Wednesday, July 29, 2009
Disease researchers have begun modeling how a future H1N1-09 swine-flu outbreak would spread throughout the world and have come up with some troubling scenarios. Infectious disease experts are beginning to describe modern efforts to quell seasonal and epidemic influenza with vaccines and anti-viral drugs using wording like “potentially dangerous,” “worrisome,” and “may do more harm than good.”
This is striking in light of the multi-billion dollar worldwide effort to rapidly manufacture huge stocks of vaccines, up to an unprecedented 2 billion doses, against the 2008–09 late-flu season H1N1 swine flu epidemic. Public health officials are fearful this unusual strain of H1N1 influenza virus may mutate into a more lethal form in the fall as did the deadly Spanish flu pandemic of 1918.
Researchers at Shizuoka University in Japan, writing in a recent March 2009 issue of the Public Library of Science (PLoS One), are among the first to sound the alarm that the most relied upon weaponry against the flu, vaccines, may actually apply “immunological pressure on circulating strains of the flu which might engender the emergence of genetic variants with enhanced potential for pathogenicity in humans.” Translation: mass vaccination, unless well monitored, may actually induce the dreaded gene mutation that could result in more cases, increased hospitalizations and a larger death toll.
Public health officials are just beginning to piece together how treatment-resistant forms of flu viruses develop. The paradox is that if the virulence of a vaccine-resistant flu strain is less than that of the vaccine-vulnerable strain, the epidemic might increase in proportion to the percentage of the population that elects to undergo vaccination. Researchers conclude that “a vaccination that is expected to prevent the spread of the disease can instead foster the spread of the disease.”
Examples of the paradoxical effect
As an example, researchers point to a compulsory vaccination campaign for all poultry in China in 2005 involving the H5N1 influenza virus. Genetic analysis revealed that the H5N1 variant flu strain (Fujian-like influenza) emerged and subsequently became the prevalent variant in each of the 12 provinces of China, replacing previously established viruses.
In another example, H5N2 vaccines used in Mexico since 1995 appear to have promoted the emergence of various sub-strains of the flu after introduction of vaccines.
Type-A influenza viruses, which are the most common, are characterized by rapid mutation, that is, they learn to rapidly skirt around anti-viral agents. Efforts to quell flu outbreaks through vaccination in poultry may actually generate “a new pandemic virus that is dangerous for humans through a bird-human link,” say researchers. All those animal influenza vaccination programs may actually increase the risk for a day when a highly virulent strain of bird flu wipes out large portions of the world’s human population.
The Skizuoka University researchers in Japan say they “remain skeptical that a vaccination program can reduce the number of total infectious individuals even if the vaccination protects against transmission of a vaccine-sensitive strain.” [PLoS One 4(3):e4915, March 18, 2009]
Wagering one threat against another
While the H1N1-09 swine flu in circulation has spread rapidly, illnesses have been extremely mild and mortality rates low. But what lies ahead is unknown.
One the one hand, the H1N1-09 flu could mutate into a more virulent and deadly form and the vaccines would avert another 1918 Spanish-flu-like pandemic. But on the other hand, the vaccines currently in production against this unknown mutant variety may not confer immunity against the new variant flu virus and actually induce the very mutation that could kill millions of vulnerable humans, especially those who have little or no natural immunity or have compromised immunity due to age (very young, very old), existing disease or immune suppression.
Humanity is taking a big gamble. The impetus by public health officials and politicians to prepare human populations for mass vaccination may result in an avoidable calamity of unprecedented proportion.
2nd-Tier Anti-Viral Drugs May Induce The Same Problems
There is similar concern that over-use of anti-viral drugs, particularly early in the course of a flu outbreak, may worsen the spread and severity of a flu epidemic.
The second tier of defense against influenza is primarily comprised of anti-viral drugs known as enzyme (neuraminidase) inhibitors: oral Tamiflu tablets (oseltamivir) or nasally administered Relenza (zanamivir). Another class of anti-viral agents known as M2 ion channel inhibitors: amantidine and ramantadine, are lesser disregarded because they are ineffective against influenza-B viruses and rapidly induce drug resistance in influenza-A viruses.
Unexpectedly, resistance to Tamiflu by H1N1 flu viruses appears more common in countries with less use of the drug. Widespread under-dosing of Tamiflu can result in more drug resistant flu varieties. Of greater concern, young children appear to have greater resistance to treatment with Tamiflu than adults.
One drug not enough
In a similar manner to the newly expressed concerns over vaccines generating mutations that could worsen a flu epidemic, researchers at the Mayo Clinic now declare there is “worrisome evidence” of rapidly evolving resistance to anti-viral drugs. They now suggest the use of two different classes of anti-viral drugs at the same time so as to “prevent the development of new viral species that induce drug resistance.”
The Mayo Clinic researchers say that the sequential use of one drug, such as Tamiflu initially, followed by amantidine when Tamiflu resistance occurs, is inherently flawed. The researchers say “the use of single-drug anti-viral drug therapy against influenza is unwise and dangerous.” These strong comments, published in the May 2009 issue of Communicable Infectious Diseases, have drawn little or no attention from public news sources.
The cost of availability of two anti-viral drugs would further limit the number of communities that could adequately mount a defense against a deadly flu virus.
Will anti-viral drugs block or spawn a flu epidemic?
European researchers write in a report published in the October 30, 2008 issue of the Virology Journal that while the emergence of a drug resistant strain of flu virus may not necessarily be dangerous given that most prior treatment-resistant flu strains have been unlikely to spread, early surveillance data from the 2007–08 flu season in the northern hemisphere suggest the development of a type-A H1N1 Tamiflu-resistant flu virus that circulates in Europe and the US. The proportion of resistant infections ranges from 4 to 67 percent. Drug resistance occurs even without widespread use of Tamiflu. [Virology Journal 5: 133–39, October 2008]
In real numbers, not a simulation, the prevalence of Tamiflu-resistant H1N1 flu cases across Europe increased gradually over time, from near 0 in week 40 of 2007 to a startling 56% in week 19 of 2008! [Emerging Infectious Diseases 15: 552–60, April 2009] This means more than half of flu patients treated with anti-virals could face the end of their treatment options. Doctors will end up fighting the symptoms rather than the replicating virus.
Simulation of a drug-resistant flu epidemic
Flu researchers simulate a flu epidemic in a community of 100,000 people where there is no drug resistance and the flu outbreak causes 19,500 to seek doctors’ care and 258 hospitalizations.
If drug resistance develops naturally within subjects who receive the medicine, then an estimated 20,700 would seek doctors’ care and 312 would be hospitalized.
But if resistant forms of the flu are imported into the population within 21 days after onset of the epidemic, for example by people who travel by airplane from distant lands, then the infectious cases rise to 22,700 and the hospitalizations to 420.
If the drug-resistant flu strain is imported prior to the drug-sensitive strain, then the numbers rise to 25,100 who will seek treatment and 601 who require hospitalization.
This last scenario is quite troubling as it more than doubles the demand for in-hospital care. It is unlikely there are enough extra hospital beds, respirators and medicines in a community of 100,000 to treat such a flu outbreak.
Extrapolating this data into a metropolis of 8+ million people, like Los Angeles or New York City, and you have need for nearly 50,000 extra hospital beds. [Virology Journal 5: 133–39, 2008] In a country like the United States with a population of 300 million, nearly 2 million extra hospital beds would be required. God only knows what the demand for hospital beds, respirators and antibiotics would be worldwide.
Efforts by public health officials to calm public fears by claiming there are adequate stockpiles of medicines and respirators appear meager next to these horrific scenarios now being published by disease investigators.
Other researchers point to a scenario where even without any early preventive use of anti-viral drugs to prevent spread of the flu in a community, about 13.7% all drug-treated patients would be treated in vain due to resistant flu strains, and if 10–20% of the population actually do use anti-viral drugs to prevent infection, drug-resistant cases increase by 43 to 74 percent.
H1N1-09 flu virus has high transmissibility
The ability of these simulations to become reality is controlled by the capability of a drug-resistant strain to be transmitted from person to person. What has researchers concerned is that the current H1N1-09 flu is readily encircling the globe and therefore has high transmissibility. Researchers caution that the uncontrolled use of anti-viral drugs like Tamiflu could do more harm than good. Tamiflu should be restricted to treatment of active cases rather than used for prevention, say researchers. [BMC Infectious Diseases 9: 4–12, January 2009]
A problem is that many people have already acquired Tamiflu throughout the world and have stockpiled it in their home medicine chest for future use. They may elect to use it to prevent flu infection should an outbreak of the flu occur in their community. This uncontrolled use is what worries communicable disease experts.
Researchers at the University of Manitoba are concerned about an over-response to a flu outbreak where stockpiles of anti-viral drugs are depleted so rapidly early in the course of a developing epidemic that treatment cannot be completed which results in widespread drug-resistant flu strains. If drug treatment is employed too early during a flu outbreak a second wave of more severe infections can potentially occur. Controlled use of anti-viral drugs is required to prevent an epidemic of greater magnitude. [BMC Infectious Diseases 9: 8, January 22, 2009]
What if the H1N1-09 flu virus now in circulation doesn’t mutate into a more virulent form that human populations have no immunity towards? Billions of dollars of vaccines and anti-viral drugs would only pose the potential of producing unwanted side effects and no health benefits.
Currently the H1N1-09 flu virus is running its course. Its symptoms are somewhat mild and mortality rates are low. This virus needs to mutate on time, right when H1N1-09 flu vaccines become available. The H1N1-09 vaccines won’t become available till after school starts in 2009.
Fortunately, we don’t currently have any available vaccines to induce viral mutations, but infected subjects are taking anti-viral drugs like Tamiflu which could induce resistant mutated flu strains.
There are billions of dollars of unused vaccines and anti-viral drugs ordered and stockpiled by governments and they need to unload these flu weapons onto the public, who will purchase them individually at flu clinics or through health plans.
All this has raised suspicion that vaccine makers could intentionally produce a mutated species and introduce it directly into the population, and what a better way than via vaccination.
The long dreaded H5N1 flu virus, with a 60% death rate, fizzled when it was found it is not transmitted very well from human to human. But suddenly a contaminated vaccine which combined the deadly H5N1 with more transmissible seasonal flu strains was found by Biotest, a vaccine distributor in the Czech Republic, when it was tested in ferrets and it killed all of them. [The Canadian Press February 27, 2009]
The maker of that H5N1/H1N1 contaminated flu vaccine, Baxter, had filed a patent a year prior describing a method to produce vaccines in multiple species using several different antigens (US patent: US 2009/0060950 A1). Safeguards should have prevented this contamination, which suggests the contamination was intentional.
It is just too coincidental that French President Nicolas Sarkozy visited Mexico and announced a new $126 million facility by French drug manufacturer Sanofi-Aventis at the same time the H1N1-09 swine flu outbreak broke onto the scene. President Barack Obama visited Mexico the week prior to the flu outbreak there.
There is a cozy relationship here where the World Health Organization prematurely declares a pandemic which coerces more than 80 governments to purchase flu vaccines and then public health authorities invoke mandatory flu vaccination programs for school children and become the free sales agents for the vaccine makers. The vaccine makers then funnel profits back to the vaccine makers in the form of political contributions which are veiled kickbacks.
What if vaccines and anti-viral drugs don’t work?
Should vaccines and anti-viral drugs be rendered useless by a treatment-resistant flu strain, the only backup plan is to limit the spread of the infection by quarantine and limitation of social contacts. A scenario where world commercial aircraft are grounded and schools and workplaces closed, would throw the world into economic turmoil. The masses would be grasping for any imagined flu remedy.
Researchers have begun to search for alternate treatments. Researchers in Germany write that “the increasing frequency of viral resistance to the four US Food and Drug Administration (FDA)-approved anti-influenza virus drugs underlines the urgent need for novel anti-virals to be prepared for future influenza epidemics or pandemics.”
Modern medicine casts a blind eye towards strategies to boost human immunity. There are many over-the-counter products with proven ability to boost the immune response including vitamin D, Echinacea, beta glucan, vitamin C, nucleotides (RNA), selenium and zinc.
Among other non-drug agents now being explored are NF-Kappa-B inhibitors which limit viral production and resultant inflammation as well as viral resistance itself. [Journal Antimicrobial Chemotherapy 2009 July; 64(1):1–4]
Available natural NF-Kappa-B inhibitors are found in pomegranate, wine (resveratrol, quercetin), ginseng, turmeric (curcumin), ginger and vitamin D. [Mini Review Medicinal Chemistry 2006 Aug; 6(8):945–51]
This article was posted: Wednesday, July 29, 2009 at 4:41 am