu influence in the deaths since other medications were involved as well as other clinical health conditions not to mention a lack of sufficient information outlined in the data.

The evaluation also recorded harsh epidermis reactions similar to allergies in certain young patients. Not all of these cases were found in Japanese kids and this reaction has appeared in adults as well. These severe skin anomalies in every age bracket are now being studied more closely.

The use of tamiflu – oseltamivir antiviral medicine in children suspected of suffering from H1N1 is a double edged sword but not utilizing it for any sick patient regardless of age in a time of a pandemic illness would be poor judgment on the part of health experts. Parents can make a life or death determination with the best advice available regarding the use of Tamiflu in their infant children.

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There are many flu viruses in the avian populations but the H5N1 infection is the most worrisome for health service officials for a couple reasons.

One, H5N1 infection has been responsible for the highest number of recorded cases of extremely virulent illness as well as the highest mortality rate. On three occasions it has jumped species to infect humans most recently in 2004 and our current trouble, but also in Hong Kong in 1997 when there were 18 infections and one third of them fatalities and also Hong Kong in 2003 with 2 cases and one death.

Two, and even more disconcerting is that the current H5N1 virus runs the risk of mutating, if enough chances are presented to it, into an infection of pandemic proportions. Thus far the H5N1 virus has displayed all the rudimentary qualities it needs to initiate a pandemic except one critical component, the capacity to be effectually transmitted from human to human. While currently the H1N1 virus is at the critical pandemic level, the potential for a pandemic to develop from a mutated human version of H5N1 virus must not be ignored.

The H5N1 virus can suddenly begin infecting people in two ways. The first is in an exchange process between viruses. The genetic matter is passed between a human and bird flu virus while there is a mutual infection of the two viruses with a person or a pig. This trade of material or shuffling process could mean the mutated result is a very dangerous and highly infectious pandemic virus and would be introduced into society by a rash of human cases and a rapid spread.

Another method would be slower but no less perilous, adaptive mutation is caused by the virus attaching to human cells in a steady manner through successive human infections and the virus becomes more capricious and pernicious as it gathers momentum forming small groups of human illness where there is confirmation of person to person contact. This second version of events would at least, if discovered early enough, give authorities some valuable time to respond.

In the Hong Kong H5N1 influenza spate of 1997, there were eighteen cases of illness which happened to take place when there was an outbreak of a far more severe and contagious bird flu by a virtually matching strain of the virus occurring on poultry farms and in public poultry markets. Intense follow up studies with familial and personal contacts of the patients, health care personnel, and those who culled flocks of birds determined there was little confirmation, in not any at all to confirm the spread between humans. In three days time, the culling of all poultry in Hong Kong ensured there was no further human infections. This at the expense of a million and a half birds that world medical officials credit with preventing a pandemic of avian influenza.

Everything up until now points to humans making contact with infected or dead birds as the primary source of illness in humans from H5N1 virus. People at risk are those who butcher, pluck feathers, initiate the bird kill process and those who process poultry meat for consumption when handling infected bird carcasses. Some individuals came into contact with chicken feces specifically using a poultry free range as a playground for kids and subsequently became ill. Experts also believe that swimming in water that contained dead bird cadavers or where infected birds could have contaminated with their droppings is potentially a further cause of some infections.

Not all cases of initial virus exposure could be indentified making authorities consider the possibility that some undiscovered infectivity factor with the virus may be the cause of certain cases. Some thoughts about what this cause may be area possible connection with feral birds such as pigeons or perhaps employing bird droppings as a form of fertilizer. For the time being H5N1 avian influenza is primarily a bird illness. The obstacle of single species strains of flu is noteworthy since the virus does not transfer from birds to humans without difficulty.

Notwithstanding the fact that there have been millions upon millions of diseased poultry in huge areas since the year 2003 there have only been less than a couple hundred cases of clinically diagnosed human H5N1 infection. There must be a reason, as yet not understood, why many of these infections occurred out in the country or semi rural locations where families and farmers maintain smaller stocks of poultry. It is also an anomaly that there are fewer infections in those groups that would ordinarily be considered at greater risk such as industrial poultry personnel, live poultry market vendors, those who cull flocks, veterinarians, health care workers who aid the patients that are ill, many not having the proper safety gear to do so without leaving them vulnerable.

There is also a lack of data or understanding of why kids who were in good health and medically fit young adults seemed to get ill. Health officials need to quickly discover logical reasons for this type of exposure. Are there certain behaviors involved? Perhaps there are immunity or genetic circumstances that seem to leave these groups vulnerable to infection?

Evaluating Potential infections in People

Examining many of the verified human infected with H5N1 virus, those in Asian nations and in Turkey, showed that direct contact with diseased avian species as presumably the primary reason for exposure. When reviewing likely infections, medical personnel should be inclined to look at those people displaying signs of influenza symptoms such as respiratory illness, hyperthermia etc. and those persons with a close proximity to birds. Particular attention should be paid to those presenting with these symptoms who reside in locations of verified outbreaks of the contagious H5N1 bird flu are active. If those presenting symptoms are from an environment where avian fecal matter may have caused contamination then than perhaps this would be a secondary consideration for exposure.

To this point, human infections of H5N1 virus are not all the responsibility of contact with diseased carcasses or tame bird stock that look like they are ill. In 2005 reports showed that domicile ducks could emit large amounts of high contagion virus but display none of the illness symptoms. There was no threat to people who ate poultry from these countries provided they cooked their poultry well and those people did not take part in prepping the food.

Since there is not a sign of any person to person spread of this virus anywhere, there is no discernable hazard for anyone travelling to these countries where outbreaks occur provided obvious precautions are taken such as staying away from open air poultry markets, farms or any other location where diseased bird contact is imminent or has occurred in the past.

How Clinical Symptoms Present

When a patient with H5N1 influenza becomes ill the infection is usually quite aggressive during its path, with patients displaying a fast decline with an elevated mortality. As with most new diseases, H5N1 influenza has a long learning curve for health officials. Health services data compiled in 1997 along with the latest epidemic are only now starting to illustrate the clinical characteristics of the infection yet there is so much left to study. Making matters worse is the fact that the virus has a habit of mutating quickly meaning its unpredictable nature makes disease mapping that much more frustrating for researchers.

The infection development phase for H5N1 avian flu is probably longer than the more common seasonal influenza which stand around two or three days. Any current information regarding disease incubation shows a range of two days to eight and quite probable extending to a length of seventeen days. But the Likelihood of numerous exposures to the H5N1 virus means accurately calculating a disease development period quite difficult. The WHO is currently saying clinicians should use a seven day gestation period in order to conduct examinations at ground zero for illness and when observing patient acquaintances.

The illness presents itself through elevated temperature, higher than 38° Celsius with influenza type indicators. Vomiting and diarrhea, stomach pain, chest pain and gum and nosebleeds have been cited as pre symptomatic signs with certain patients. Watery diarrhea with no blood seems more common in H5N1 than in the season variety of flu. The range of illness symptoms may be wider still. Verified patient illnesses have not all included respiratory problems.

Several Vietnamese persons infected the diagnosis was severe encephalitis: neither of these people showed any respiratory distress when they presented. Another infection in Thailand had the patient presenting with hyperthermia and diarrhea but no lung/breathing distress. In all three of these infected patients they had been in direct contact with diseased poultry.

A characteristic observed in a number of illnesses was the development of indicators in the lower respiratory tract in the beginning stages of the illness. Many patients display these lower respiratory symptoms when initially looking for treatment. Based on current knowledge, breathing irregularities begin to manifest about day five of the onset of illness. Respiratory trouble, hoarseness in the voice, and a discernable crackly noise while inhaling are most likely observed. Phlegm production is erratic and occasionally tainted with blood. Lately there have been bloody respiratory secretions seen in Turkey. Nearly all patients wind up with pneumonia.

Throughout the Hong Kong influenza illness spurt, the severely sick people showed primary viral pneumonia that antibiotics couldn’t help. Inadequate information about patients in the current outbreak show the signs of primary viral pneumonia in H5N1 that usually fail to show signs of bacterial supra-infection when determining diagnosis. Turkey medical officials have documented pneumonia as a consistent characteristic in more harsh cases, and the same as other patients, these people did not respond to being treated with antibiotics.

Those patients with H5N1 Influenza suffer a quick decline in their illness. There was a six day time period from the beginning of the flu to respiratory distress in Thai patients with an overall spectrum of four to thirteen days. Severe Turkish H5N1 illnesses the respiratory decline was three to five day after initial symptoms appeared according to medical experts. Something else which appears all too common is the irregular function of multiple organs. General laboratory anomalies, consisted of leukopenia (chiefly lymphopenia), mild-to-moderate thrombocytopenia, prominent aminotransferases, and with several occasions of disseminated intravascular coagulation.

There is some confirmation that particular antiviral medications, especially Oseltamivir or generic Tamiflu as it is known commercially, as they decrease the ability of the virus to reproduce thus improving the odds of survivability. They must be taken inside a forty eight hour window from the start of symptoms to be effectual. Data collected from the Turkish outbreak suggests that the majority of those with the virus were diagnosed and treated well into their course with the illness. It is because of this information that the use of Oseltamivir as a treatment is somewhat incomplete.

Oseltamivir or Tamiflu and other antiviral medications where produced as forms of treatment and as prophylaxis methods for seasonal variations of influenza, known to be a less severe version of flu as well as having a longer virus reproduction process in the body. The options for treatment courses and dosage quantities are still in a state of fluidity for oseltamivir – tamiflu therapeutic treatment of H5N1 influenza as it is with child illness of the virus. The WHO is continually monitoring and reviewing these antiviral practices as they require vital revision.

When a case of H5N1 influenza is suspected, generic tamiflu needs to be prescribed and taken as quickly as possible, preferably within forty eight hours from becoming symptomatic in order to optimize the value of the medication. Given the virulence of the current strain and the length of time of replication process, mortality rate etc. it would behoove the primary physician to begin treatment with generic Tamiflu also in those patients who are well into the illnesses course.

The existing suggested dosages for generic tamiflu for influenza virus treatments can be located on the Manufacturer – Roche’s website under product information. Currently the optional dose for generic tamiflu for influenza therapy is 150 mgs daily for children thirteen years and over and also adults, administered twice daily at 75 mg each for a course of five days minimum. There is no record of Tamiflu treatment for kids under one year old. The WHO health experts are looking into issuing treatment dosages and recommendations for children under the age of one year.

Since H5N1 viral reproduction periods could be extended, clinical personnel should reflect on increasing the tamiflu course treatment from five days up to seven or ten days in patients who are not responding to average treatment courses. When a patient displays severe H5N1 infection, they may want to raise the suggested daily dosage or length of treatment time. Clinicians also need to remember that Tamiflu dosages higher than 300 mg per day can be responsible for an increase in adverse effects . These same clinicians may want to consider administering serial clinical samples for future examination so viral loads can be monitored, an assessment can be made on medication susceptibility and levels of tamiflu can be reviewed. But, these samples should only be ingested where suitable procedures for infection control are available.

When a patient with H5N1 is suffering from a severe form of the illness and hampered by gastrointestinal symptoms, the absorption of Oseltamivir – Tamiflu could be hindered. Clinicians need to be cognizant of this prospect when treating patients such as these.

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The recorded cases of H5N1 have been dropping in previous years but the H5N1 strain is known to vary in intensity year to year, though the drop is an indicator that efforts to manage the virus have been somewhat successful in domestic poultry birds. There has been better observation of the disease globally and China has instigated a huge poultry inoculation endeavor but China has experienced a cluster of illness from bird flu that felled eight people in one month. Six of those cases were in areas with no reports of outbreaks in their poultry stocks.

Influenza H5N1 is still difficult for humans to contract, it has still claimed two hundred fifty four victims around the world since 2003. Health scientists have been sounding the alarm for a while now that if H5N1 wasn’t under control in the avian population it could well mutate into a modified strain that would infect humans and cause the spread to activate the strain into a pandemic.

The peril is that after years of controlling this H5N1 strain and keeping it from becoming a more serious threat to humans there could be slippage in vigilance due to economic stress and general flu fatigue. After years of pandemic preparedness operations and a recession, would there be a call for financial curbs on funding? A number of less resourceful nations could be the impetus for this to happen.

The World Health Organization still thinks a flu pandemic from H5N1 virus is only a matter of time, there is no IF in the equation. The international community must keep a vigilant eye not only for modification of the H5N1 virus but also for other influenza strains in addition to what has already been identified. We are already a world under threat from a pandemic of H1N1 influenza and if these two viruses were to somehow mutate from mutual contact the result could be catastrophic.

Bird Flu Symptoms And Treatment Protocols

People who contract the H5N1 illness will present with hyperthermia or fever, sore throat, cough, severe respiratory distress and viral pneumonia. People of all ages can be infected and can be in various situations with their health. Today there are tests that can be performed quickly in order to diagnose a particular influenza strain. Antiviral medications like Generic Tamiflu or Oseltamivir are considered effective for treating and preventing the influenza A strains of the virus and this is good since when a new strain of flu develops it can take a good number of months to produce a viable vaccine.

The WHO is recording and posting regular updates concerning any new human infections of H5N1 Bird flu. They must gather information as to how the person was exposed to the virus whether by wild or domestic birds and which species of bird they made contact with. It’s critical to inform the public not to keep wild birds with domestic flocks, not to allow free ranging poultry, to keep the public away from wild birds, or keep in captivity any wild birds’ period and this must be done to aid in preventing a global pandemic. The public must continually wash their hands after coming in contact with poultry stocks or subsequent to handling chicken meat, cooking poultry well and keep domestic bird species separate from each other.

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The risk would be calculated but how do you respond when there is no way to forecast when it will get severe and yet the cost of doing nothing could be ominous. It is an impossibility to know in advance when a bird flu pandemic will happen and so forecasting a crisis is difficult and the possibilities are vast. What is certain is that the next great pandemic is nearing its due date if not having surpassed it.

The twentieth century bore witness to three deadly pandemics. The Spanish influenza in 1918 -1919 in which some estimates claim nearly fifty million people perished. The Asian influenza of 1957 -1958 with approximately one million fatalities and the 1968 – 1969 Hong Kong influenza took anywhere from one million to four million lives. Estimates vary widely as a testament to the lack of record keeping and resources during a major worldwide health crisis.

All three of these outbreaks are believed to have had their origins in avian species. There are fifteen known bird flu virus sub variations and H5N1 is specifically anxiety producing. This strain of avian flu has slammed domestic bird sectors in eight nations, of these three of them, Cambodia, Thailand and Vietnam, have reportedly had altogether seventy nine human infections and more than fifty percent of these illnesses were deadly.

Never has there been such destructive fallout to so many nations by the H5N1 bird influenza virus at once causing anxiety to populations and economies to suffer so greatly in both farms and residences as well as industrialized poultry producers. The H5N1 Bird flu strain has displayed two frightening characteristics thus far, the ability to spread infection quickly and to cause harsh disease in humans. What it has not yet shown is the capability to spread human to human. If and when this third indicator appears it would be considered the beginning of a pandemic and would certainly prompt an international reaction from The World Health Organization and the initiation of emergency preparedness plans for an influenza pandemic.

The worry right now is that this H5N1 bird flu virus could mutate, it has a history of doing just that, developing the means to spread more easily from person to person contact. Experts wonder if this mutation or change could occur from adjusting to the infected masses or via an inherent modification with a known human influenza virus. Currently the infection is spread through direct human exposure with contagious domestic poultry.

The WHO has stated that there is no confirmed link of any continued person to person diffusion instead there were limited infection sequences that remain quite typical in bird flu virus not yet tailored to people. It is understood by authorities that each specific cluster of infected persons could be an indicator of an oncoming pandemic, meaning each case needs to be examined promptly.

Expert clinicians concur the unparalleled scope and transmission of H5N1 bird flu has increased the chances of a serious influenza pandemic reoccurring, their human mortality approximations are anywhere from two million to fifty million globally. Because of international travel being so common and the massive amount of trade between countries there is little that can be done to inhibit the spread of the virus worldwide.

When SARS [severe acute respiratory syndrome] was a problem a few years ago, infected persons were able to be identified and quarantine measures taken at airports. H5N1 Infected persons during a pandemic are going to be able to infect anyone they come in contact with before symptoms even start to present. This is a real concern for the medical and health services since infected travelers won’t be caught at the airports this time.

The WHO is asking all of its member nations to urgently review and revise their influenza pandemic emergency response plans. It is mainly industrialized, more affluent nations that have done these revisions while many others are scrambling to do so. These preparedness plans are based on suggestions made by the WHO to utilize a phased reaction in order to decrease the feared force of any influenza pandemic.

The plan is to produce a vaccine quickly and warehouse antiviral medications such as generic tamiflu or Oseltamivir, which has displayed an effectual response to the H5N1 bird flu virus. Generic Tamiflu will probably be as effective against any upcoming flu strains in the future as well. The WHO has also recommended thirty other pandemic guidelines not related to medical intercession that should prove valuable if we are facing a pandemic.

If we make the assumption that the H5N1 has its roots in the Far East Asian nations we must also assume that we will not be able to stop it from reaching the industrialized western nations of North America and Europe. When it lands here it will hit with a ferocity racking up illnesses and causing havoc with our daily lives. Preplanning for this event horizon will go a long way to decreasing the effect overall on the national communities affected.

The United Kingdom has decided to acquire nearly fifteen million therapeutic courses of anti viral medication Oseltamivir or Generic Tamiflu. This means treatment can be given to one in four Britons who could potentially be infected, this number estimated by the WHO for antiviral stocks on hand. Great Britain is only one of a number of countries that are stockpiling Tamiflu and other antiviral medications. They are also taking part in the research to quickly ramp up production of a vaccine against any future H5N1 pandemic flu outbreak.

Current influenza vaccines won’t give any defense against a future pandemic flu virus. But knowing that a potential mutation will initiate from H5N1 and have little difference genetically, The WHO is urging its members that preventative warehousing of current vaccine may be an option of some protection for wealthier countries to consider. At least it would be available immediately and it may offer a certain amount of help from the human exposed pandemic virus. There is the hope that this could also bring about investment from companies to begin pandemic vaccine development. Vaccine has an expiry date of a couple years so it could in the end just be thrown away but it would be considered cheap insurance in the event of a full blown pandemic health crisis.

Countries like China, France, Canada, Japan, the UK and the United States have made arrangements with manufacturers to produce a sample H5N1 vaccine, but if any new flu strain is drastically modified from the H5N1 virus the vaccine will be deemed ineffective. This on the back of a report from the WHO stating that a vaccine offering protection against the H5N1 as it is now could be nearly as effective against a new variation. Error on the side of caution according to the richer nations.

For the first time many countries are affected outright by the disease and the economic losses alone are overwhelming for farmers, industrial poultry producers and common households in these countries.

Currently the vaccine production is taking place in Australia, North America, Europe and Japan but during a pandemic the need will stretch around the world. There are concerns that less affluent countries seem to get hit the hardest by the influenza pandemic because their people tend to be less fit and undernourished. Poor countries have fewer health service staff and weaker health organizations overall that can’t stand up to the load of a pandemic virus and are lacking an emergency preparedness plan of any significance.

Because of a lack of resources most emergent nations are concentrating on surveillance of the H5N1 disease rather than warehousing antiviral tamiflu and vaccine production. If a pandemic hits these areas they will be extremely susceptible to illness in overwhelming numbers and not have the medicinal resources to anything about it.

The danger faced by humans from H5N1 flu has been second guessed lately. Medical personnel initially approximated the mortality figures at about ninety percent but adjusted that number as additional cases became obvious so the number dropped down to sixty seven percent along with newer confirmation of a lack of symptoms shown in many people so there may well be more cases that go unnoticed making an accurate death toll difficult to predict and possibly much lower than originally considered. It should be mentioned that a lower death tally doesn’t necessarily mean a lesser menace to humans from the H5N1 virus.

With H5N1 it was always suspected that the illness cases to death ratio seemed strangely elevated and the range of illness more general than only severe cases that were being recorded. Still, with lower fatality numbers based on more cases of illness, easier spreading of the flu virus means more people will get infected and hence, more individuals will become fatally ill.

The WHO is still quite certain that a pandemic of H5N1 virus will hit us globally. Regardless of all the unanswered questions surrounding the bird flu virus and its shock to society, preplanning for a pandemic will have a positive effect on the outcome. Lives will be saved, some will be lost, and the economy will still take a beating along with societal structure in general but emergency response organization will be improved and that is at least something positive. Better to be prepared as much as possible regardless of a nations internal capabilities.

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Any chance for a vaccine to combat the H5N1 influenza will probably take a while yet to produce. Should the major pharmaceutical companies start producing immediately after an epidemic occurs, there won’t be enough of the vaccine to offer any kind of adequate provision for the nations that are in dire need – meaning the Asian countries. This means that for the foreseeable future antiviral medications such as oseltamivir –generic tamiflu and zanamivir – relenza and perhaps other older antivirals such as amantadine and rimantadine are going to be the first line of defense.

Drugs such as generic tamiflu and amantadine are referred to as neuraminidase inhibitors which both decrease and shorten the severity of flu symptoms and they can provide prevention measures from influenza as subsequent contact and seasonal prophylaxis medications. Influenza preparedness strategies recommended by the World Health Organization, WHO, and many governments globally as a rule support detection, isolation, primary responder protection, and beginning antiviral treatment therapy for those with the illness and those in contact with them. Most national governments have already begun warehousing at exorbitant costs, huge amounts of generic tamiflu [Oseltamivir] in preparation for a potential epic rash of illness.

in any case, the effectiveness of the neuraminidase inhibitors, even when taken as a prophylaxis in healthy people taken within the forty eight hour window from the beginning of flu symptoms is only small. The utilization of tamiflu in five of ten cases documented in Vietnam did not display any clear medical effectiveness and there was an eighty percent fatality rate found in this effort. Neither tamiflu – oseltamivir nor relenza – zanamivir, were directly evaluated in the restricted study.

Both antiviral medications have related pharmacological properties and both offer comparable effectiveness; zanamivir- relenza appeared to have fewer side effects to manage and a better resistance report. This resistance report would carry much weight in the event of a pandemic. The zanamivir is not being stockpiled in anywhere near the amounts as tamiflu is and this could be because of the potential challenges of administering an inhalant medication for children and intellectually impaired persons. Zanamivir does have some original and practical methods for use in children.

The incidence of bronchial problems and decreased lung utility is not very common, and those suffering with asthmatic conditions and chronic obstructive pulmonary disease or [COPD] are able to abide by the inhalation of the zanamivir – relenza, along with the placebo. Zanamivir has options for dry inhalant devices which are popular among these same patients even in times of problematic situations with their illnesses.

With this in mind, nation governments need to contemplate warehousing zanamivir as an antiviral option along with generic tamiflu as part of their emergency preparedness planning. The antivirals must be dispensed to ill patients and those who have been exposed to them within forty eight hours of becoming symptomatic. The logical position for health officials to take is allowing community health care services and drug store pharmacists to be responsible for getting the antivirals medications into the hands of those who need them in a timely manner rather than counting on potentially overstretched hospital based health providers to do the job.

All nations and their health services sector should include H5N1 study trials in their preparedness planning testing a dual role for tamiflu and zanamivir with prospective new medications and not; specifically testing SIRNA’s and interferon. These are in experimental phases now and hold promise as antivirals. More important is that these studies when conducted in the outset of a pandemic offer valuable data for late stage virus control and patient care. Vaccine producers are located mainly in wealthier industrialized nations and so delays getting the bird flu vaccine into the underprivileged Asian countries that need it. The wise decision would be to initiate some production of neuraminidase inhibitors and vaccine in these areas to rectify these shortages. Questions arise about drug patents during a pandemic that could lead to global crisis.

From a virus control perspective having available tamiflu and zanamivir antivirals stockpiled and or produced in these outbreak countries would aid in controlling the anticipated spread of the illness, nipping it in the bud so to speak. Developers such as Roche for oseltamivir [generic tamiflu] are already licensing out to many overseas countries. India has pharmaceutical companies prepared to begin producing generic tamiflu but cannot obtain government approval to do so. Restrictions and red tape need to be removed in order to take the fight to the virus with as much clinical punch as possible.

Medical study modeling has displayed to researchers that H5N1 influenza is more contagious than severe acute respiratory syndrome [SARS virus] and the preparations and management model for controlling SARS may not be sufficient for a pandemic of influenza, particularly H5N1. If this isn’t looked at and changes aren’t made to these plans the community health services in infected nations will become strained to the maximum in short order. SARS showed that when hospital personnel are under equipped in staff and resources they become discouraged and personnel begin to abandon their posts. Especially when these first responders begin to see their co workers become infected by clinic borne H5N1 contagion and they aren’t treated in an ICU setting. Health care officials at all levels of government must see that they protect their health care providers and show they are being conscientious. These health care professionals on the front line will also be depended on for their skills to handle the repercussions of a pandemic so their continued health should be paramount in the planning stages of a pandemic.

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