Tuesday, March 29, 2005
two for tuesdays; alarming health news bits this week...
With a proliference of viruses to die from - include this Ebola-like virus in Angola now - combining with inefficiency in the all-important medecine men themselves when faced with THE one... hmm... no wonder thinking men (such as myself) think things are a bit... bleak indeed! :(
Gloomy (and doomy?) details - in the comments section!
23/03/2005 6:38:00 PM
TORONTO (CP) - Antiviral drugs will be the big guns in the health-care arsenal in the early days of the next influenza pandemic. But Canadians and their doctors have little experience with antivirals, leaving some experts concerned that lack of expertise could impede proper usage during a pandemic.
They suggest increasing the use of flu drugs such as oseltamivir during annual flu seasons would help people and health-care practitioners gain comfort with the drugs while providing incentives for pharmaceutical companies to invest in the underdeveloped - and until recently, not terribly lucrative - field of flu drug research and development.
"It's one of my concerns, that there is no familiarity - very little familiarity - of Canadian doctors with these drugs," said Dr. Fred Aoki, an antiviral expert who spoke Wednesday at a conference on the drugs hosted by the Public Health Agency of Canada and Manitoba Health.
"And similarly the public, the patients, have very little familiarity with this. You'd probably be hard pressed to find someone who actually had received a prescription, filled it (and) used it."
The conference, in Winnipeg, was staged to present provincial, territorial and municipal public health officials with up-to-date information on antivirals and their proper use as part of ongoing preparations for a flu pandemic.
Currently there are only four antiviral drugs available for treating or protecting against flu, three of which are licensed for sale in Canada. If taken early after the onset of symptoms, the drugs can trim a day or two off the period when one is laid low and generally allow for a speedier recovery.
The older drugs amantadine and rimantadine (the latter is not sold here) are inexpensive, but influenza viruses quickly lose their susceptibility to them. Two newer drugs, oseltamivir and zanamivir, are more costly but have fewer side-effects. And the viruses appear to be less likely to develop resistance to these drugs.
An official of the public health agency said it is taking a cautious approach on antivirals during what's called the interpandemic period and will consult expert groups before advocating any major changes in usage of the drugs. Still, Dr. Theresa Tam agreed the drugs may be underused.
"I think that there would be some increase in judicious use of antivirals during the interpandemic period that can be achieved," said Tam, associate director of respiratory diseases at the agency.
Aoki, who has been studying antivirals for decades at the University of Manitoba, admitted the drugs pose a dilemma.
There is good evidence they work well in healthy adults, who are least at risk of complications from flu. But there is limited data about how useful they are in people most likely to run into trouble when they get the flu, such as people with lung disease, heart disease or other conditions that dampen their ability to fight off infections. And those data have been slow to emerge because the drugs are so rarely used.
"And so when we're saying 'Should we use more of these drugs?' one is caught," he said.
"As a physician, on one hand, I'd like to be able to prescribe them with enthusiasm for these groups of individuals who are at higher risks of complications. But I recognize there is some limitation in the evidence base . . . for prescribing them widely for this population.
"I think there will be more and more data coming together and I think we will reach the point where we agree that these drugs do in fact do all these things: prevent hospitalization, prevent complication, prevent death. But it's a work in progress."
While some experts advocate increased use of the drugs, some worry that greater usage of antivirals now could push flu viruses to develop resistance, making the evolutionary changes needed to lose susceptibility to the drugs, just as bacteria have done with antibiotics. Some even suggest the newest and most effective antiviral drugs, neuraminidase inhibitors like oseltamivir, should be kept in reserve for the next pandemic.
But Dr. Frederick Hayden, a virologist and antiviral expert from the University of Virginia, disagreed.
"I really think that in order for us to have an effective pandemic antiviral response we have to increase use during the interpandemic period," he insisted.
In addition to fostering familiarity with the drugs, increased use would provide more incentives to pharmaceutical companies to develop additional antivirals, he said.
"In our current system, unless there is some incentive for these private companies to develop drugs, whether that's increased use in the interpandemic period or government approaches for pandemic use, it's unlikely that they're going to move these drugs forward in terms of clinical testing and then ultimate commercialization."
25/03/2005 2:30:00 PM
LISBON, Portugal (AP) - Five cases of an Ebola-like fever that has killed as many as 112 people along the Angola-Congo border have been detected in the Angolan capital.
The Portuguese news agency Lusa quoted health officials as saying three of the five Luanda patients - a 15-year-old boy, an Italian aid worker and a Vietnamese doctor - had died. They said all five patients had come from Uige, the province along the Congo border where the outbreak was first reported, including a child hospitalized in Luanda.
Officials feared the patients could have come into contact with more people in Luanda.
"We are running tests on family members and people they might have been in contact with to rule out infection of others," health official Vita Vemba told Lusa.
World Health Organization spokesman Dick Thompson in Geneva could not confirm the report but said by telephone that several teams are travelling to Angola in the coming days to help with diagnosis and containing the disease.
WHO said Tuesday that the illness was Marburg, a disease similar to Ebola. Analysis had identified 102 cases of the virus since October, 95 of which had proved fatal, WHO said. Angolan officials now put the death toll at 112.
Authorities initially feared the deaths were caused by Ebola, which still exists in nature in Congo.
Doctors have no vaccine or cure for Marburg, which, WHO said, "can be rapidly fatal."
Previous outbreaks have indicated that the risk of infection is increased by close contact with bodily fluids of infected people, as may occur during treatment or burial practices, WHO said.
Airports in Portugal were on alert for passengers coming from Angola, Portuguese health officials said. Angola is an ex-Portuguese colony and has a large community living in Portugal.