Pandemic Flu - Page 24

mugwump · 10-04-2006, 09:29

The potential of statin therapy in H5N1 treatment has hit the MSM:

Cholesterol drugs could combat flu pandemics

Statins, the cholesterol-lowering drugs prescribed to two million people in Britain each year, could play a pivotal role in combating a flu pandemic, scientists believe.

Early evidence suggests that the cheap, readily available drugs are a potential treatment for virulent influenza strains such as H5N1, which has killed 148 people in Asia...

http://www.timesonline.co.uk/article...387803,00.html

[Note: vets/AD should look into getting the following stuff via the VA, it's all in the formulary (including Tamiflu as of 6 weeks ago) and it's obviously much cheaper by that route. ]

I know a person who has obtained without prescription 100 tablets of generic Zocor/simvastatin from Europe (much cheaper than in the US, where no generics currently are marketed) via the online pharmacy GoldPharma (There's another good European pharmacy I've recommended via PM, but this is the one with a spotless track record among the last 3 folks using them.)

zocor FORTE 40mg 100 Tbl. N3 100 Tablets € 185.55 40.00 mg Simvastatin (Dieckmann Arzneimittel GmbH, Germany)

Note that purchasing 100 tablets x 40mg is significantly cheaper that 200 tablets x 20mg. This person I know is planning on using a drugstore pill splitter to create 200 half-tablets of 20mg each. The daily dose of 20mg in the morning and 20mg in the evening would be administered to anyone showing the first hint of illness. When the first family member showed symptoms, young asymptomatic adults would get 20mg once daily for 10 days if they remain asymptomatic (they are the most susceptible to ARDS but you can't eat up the whole supply treating prophylactically) with another another 20mg added if they developed any symptoms.

Be aware that ex-US purchase of prescription drugs is a legal grey area. That said, many state .gov websites have links to reliable Canadian pharmacies (which all require a script--something GoldPharma doesn't).

GoldPharma also have Tamiflu and antibiotics. The last three shipments that I know of have arrived successfully, but you bear the risk of financial loss if a shipment is intercepted by customs.

Previously-discussed big-boy rules are obviously in play. Do research into contraindications and side effects and make up your own mind. Note that while statin therapy data suggest that it's effective in short-circuiting ARDS, the data are not conclusive. Also note that Tamiflu resistance is cropping up in Indo (it may be ineffective when flu hits locally) and the dose being used is twice the one recommended on the labeling (they are using two tablets per day, not one). You will obviously have to assess your own situation and determine if the money is better spent elsewhere.

Personally, I'd go for statins and a good broad-spectrum antibiotic (Augmentin, azithromycin, or moxifloxacin) before Tamiflu. And I'd get my oral re-hydration supplies, fever and diarrhea OTC meds, seasonal flu shot and Pneumovax II shot before anything.

mugwump · 10-04-2006, 10:00

This next tidbit is third-hand info, but I pass it on because it seems credible and I haven't heard it anywhere else. It comes via my one lonely employee in Singapore, who heard it from a friend in Jakarta. (In other words, this is not Charter House Rule gouge from the vaccine community.)

There is talk in Indo of many less-critical human avian-flu cases. The word is that many of these are being treated by traditional "medics"/shamans and only some of the worst cases end up in the hospital. Hospitals and Tamiflu are associated with fatal outcomes and are being avoided like, well, the plague. This flu they report is characterized by a distinctive sounding cough (it is being called "clucking flu" in a play on its avian origin and the funny-sounding cough), shortness of breath, stubborn high temperature with severe chills, widely distributed bruising and splinter hemorrhages on the fingernails. These all sound credible, given the hemorrhagic nature of this flu.

I don't know what his means. I think everyone who follows this topic believes there are more cases in Indo than are being reported. The rumor that people are recovering from this flu is good news but this may herald the drop in mortality that many expect prior to a major breakout. Who knows, just another piece of the puzzle.

mugwump · 10-04-2006, 10:11

Checking for corroboration for the previous post: Niman reports recovering patients in the report below (from today). Note the new patients haven't been established to be H5N1:

H5N1 Suspect Cluster in Makassar South Sulawesi Grows
Recombinomics Commentary
October 4, 2006

As Many As eight citizens who lived in Street Perintis Breakingprep Kemerdekaan, Makassar, were taken the sample of his blood because of experiencing the sign that was similar to the bird flu sufferer.

Two among them, the older brother was siblings, Dion (7) and Mustarisa (4), underwent the intensive maintenance in the Public Hospital (RSU) Wahidin Sudirohusodo, on Tuesday (3/10).

The official also combed the patient's neighbour.Two citizens, Nurwan (30) and Hidayati (21), kedapatan experienced the similar sign.The neighbour Dion that lived in Street Perintis Breakingprep Kemerdekaan KM 8 No 8 this took part in being taken the sample of his blood and was recommended to RS Wahidin to undergo the intensive maintenance.

Six patients suspect this was their respective, Dion R (7), Mustarisa (4), Nur Asiah (11), Apriliyani, Paturungi, and Salsabil.

From six patients tesrebut, four among them, Dion, Mustarisa, Nurasiah, and Salsabil entered on the same day, on Monday (2/10).

The above translation indicates the number of hospitalized suspect H5N1 bird flu victims continues to increase in Makassar in South Sulawesi. In June a confirmed H5N1 case died in Makassar and recently the number of additional hospitalized patiens began to increase dramatically. Some of the earlier cases are recovering, so the recent cases could be seasonal flu, or H5N1 responding to Tamiflu treatment.

The clustering in the same neighborhood, however, remains a cause for concern.

mugwump · 10-09-2006, 08:09

Excellent article: Deception Dominates World Health Organization's Bird Flu Releases

InTheBlack · 10-10-2006, 17:03

Seasonal Flu Vaccines:

Since a shot is so very cheap to get, it might be a useful strategy to get two shots with different brands of vaccine.

There are currently 5 brands licensed in the US. Still looking for the names of the other three. Two were "fast tracked:"

http://www.fda.gov/bbs/topics/NEWS/2006/NEW01478.html

FluLaval- by ID Biomedical Corporation of Quebec, Canada, a subsidiary of GlaxoSmithKline Biologics
GlaxoSmithKline's Fluarix received approval in 2005.
***

This patent description for a Glaxo nasal vaccine contains a good review of the nature of vaccines:

http://www.freshpatents.com/Intranas...0050201946.php

Vaccines can use either inactivated or live attenuated virus. Inactivated can contain "whole," "split," or "purified" viral portions.

Protection can be measured either systemically or in the nasal mucosa. Inhaled (vs injected) vaccines give lower odds of systemic but higher odds of mucosal protection:

"Mucosal immunity constitutes the first line of defence for the host and is a major component of the immune response in the nasal passages and in the airways of the lower respiratory tract. Although the presently used injectable influenza vaccines stimulate serum HA-specific IgG in the majority of healthy individuals, a significant rise in HA-specific nasal IgA antibody occurs in only a minority of vaccinated subjects."
***

I'm still looking for the actual submitted efficiency on the 5 vaccines, and for the US standards.

Which of the three strains in the seasonal vaccine is the one that might help vs H5N1? We would want our seasonal shot brand to be the one with the best protection against that particular portion of the "trivalent."

"Theoretically, to meet the European Union requirements, an influenza vaccine has to meet only one of the criteria in the table, for all strains of influenza included in the vaccine. However in practice, at least two or all three of the criteria will need to be met for all strains, particularly for a new vaccine such as a new intranasal vaccine. Under some circumstances two criteria may be sufficient. For example, it may be acceptable for two of the three criteria to be met by all strains while the third criterion is met by some but not all strains (e.g. two out of three strains). The requirements are different for adult populations (18-60 years) and elderly populations (>60 years).
TABLE 1
18-60 years >60 years
Seroconversion rate* >40% >30%
Conversion factor** >2.5 >2.0
Protection rate*** >70% >60%
*Seroconversion rate is defined as the percentage of vaccinees who have at least a 4-fold increase in serum haemagglutinin inhibition (HI) titres after vaccination, for each vaccine strain.
**Conversion factor is defined as the fold increase in serum HI geometric mean titres (GMTs) after vaccination, for each vaccine strain.
***Protection rate is defined as the percentage of vaccinees with a serum HI titre equal to or greater than 1:40 after vaccination (for each vaccine strain) and is normally accepted as indicating protection. "

*****
Here's the March 2006 FDA draft criteria for licensing a Pandemic Flu Vaccine:

http://www.fda.gov/ohrms/dockets/98f...88-gdl0001.pdf

Here are comments on that document by the National Institutes of Allergy and Infectious Diseases (NIAID) within the NIH:

http://www.fda.gov/OHRMS/DOCKETS/DOC...emc0001-03.pdf

"With regard to the criteria on rates of seroconversion, NIAID’s recent experience with the FDA has included an additional parameter where a four-fold rise was considered seroconversion as long as the titer was greater than or equal to 1:40."

InTheBlack · 10-10-2006, 23:53

Researchers have infected mice with the completely reconstructed 1918 virus:

http://www3.niaid.nih.gov/news/newsr.../1918mouse.htm

>>>
Modern analyses of 1918 flu victim autopsy samples show extreme and extensive damage to lung tissues. This observation gave rise to the hypothesis that the 1918 flu virus infection provoked an uncontrolled inflammatory response leading to rapid lung failure and death.

To test this idea, Dr. Tumpey infected mice
SNIP
In particular, genes involved in promoting inflammation were strongly and immediately activated following infection by the reconstructed 1918 virus. “We clearly see a dramatic and uncontrolled immune response in the mouse lungs as early as one day following infection with the reconstructed 1918 virus,” he says. A complete understanding of the host’s response to the 1918 flu virus, adds Dr. Katze, requires use of a fully reconstructed virus.
>>>

In the people infected with H5N1, have they done careful analysis to distinguish inflammation from a secondary infection vs that caused by the virus itself?

mugwump · 10-11-2006, 07:14

Quote:

Originally Posted by InTheBlack

In the people infected with H5N1, have they done careful analysis to distinguish inflammation from a secondary infection vs that caused by the virus itself?

Yes and no. There are six(?) postmortems total AFAIK -- in Christian children (many of the VN and Indo folk who are nominally Christian or Muslim are basically still animist at the core -- the Bandug cluster in Indo was in Christians -- but only the Christians allow pm's.). They revealed the lesions described, and also kidney, gut and brain involvement. These are the hallmarks of disseminated hemorrhagic infection.

When you hear about someone in Indo going into the hospital, going on vent support, and dieing -- that's primary infection and the inflammatory response/cytokine storm is likely to blame. If they improve, come off vent support and then worsen and die -- that's secondary infection.

Ventilator support is always bad; it often causes as many problems as it solves. Secondary infection is common even if the vent was used for a non-infectious cause.

If a pandemic hits, there will most likely be people who just get a bad case of the flu (recovery likely if no 2' bacterial pneumonia) and those who get the inflammatory response (survival possible but unlikely). The proportion between the two is unknowable at this stage.

InTheBlack · 10-12-2006, 00:07

Mug- I talked the people at my HMO into giving the HiB vaccine except that they don't know the adult dose or number of repeats. The package insert doesn't mention it; they left it up to me to find the documentation for them. Do you happen to know where to find it?

Searching the web for "HiB" brings up only Hep B, and any use of the word "influenza" drowns the results in seasonal flu noise.

& this thread is so long and the Search function so restricted... looking for the post documenting who in Indonesia is using twice the normal Tamiflu dose. Do you recall what month that was?

InTheBlack · 10-12-2006, 22:14

FYI: ZOCOR product insert at Canadian Merke site:
http://www.merckfrosst.ca/mfcl/en/co...cts/zocor.html

mugwump · 10-20-2006, 07:25

I haven't posted an update here for a while, so I guess it's time.

Avian flu (in birds) has returned to Africa and SW Asia with the migrating waterfowl. There's been one confirmed human case in Egypt and several suspected ones in northern Nigeria (dead and buried). There are strong suspicions of avian infections in Iran (confirmed infections in neighboring states).

Expect a resurgence of human cases in Africa and SW Asia. Remember that the closest we've come to a breakout was Turkey in Dec '05 -- Jan '06. (It was a bigger cluster than Karo, Indonesia. The WHO still had some credibility then -- people believed them when they said there was no H2H. We now know from the DNA sequences that they were wrong or lying.)

Indonesia is moving from a high simmer to a slow boil. The government is reeling under increasing criticism for the way they've mishandled the whole affair and they're getting increasingly defensive. There have been numerous, widely distributed deaths over the last weeks with the tempo of infections apparently increasing (three deaths in three days last week, different locales).

Journal articles have confirmed H5N1 infections in Indonesian pigs, dogs and cats. The DNA sequences from cat and human infections are nearly identical with big differences from bird viruses. They are working on the dog sequences now and I wouldn't be surprised if they matched as well. I've passed on the concerns of others that the direct poultry-human link was weak, and this seems to indicate another vector is possible, even likely.

Nearly every MSM article you read will say "every/nearly every case of human bird flu is linked to close contact with dead or dying birds." This mantra has replaced the now defunct "there have been no cases of human-to-human transmission." They are both bullshit. Clearly, birds are sick and dieing but many, many smart people think direct bird to human transmission is of minor importance now.

NAMRU-2, the US Navy research facility in Jakarta, is apparently back up after publicly announcing they'd left the country a while back. Who knows the politics behind all that.

The latest worry: Bird Flu Suspected in Nine More Indonesians on Sulawesi Island

InTheBlack · 10-20-2006, 07:56

WRT giving HiB vaccine to adults:

Sanofi says to refer to CDC guidance in the MMWR of April 9, 1993 which says to give a standard (child) dose to adults with altered immuno competency (which seems to be the only adult use envisioned). This is for their "ActHIB" vaccine (Haemophilus b Conjugate Vaccine).

***
What are the chances that pandemic control measures in the US will include large scale or local zone euthanising of pet dogs & cats?

***
My wife just got over a sinus to bronchial infection lasting 5-6 weeks. After about 10 days of being sick myself, hindsight says I must have the common cold.

How the heck are you supposed to recognize Influenza within 48 hours to utilize the Tamiflu strategy? What are the key symptoms (or absent symptoms) ? Everything I have read about Flu, Strep Throat, and Common Cold indicates that the early symptoms are variable and make differentiation a crap shoot without lab tests.

At least now I have one course & a bottle of antibiotics on the shelf.

mugwump · 10-20-2006, 11:10

Quote:

Originally Posted by InTheBlack

What are the chances that pandemic control measures in the US will include large scale or local zone euthanising of pet dogs & cats?

Not a chance in the world. And it's a good thing -- they'll be the only food available to many. Tastes like chicken.

Quote:

Originally Posted by InTheBlack

My wife just got over a sinus to bronchial infection lasting 5-6 weeks. After about 10 days of being sick myself, hindsight says I must have the common cold.

How the heck are you supposed to recognize Influenza within 48 hours to utilize the Tamiflu strategy? What are the key symptoms (or absent symptoms) ? Everything I have read about Flu, Strep Throat, and Common Cold indicates that the early symptoms are variable and make differentiation a crap shoot without lab tests.

Fever over 99F and headache usually mean flu. Currently 30% in Indonesia get diarrhea -- not found in colds. It's a tough call, you're right. Differential Diagnosis: Cold vs. Flu

**The Reaper** · 10-22-2006, 10:26

http://haaretz.com/hasen/spages/777902.html

Last update - 18:11 22/10/2006

Four people die after receiving flu vaccinations in 2 separate clinics

By Ron Reznik, Haaretz Correspondent and Haaretz Service

Four people have died after receiving flu vaccinations, it was announced Sunday. The Leumi health maintenance organization informed the Health Ministry of three victims among its subscribers, and the Meuhedet HMO announced that one of its subscribers had also died.

In response, the Health Ministry has instructed health facilities to immediately stop providing the vaccinations.

Army Radio reported that the first three victims were all vaccinated last week at the same branch in Kiryat Gat. The injections were all performed from the same vaccine pool.

Three of the victims, ages 75, 70 and 52, had been vaccinated in previous years against the flu, and none showed abnormal reactions.

An initial investigation conducted by the Health Ministry discovered that all four had suffered from various illnesses, including diabetes, high blood pressure and heart problems.

The first three people died of cardiac arrest - one of them a day after receiving the vaccination, another three days after and the last six days after. The fourth victim, a 67-year-old male from Petah Tikva, died several hours after receiving the immunization.

Ashkelon District physicians are investigating the deaths. The Health Ministry has contacted the manufacturer of the vaccine, Aventis of France, whose products are used all over the world, and requested that it perform extensive examinations of its laboratories.

It is still unclear whether there is a connection between the vaccinations and the fatalities, or the nature of such a connection if it exists.

It is also unclear whether there were complications in the administration of the vaccine, whether related to the method of injection or the vaccine itself.

mugwump · 10-23-2006, 07:45

Quote:

Originally Posted by The Reaper

http://haaretz.com/hasen/spages/777902.html

Last update - 18:11 22/10/2006

Four people die after receiving flu vaccinations in 2 separate clinics

While there's no reason why a flu vaccine would cause cardiac deaths, I'm sure this situation is causing an all-out fire drill at Aventis. Heart patients, diabetics, etc. are often the first to be immunized and some deaths in the recently-immunized are likely. That said, I'm sure no one is taking this lightly.

This is the nighmare scenario for vaccine developers and not for financial reasons (although this type of thing can wipe out a company). I'm sure after the fire drill is over quite a few companies will be asking "Is this worth it?"

InTheBlack · 10-24-2006, 08:51

http://www.cdc.gov/flu/professionals..._100206.htm#12

Although overall influenza supply should be very good, CDC anticipates providers may have difficulty in obtaining sufficient vaccine to vaccinate all three-year-old children. Sanofi pasteur is the only supplier of vaccine that can be administered to these children and all of this vaccine was pre-booked in January 2006, prior to ACIP’s February 2006 recommendation to routinely vaccinate all children aged 24 to 59 months. If a provider has insufficient vaccine for this age group, CDC recommends that children 6 to 23 months of age be prioritized as they are at increased risk for hospitalization.