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Avian Flu Pandemic?

The "hybrid" viron has the surface antigens of birds, but the core RNA thats infectious to humans. Thats very bad, because it means that if that hybrid virion infects humans, it will have avian surface antigens, which no human immune system has ever recognized before.
The M2 protein is a conserved surface protein of B strain (avian) viruses which might protect you if you had prior exposure to another B strain. Repeated vaccination with inactivated whole virus vaccine might provide immunity too, but M2 is only a small protein and is poorly immunogenic.
 
Eos of the Eons:
I have a basement to hide from tornadoes now, so I feel a little better.
There it is. I propose that sort of preparedness as an alternative to worrying, and a more mature response than the alternative alternative: "the experts are on it; just think happy thoughts". Unforunately, before you can get to that, you first have to get worried enough to take some kind of action.

HopkinsMedStudent:
By subtly changing the surface architecture of HA every season, the virus ensures that previous immunity does not pass over to the next year. Thats why you have to get a flu shot every year.
Well, the same degree of immunity does not pass over to the next year. While the reason flu keeps coming back year after year is that it is constantly on the move genetically, the reason a typical year's flu virus kills merely tens of thousands of people instead of tens of millions is that immunity to a previous year's strain does provide some immunity against a mutated version, even if it isn't enough to prevent infection completely. Since only the H1, H2, and H3 subtypes are known to have circulated in human populations during the last century, humans can be expected to have little or no pre-existing natural immunity to H5N1.

The other 4 mutations code for different virulence factors that would allow increased replication, reduced growth/latency checkpoints, and proteins that inhibit cytokines secreted by macrophages.
Considering that cytokine storm tends to be the primary cause of death in influenza patients, I've been wondering how the high fatality rates among healthy young adults in 1918 is related to this. I'm thinking: younger, more robust innate immune system response -- maybe too robust. Does that sound right to you?

I often see it stated that influenza death is often due to secondary bacterial pneumonia. It should be noted that while this is true of typical human influenzas, one of the things that makes H5N1 so dangerous is that it causes primary viral pneumonia. We aren't in much better shape to treat that than we were in 1918 (especially once all the ventilators are in use, and we're nearly there now).

When a pig cell gets co-infected by 2 flu virions, what happens is the segmented RNA genomes can reassort into a "hybrid" virion
Henry Niman (for one) seems to be making a pretty strong case for recombination in addition to the well-documented mechanism of reassortment. What's your take on that?
 
There it is. I propose that sort of preparedness as an alternative to worrying, and a more mature response than the alternative alternative: "the experts are on it; just think happy thoughts". Unforunately, before you can get to that, you first have to get worried enough to take some kind of action.

Yes, that awareness can allow you take steps within your control. There is not a lot a person can do to prepare for an illness like the flu except get a vaccination. There isn't one available yet since the mutation/recombination hasn't happened yet...so why worry so much?

I am glad this awareness of the disease and the implications allow for the monitoring that will be needed in case the mutation occurs. Not much *I* personally can do though.

Any suggestions? Someone already mentioned the wash hands a lot. I can do that, and that will also help prevent the spread of any flu. Anything else?
 
Considering that cytokine storm tends to be the primary cause of death in influenza patients, I've been wondering how the high fatality rates among healthy young adults in 1918 is related to this. I'm thinking: younger, more robust innate immune system response -- maybe too robust. Does that sound right to you?
The elderly survived perhaps because they may have had prior exposures and generated an anti-M2 response which would have protected them against all B strains.
 
There is not a lot a person can do to prepare for an illness like the flu except get a vaccination.
I relate to the feeling of helplessness; there certainly are limits to what the average person can do to prepare.

A lot of people either don't seem to fully appreciate the impact a global pandemic would be likely to have on their daily lives, or they are so terrified of the prospect that they don't want to talk about it or even think about it. My opinion is that somewhere between these two extremes: "light another doobie" and: "deer in the headlights" lies a rational degree of concern, and a reasonable level of response.

People mostly seem to anticipate merely going about their normal daily routines while hoping for the best. This I regard as extremely naive. Keep in mind that even the worst case scenarios involve attack rates of maybe 25% to 35%. I expect that in the teeth of a pandemic, there will be a dawning of awareness of the significance of this number, and many people will suddenly find themselves giving more thought to ways in which modest changes in their activities might reduce their chances of being included. The fact that among these will be folks like truck drivers and grocery clerks also creates certain difficulties worthy of some consideration. I also expect that if the bug jumps out with a high mortality rate, many who currently indulge a rather cavalier attitude will suddenly discover that they love life more than they realized, and will find themselves willing to take steps they would not have dreamed of before the outbreak.

I find a possible irony in the observation that church attendance (the sort of indoor gathering which creates conditions ideal for transmission of a virus) is likely to increase during a pandemic, and I must confess that the rather unkind thought also occurred to me that this might act as a sort of selective pressure against memes that produce this behavior.

I do not regard it as paranoid thinking to give some consideration to how one might deal with shortages of food, fuel, or services for a period of at least some weeks, and most of us probably are in a position to make at least some efforts to be better prepared for such a prospect. Better preparedness for other, possibly unforseen types of crises such as floods, tornados, terrorist attacks, etc, is a bonus.



Capsid:
The elderly survived perhaps because they may have had prior exposures and generated an anti-M2 response which would have protected them against all B strains.
That makes better sense. (Spanish flu was type A, though). While we're on the subject of M2, I find some cause for optimism in recent indications that sensitivity to Amantadine has been seen in Russian H5N1 isolates (especially since my personal stash currently includes a modest supply of Amantadine, but not Tamiflu).
 
That makes better sense. (Spanish flu was type A, though).
OK, I should have checked, I got confused by earlier posts. The M2 protein is present on A strain viruses which are the pandemic causing avian influenzas.
 
The media coverage reminds me of the killer bee threat of about ten years ago, or the year 2000 computer bug. Its shrill and focuses almost totally on worst case scenarios (2 million dead in the US!). Meanwhile whether the pendemic even happens or not is dependant on a lot of "what ifs".
 
Thank you for backing my opinion that it is a lifestyle disease, even in Africa.

You clearly have no idea what the term "lifestyle disease" means.

"Lifestyle disease: A disease associated with the way a person or group of people lives, not caused by an external pathogen. Lifestyle diseases include atherosclerosis, heart disease, and stroke; obesity and type 2 diabetes; and diseases associated with smoking and alcohol and drug abuse."

In other words, it's not a "disease" in the pathogenic sense, but the results of indulging in behaviours that result in progressive physical degradation of one or more specific organs or systems due to chronic, excessive overuse of a particular substance or activity.

You're confusing behaviour with pathogen-transmission vectors. By your definition, pretty much every single disease in the entire world is a "lifestyle disease", since risk of exposure can be reduced or eliminated by a sufficient significant change in lifestyle.

Pardon me for being so US-centric, but a virus in Africa has little effect on me in my nice warm suburban home. It's not as if it is expected to become airborne and waft across the Atlantic, is it?
Nope, Ebola, Sars, Spanish Flu, Asian flu, nothing like this you'll ever have to worry about, because viruses never mutate, are never carried by travellers, and are only transmittable by evil people doing evil things. No need to wrry about any diseases those untermenchen mud people, or immoral queers, get.

Do you happen to know how many people have gotten HIV from infected blood transfusions, improperly cleaned medical instruments, or through contact with infected blood on various sharp objects? No, I didn't think so.

You don't see anyplace for bias in this statement? Do you think an organisation with "Health" in it's name would downplay any 'epidemic'?
No, I don't; but you've clearly shown an immense amount of bias in yours. Do you even know what the World Health Organization is?
 
Avian flu

There is an interesting article in the New York Times, about the government's plan for the possible pandemic, try their website.

I do not want to sound paranoid, but there was an illogical article from some Tokio researchers on the tolerance to Tamiflu, the vietnamese girl had a virus resistant to Tamiflu that responded to higher doses of Tamiflu! My impression on the article was that the authors were trying to reduce the demand/hoarding for Tamiflu.

I plan to try toget some doses of both oseltamivir and rimantadine for my family!

p.s. I am not allowed to post weblinks yet, this is only my second post!
 
What are oseltamivir and rimantadine? Other antivirals? How effective are they at helping with the flu compared to Tamiflu?

Do you happen to know how many people have gotten HIV from infected blood transfusions, improperly cleaned medical instruments, or through contact with infected blood on various sharp objects? No, I didn't think so.

There are cases of people who also contracted HIV via improperly cleaned dental tools as well. The notion HIV is a lifestyle disease is quite laughable.
 
The media coverage reminds me of the killer bee threat of about ten years ago, or the year 2000 computer bug.
I agree that the way an issue like this is treated in the media is not necessarily a good indication of the actual degree of risk. As I've indicated earlier, I'm more concerned by the growing consensus among experts in virology, microbiology, and epidemeology that the risk is very high.

It's always a good idea to consider the objectivity a source of information. Like yourself, I regard mainstream media as particularly suspect; much of it hardly rises above the level of entertainment. It's unfortunate that our appetite for thrills has created an atmosphere in which distinguishing genuine concerns from sensationalized ones often presents such a challenging figure-to-ground problem. Perhaps there is something about human nature that makes this unavoidable. What may be even worse is the way so many people seem to become desensitized to an issue once it has recieved a certain amount of media attention.

As far as overenthusiastic media coverage of the Y2k bug problem goes, it is often noted that millions of dollars and thousands of programmer-hours were spent toward preventing serious widespread problems from that. The fact that those efforts were successful does not mean that the threat was not real, and neither does the fact that the media got a lot of mileage out of it.

Its shrill and focuses almost totally on worst case scenarios (2 million dead in the US!).
In coming up with realistic predictions of the numbers likely to be affected by H5N1, does it seem reasonable to you to rely on previous pandemics as models? Two million deaths is based on an attack rate of less than thirty percent, and a mortality rate of less than three percent (in other words, about like the Spanish flu pandemic). To put this in perspective, while AIDS killed 25 million in its first 25 years, the Spanish flu probably killed that many in 25 weeks.

But those really aren't "worst-case" numbers anyway; one leading researcher in the field, Henry "not just some guy in a garage" Niman, has criticized the WHO for being too conservative in their estimates. He warns that if H5N1 is transmitted with the same efficiency as human flu, even a single digit mortality rate could have an impact significantly greater than 1918, and the high pathogenicity H5N1 has demonstrated so far indicates that the possibility of a double digit rate cannot be easily dismissed. NOW you're talking worst-case scenario.

Keep in mind that influenza typically strikes 10% to 20% of the U.S. population yearly, and is often associated with about 36,000 deaths nationwide -- and this in the face of antivirals, antibiotics, steroid anti-inflammatories, and all that modern medicine can bring to bear.

Meanwhile whether the pendemic even happens or not is dependant on a lot of "what ifs".
If you take a close look at the mechanics of viral reproduction, you may come to appreciate why it is that so many of the people who do that sort of thing for a living have come to regard whether a flu pandemic will happen as pretty much a slam dunk. The open questions mostly have to do with when and how bad. There are also some specific and (very scientifically defensible) reasons why they consider H5N1 to be such a likely candidate.
 
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What are oseltamivir and rimantadine? Other antivirals? How effective are they at helping with the flu compared to Tamiflu?
Tamiflu is Roche's trade name for oseltamivir. A similar drug, zanamivir, made by GlaxoSmithKline and sold as Relenza, must be inhaled -- a drawback in treating patients with severe respiratory illness. These both belong to a new class of antivirals known as neuraminidase inhibitors. Rimantadine and Amantadine are M2 inhibitors. We can't know at this point how much resistance a pandemic strain of H5N1 might have to any of them, but I'd rather have any one of them than nothing (even though some of the side-effects can be a little gnarly). To be effective in treating those already infected, they all must be administered early on.
 
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I wrote a letter to my doc (no office visit) and asked that a Tamiflu prescription be sent to my pharmacy. It was there in 3 days and 2 days later I had it in my very hands. $85.
 
I wrote a letter to my doc (no office visit) and asked that a Tamiflu prescription be sent to my pharmacy. It was there in 3 days and 2 days later I had it in my very hands. $85.
And was that two doses a day for 10 days (more than what is usually prescribed)? In other words, a total of 20 pills? If not, it is unlikely to be effective against h5n1. And how do you know when to start to make sure you don't waste it on a lesser flu by mistake? For those who put good money down on only one dose, that will be a dilemma. There are currently three pharma anti-viral candidates. Amantadine is the third one, and not likely to be effective because the Chinese have been dosing their poultry with it. Fortunately there are non pharma anti-virals which will be available long after the pharmas run out, and the vaccine is still nowhere in sight.
 
Amantadine is [ ] not likely to be effective because the Chinese have been dosing their poultry with it.
Some good news related to veterinary use of antivirals:
The resistance may be short-lived.

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"16 sequences from Qingahi Lake in China have been published, and none have amantadine resistance markers. Similarities in sequences between isolates from Qinghai Lake in China and Chany Lake in Russia suggest that most or all sequences of H5N1 from wild birds are amantadine sensitive."
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http://www.recombinomics.com/News/09170502/Tamiflu_Amantadine_Prevention.html

Some bad news (potentially) related to veterinary use of antivirals:
Domestic cats can become infected with H5N1. Talk about a vector; that almost has rats beat.
 
Some bad news (potentially) related to veterinary use of antivirals: Domestic cats can become infected with H5N1. Talk about a vector; that almost has rats beat.
Dogs and cats, and probably a great many other species as well. (It goes both ways. The human residents may all survive, but housebound fluffy might not.)

That's good news about amantadine, but it all comes down to which h5n1 strain(s) win out.
 
Black elderberry extract is a proven anti-viral for the more common flu (sorry, BSM, you get to do your own homework on that one), but may be contraindicated for h5n1 for some people because it may promote the bad cytokines.
I'm stuck on the homework. (I know you gave the assignment to BSM, but I'm interested too).

There are lots of websites touting the "proven antiviral properties" of Elderberry extract. They invariably mention that it has pleasant taste as well. Royal jelly and Echinacea are also frequently included among the items they invite me to add to my shopping cart. I found one or two that even mentioned neuraminidase inhibition specifically. But the closest thing to citations any of them offer are vague references to "findings by a team of Israeli scientists", or "a new, Norwegian study involving 60 patients", or (most often) simply: "scientific studies". I found a PubMed article on polynucleotide-adenosine glycosylase activity towards tobacco mosaic virus RNA, and another talking about how "Sambucol Elderberry Extract and its formulations activate the healthy immune system by increasing inflammatory cytokine production." (As you noted, increased cytokine production might not be such a great idea for someone infected with avian flu).

Are you giving out any hints?
 

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