Important Bullets from Dr. O!

Important Bullets points for Avian Flu from Michael Osterholm, MD

• We have no detailed plans for staffing the temporary hospitals that would have to be set up in high-school gymnasiums and community centers — and that might need to remain in operation for one or two years. Health care workers would become ill and die at rates similar to, or even higher than, those in the general public. Judging by our experience with the severe acute respiratory syndrome (SARS), some health care workers would not show up for duty. How would communities train and use volunteers? If the pandemic wave were spreading slowly enough, could immune survivors of an early wave, particularly health care workers, become the primary response corps?
  
• For example, in the United States today, we have only 105,000 mechanical ventilators, 75,000 to 80,000 of which are in use at any given time for everyday medical care; during a garden-variety influenza season, more than 100,000 are required. In a pandemic, most patients with influenza who needed ventilation would not have access to it.
  
• Only when a vaccine shortage occurs or young children die suddenly does the public demand that someone step forward to change the course of the epidemic. Unfortunately, the fragile and limited production capacity of our 1950s egg-based technology for producing influenza vaccine and the lack of a national commitment to universal annual influenza vaccination mean that influenza epidemics will continue to present a substantial public health challenge for the foreseeable future.
  
• An influenza pandemic has always been a great global infectious-disease threat. There have been 10 pandemics of influenza A in the past 300 years. A recent analysis showed that the pandemic of 1918 and 1919 killed 50 million to 100 million people,1 and although its severity is often considered anomalous, the pandemic of 1830 through 1832 was similarly severe — it simply occurred when the world's population was smaller. Today, with a world population of 6.5 billion — more than three times that in 1918 — even a relatively "mild" pandemic could kill many millions of people.
  
• So how can we prepare? One key step is to rapidly ramp up research related to the production of an effective vaccine, as the Department of Health and Human Services is doing. In addition to clinical research on the immunogenicity of influenza vaccines, urgent needs include basic research on the ecology and biology of influenzaviruses, studies of the epidemiologic role of various animal and bird species, and work on early interventions and risk assessment.2 Equally urgent is the development of cell-culture technology for production of vaccine that can replace our egg-based manufacturing process. Today, making the 300 million doses of influenza vaccine needed annually worldwide requires more than 350 million chicken eggs and six or more months; a cell-culture approach may produce much higher antigen yields and be faster. After such a process was developed, we would also need assured industrial capacity to produce sufficient vaccine for the world's population during the earliest days of an emerging pandemic.
  
• The global economy would come to a halt, and since we could not expect appropriate vaccines to be available for many months and we have very limited stockpiles of antiviral drugs, we would be facing a 1918-like scenario.
• from New England Journal of Medicine