How Bad Is the Threat of (Pandemic) Flu

Source: "Pandemic Influenza: An Inconvenient Mutation," Scott P. Layne, Arnold Monto and Jeffery K. Taubenberger, Science 20 March 2009: Vol. 323. no. 5921, pp. 1560 - 1561.

Seasonal influenza affects 10% of the population annually, killing up to one million persons worldwide. Pandemic viruses have even greater potential for mortality.......

About 425 million doses of trivalent influenza vaccine are produced annually, enough to protect less than 7% of the world's population. In the event of a pandemic, well-matched protective vaccines against a novel agent would not be available for at least several months, highlighting the importance of therapeutic options.

By 2009, however, 98% of circulating influenza A/H1N1 strains in North America have become resistant to the frequently prescribed and widely stockpiled neuraminidase inhibitor oseltamivir (Tamiflu), and 98% of A/H3N2 strains are resistant to the adamantanes. The alternative neuraminidase inhibitor zanamivir and the two approved adamantanes--amantadine and rimantadine--are all in short supply, and the adamantanes have substantial side effects. Influenza therapeutic options are clearly unraveling at a time when public health officials are appropriately concerned about pandemic emergence.

Comment: The most recent flu pandemics occurred in 1957 and 1968, and the Spanish flu that occurred during World War I killed tens of millions of people. The question, failing to have radically new vaccines, radically improved medicines, radically improved case finding and sentinal warning systems, and radically improved public health measures would seem to be now whether but when the next pandemic will kill millions of people. JAD

Source of photo: "Antibodies Resurrected from 1918 Flu Pandemic That Killed 50 Million," Posted by Casey Kazan. (Adapted from a Vanderbilt University Medical Center release.) The Daily Galexy, August 18, 2008.