Why Don’t We hearabout it in the News • The news media is fickle and jumps from story to story with no respect for magnitudes of importance. • Absence from the news is not absence from existence. • The entire world is preparing for this. • This is not a matter of “if” it is a matter of “when”.
Pandemics in the 20th century 1957: “Asian Flu” 1968: “Hong Kong Flu” 1918: “Spanish Flu” 50-100 million deaths 675,000 died in US 1 million deaths 70,000 died in US 1 million deaths 34,000 died in US H3N2 H1N1 H2N2
What We Know • H5N1 is a new, highly pathogenic form of influenza. • We have no immunity to this new subtype of Avian Influenza. • It is mutating at a rapid rate. • It has yet to acquired sustained human-to-human transmission. When it does it will mark the beginning of the pandemic.
Bottom Line • The current risk of a pandemic is great. • This risk will persist and is unpredictable. • We are overdue and unprepared for a pandemic. • A pandemic will cause significant disease, death and disruption to socio-economic systems.
NO-ONE knows when mutants will arise that would allow the virus to spread easily • NO-ONE knows when or if such mutants will also cause severe disease or death • We do know that we are overdue for a pandemic and whether it will be H5N1 or another subtype the world will face another pandemic in the future.
What is the Flu? • The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death • On average every year in the US, 5% to 20% of the population gets the flu, more than 200,000 people are hospitalized and about 36,000 people die from the flu.
Symptoms of the Flu • fever (usually high) and headache • extreme tiredness • dry cough and sore throat • runny or stuffy nose • muscle aches • Stomach symptoms, such as nausea, vomiting, and diarrhea
How do you get the Flu? • Flu viruses spread in respiratory droplets caused by coughing and sneezing. • Sometimes people become infected by touching something with flu viruses on it and then touching their mouth or nose. • Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. • That means that you can pass on the flu to someone else before you know you are sick, as well as while you are sick.
There are 3 Types Of Influenza
Type C Type C • Only infects Humans • Only result in mild illness • Do not cause epidemics or pandemics
Type B Type B • Only infects Humans • Can cause epidemics but have not caused pandemics • Are a major cause of yearly Flu in the US
Type A Type A • Naturally found in wild birds • Can infect pigs, horses, humans and other animals • Causes epidemics and pandemics • Yearly Flu outbreaks in the US are predominantly caused by Type A viruses
Type A Type A • Influenza type A viruses are divided into subtypes based on two proteins on the surface of the virus.
Hemagglutinin Neuraminidase H1N1 HandN H3N2 There are 15 different types of H H5N1 There are 9 different types of N
The Problem • The flu is a virus and is not affected by antibiotics that treat only bacteria • Viruses are very hard to treat because they replicate inside our body cells. • In fact it is our body, using our energy and nutrients that make the new viruses that go and infect more of our cells.
Viral Replication 1. Virus Attaches to Cell 5. Virus particles are released from cell • Cell produces viral particles • Virus releases genetic material 2. Virus is brought into cell
Two Ways • There are two ways that scientists have developed to stop the influenza virus: Drugs and Vaccines • First Way: Drugs • Rimantadine and Amantadine are older drugs and stop the virus from releasing its genetic material into the cell.
Drugs • A newer class of drugs know as neuraminidase inhibitors prevent the virus from being released from the infected cell, thus preventing further infection. • The most well know of these is Tamiflu (Oseltamivir) and Relenza.
Tamiflu • Associated with less toxicity • Effective against all subtypes of type A • Have some potential for diminishing the effects of influenza infections • Governments are stockpiling this drug
Problems • Both of these drugs are not very effective as a cure but can be used as a preventative measure to avoid getting the flu. • The flu virus can quickly develop resistance to these drugs especially Tamiflu. • Tamilfu is now been shown to increase the risk of self injury and delerium.
Vaccines are not cures • Vaccines are effective against viruses and bacteria • Vaccines stimulate our bodies natural immune system to be prepared for a specific disease. • Vaccination does result in a mild reaction because it does stimulate the immune system just like a disease would.
Yearly Flu Vaccine • The yearly vaccine is known as a trivalent vaccine: contains recent representatives of H1N1, H3N2 and type B • Vaccine production begins in February based on recommendations by WHO • Vaccine viruses are grown in embryonated hens’ eggs and the infected fluid is harvested.
Yearly Flu Vaccine • The viruses are purified, inactivated and further treated to produce either a whole virus, split or subunit vaccine. • It is likely to take at least 6 months before the first doses of vaccine are available. • Numerous clinical trials have confirmed the effectiveness of influenza vaccines in reducing clinical illness, hospital admissions and deaths.
Problems • You cannot make a fully effective vaccine until you have the actual virus causing the pandemic. This virus does not exist yet. • It takes 900 million eggs to make the desired 300 million doses of vaccine. If birds become in short supply so could the ability to produce vaccine. • If you are allergic to eggs you cannot get vaccinated using these vaccines
Problems • We don’t know the dosages required to convey immunity to the new virus. It may take several doses to fully immunize an individual thus limiting the supply. • One of the issues that delayed the ‘swine flu’ immunization campaign in 1976 in the USA was the need to negotiate for product liability i.e. ensuring a guaranteed market for the vaccine and organizing who would take liability in the event of adverse reactions.
Problems • We don’t know how effective the vaccine will be as the virus mutates and the virus will mutate.
Answers • The government has put 1 billion dollars into the development of cell-based vaccine production. 2 year away from production. • 8 million doses of vaccine against an H5N1 virus strain isolated from Vietnam in early 2004 have been stockpiled. • Progress has also been made toward development of a vaccine against an H5N1 strain isolated from Indonesia in 2005.
Strengthen your Immune System • Vitamins C and E • Carotenoids and Bioflavenoids • Zinc and Selenium • Garlic and Echinacea • Omega-3 Fatty acids • Bottom line: Lots of Fruits and vegetables, fish…
Weakening the Immune System • Overdosing on Sugar: 1 can of soda will reduce the ability of white blood cells by 40% for five hours • Excess Alcohol: deprives the body of important nutrients and weaken the immune system • Too much Fat: Obesity depresses the immune system
The Bottom Line • Its time to get healthy • Exercise, eat well, sleep • Its time to get healthy • Do not do fad diets, make life style changes that you will keep for the rest of your life • Its time to get healthy
“Oh Coffee, you dispel the worries of the great, you point the way to those who have wondered from the path of knowledge. Coffee is the drink of the friends of God, and of His servants who seek wisdom. As coffee steeps in the cup it gives off a musky aroma and turns the color of ink. No one can understand the truth until he drinks of its frothy goodness. Those who condemn coffee as causing man harm are fools in the eyes of God. Coffee is the common man’s gold, and like gold it brings to every man the feeling of luxury and nobility. Coffee differs from pure, gentle milk only in its taste and color. Take time in your preparation of coffee and God will be with you and bless you and your table. Where coffee is served there is grace and splendor and friendship and happiness. All cares vanish as the coffee cup is raised to the lips. Coffee flows through your body as freely as your life’s blood, refreshing all that it touches: look at the youth and vigor of those who drink it. Whoever tastes coffee will forever forswear the liquor of the grape. Oh drink of God’s glory, your purity brings to man only well being and nobility.” -Sheikh Djezeri Hanball Abd-al-Kadir, 1587
Reassortment • Virus can reassort in another mammal such as a pig which is able to be infected by both avian viruses and human viruses. The recombinant virus can then infect humans. This occurred in the last two pandemics (1957 and 1968).
2. Reassortment Virus can reassort in a human that has a strain of human influenza.
3. Genetic Mutation Virus can mutate and gain the ability to be transmitted human to human. This type of mutation tends to result in more potent pandemics (1918). This is what we believe H5N1 will do.
Some Numbers "It is sobering to realize that in 1968, when the most recent influenza pandemic occurred, the virus emerged in a China that had a human population of 790 million, a pig population of 5.2 million, and a poultry population of 12.3 million; today, these populations number 1.3 billion, 508 million, and 13 billion, respectively. Similar changes have occurred in the human and animal populations of other Asian countries, creating an incredible mixing vessel for viruses. Given this reality, as well as the exponential growth in foreign travel during the past 50 years, we must accept that a pandemic is coming.” • Dr Michael Osterholm
"Frankly the crisis could for all we know have started last night in some village in Southeast Asia. We don't have any time to waste and even if we did have some time, the kinds of things we need to do will take years. Right now, the best we can do is try to survive it.” • Dr Michael Osterholm