Blackbird
Have a bird for the holidays, before a bird has you! While chickens are vaccinated in China, globalization and shrinking U.S. manufacturing muscle have given the “blackbird” a head start of five years in the race to the next pandemic. It is no longer a question of “if” an influenza pandemic will occur, but “when.” Will we be more prepared than our cousins of 1918 to face the viral challenge, or will politics bring modern medical machinery to a screeching halt? Here are the facts. You be the judge.
Some statistics will put the “bird attack” in perspective and move hands closer to the alarm bell. A typical year in the U.S. brings the deaths of 30,000 to 50,000 people as a result of influenza virus infection, and global death rates are 20 to 30 times higher. The past 300 years have seen 10 pandemics of influenza A, and the now famous pandemic of 1918 and 1919 killed 50 million to 100 million souls. The number of hospitalizations each year from 1979 to 2001 related to influenza in the U.S. reached 226,000, and 325,000 patients died in the U.S. from pulmonary and circulatory causes connected to influenza from 1990 to 1999.
Now comes the bad news. The H5N1 avian influenza virus promises to eclipse those statistics if action is not taken immediately. Although to date there have been only 100 cases of human infection with the avian virus since 19974, mutation and reassortment of genetic material are likely to shift the balance and create a highly infectious “viral monster” capable of easy spread from human to human. As the matter stands now, infected wild birds shed the influenza virus in their saliva, nasal secretions, and feces. Their domesticated “kissing cousins” contract the virus directly from their wild relatives, or through contaminated surfaces, cages, water, or feed.
Hapless humans in direct or close contact with domesticated chickens, ducks, and turkeys develop symptoms of fever, cough, sore throat, muscle aches, eye infections, severe respiratory illnesses (acute respiratory distress syndrome), and other life-threatening conditions. To halt the onslaught, killing the birds, the chicken farmers, and their progeny might have been a suitable solution for Pharaoh, but civilized man is a humane creature. His arsenal is a ban on poultry importation, a limitation of travel, and prescription medicines, some of which have already been rendered impotent by viral resistance. Stop-gap measures simply cannot win the day.
Questions continue to abound, and expedited solutions are not forthcoming. Mechanical ventilators are in short supply, and it will take a while for cell-culture technology for production of vaccine to replace the current egg-based manufacturing process. Furthermore, most vaccines are manufactured abroad. The U.S. might have contemplated a similar “doomsday scenario” when it decided to become a service economy, close down factories, and export manufacturing plants overseas and to countries where the per capita income is pennies to the dollar.
Ramping up vaccine production would require a minimum of six months, and that only after isolation of the circulating strain of virus. Supplies of those vaccines during those months might reach doses sufficient to vaccinate perhaps 500 million people, or roughly 14% of the world’s population.1 Perhaps Pharaoh’s idea would not be so bad in the long run, after all. The extremely limited supply of antiviral agents and vaccine might even mandate it.
Enough bickering. Is it too late? What are the options? Where do we go from here? U.S. health authorities must “come clean,” and develop a system of risk communication in order to allay the public’s fears. A detailed plan for vaccine and antiviral agent allocation and stockpile positioning will also be needed, and unpopular decisions are going to have to be made in the short-term, in order to prevent devastation in the long-term. Vaccination of health care workers at the expense of our children might be one such unfavorable stance to take. After all, sick doctors and nurses would put us all in jeopardy.
If cell culture-based technologies for vaccine production are not developed, implemented, and sustained in short order, we may become the birds on holiday tables.
Copyright 2005, Albert M. Balesh, M.D. All rights reserved.
Some statistics will put the “bird attack” in perspective and move hands closer to the alarm bell. A typical year in the U.S. brings the deaths of 30,000 to 50,000 people as a result of influenza virus infection, and global death rates are 20 to 30 times higher. The past 300 years have seen 10 pandemics of influenza A, and the now famous pandemic of 1918 and 1919 killed 50 million to 100 million souls. The number of hospitalizations each year from 1979 to 2001 related to influenza in the U.S. reached 226,000, and 325,000 patients died in the U.S. from pulmonary and circulatory causes connected to influenza from 1990 to 1999.
Now comes the bad news. The H5N1 avian influenza virus promises to eclipse those statistics if action is not taken immediately. Although to date there have been only 100 cases of human infection with the avian virus since 19974, mutation and reassortment of genetic material are likely to shift the balance and create a highly infectious “viral monster” capable of easy spread from human to human. As the matter stands now, infected wild birds shed the influenza virus in their saliva, nasal secretions, and feces. Their domesticated “kissing cousins” contract the virus directly from their wild relatives, or through contaminated surfaces, cages, water, or feed.
Hapless humans in direct or close contact with domesticated chickens, ducks, and turkeys develop symptoms of fever, cough, sore throat, muscle aches, eye infections, severe respiratory illnesses (acute respiratory distress syndrome), and other life-threatening conditions. To halt the onslaught, killing the birds, the chicken farmers, and their progeny might have been a suitable solution for Pharaoh, but civilized man is a humane creature. His arsenal is a ban on poultry importation, a limitation of travel, and prescription medicines, some of which have already been rendered impotent by viral resistance. Stop-gap measures simply cannot win the day.
Questions continue to abound, and expedited solutions are not forthcoming. Mechanical ventilators are in short supply, and it will take a while for cell-culture technology for production of vaccine to replace the current egg-based manufacturing process. Furthermore, most vaccines are manufactured abroad. The U.S. might have contemplated a similar “doomsday scenario” when it decided to become a service economy, close down factories, and export manufacturing plants overseas and to countries where the per capita income is pennies to the dollar.
Ramping up vaccine production would require a minimum of six months, and that only after isolation of the circulating strain of virus. Supplies of those vaccines during those months might reach doses sufficient to vaccinate perhaps 500 million people, or roughly 14% of the world’s population.1 Perhaps Pharaoh’s idea would not be so bad in the long run, after all. The extremely limited supply of antiviral agents and vaccine might even mandate it.
Enough bickering. Is it too late? What are the options? Where do we go from here? U.S. health authorities must “come clean,” and develop a system of risk communication in order to allay the public’s fears. A detailed plan for vaccine and antiviral agent allocation and stockpile positioning will also be needed, and unpopular decisions are going to have to be made in the short-term, in order to prevent devastation in the long-term. Vaccination of health care workers at the expense of our children might be one such unfavorable stance to take. After all, sick doctors and nurses would put us all in jeopardy.
If cell culture-based technologies for vaccine production are not developed, implemented, and sustained in short order, we may become the birds on holiday tables.
Copyright 2005, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/08/2006 07:40:00 PM
2 Comments:
Very pretty site! Keep working. thnx!
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