Giuseppe
Emeritus
Meeting the challenge of influenza pandemic preparedness in developing countries - ECDC Health Content
Scientific Advances ? Pandemic Influenza ? Treatment
Meeting the challenge of influenza pandemic preparedness in developing countries
Fedson DS. ?Meeting the challenge of influenza pandemic preparedness in developing countries?. Emerg Infect Dis. 2009 Mar; [Epub ahead of print]
Description:
This paper highlights the difficulties that developing countries face in preparing for an influenza pandemic suggesting that approaches applicable in rich countries will not suffice to protect the population since supplies of vaccines and antiviral agents cannot be used. Instead, a bottom-up perspective is analysed, paying particular attention to the potential use of less expensive generic agents especially ?statins?, that either modify the host response to influenza virus or act as antiviral agents.
The author points out if a pandemic emerges within the next few years, all countries will depend on egg-derived inactivated influenza vaccine, but this approach will not succeed in the developing world. Even if limited supplies of vaccines were produced for developing countries, there is still not an international mechanism in place to pay for and distribute the vaccines.
The ?bottom-up? approach that this paper claims for is based on existing healthcare workers and institutions and the use of inexpensive and widely available generic agents that may have intrinsic antiviral activities (or modify the host response). Statins are especially mentioned citing retrospective studies suggest that outpatient ?statins? for instance, can reduce pneumonia mortality rates by half, although the author notes these observational studies must be cautiously interpreted until more clinical trials are readily available to reinforce these results. It is pointed out that ?statins? and PPAR agonists have anti-inflammatory and immunomodulatory activity Used alone or together, it might benefit patients during an influenza pandemic. The paper also mentions other agents like chloroquine. Many of these agents are currently being produced as generic drugs in developing countries; they are inexpensive, can be produced in big amounts and could be stockpiled in a similar manner to that of classical antivirals, being available for use in the population from the very first day of occurrence of a pandemic.
ECDC comment ? (24/02/2009):
This is continuing a theme started by Oshitani et al (1) but then goes onto a controversial areas about whether statins and other agents that among other actions modulate inflammatory actions will reduce the disease that follows influenza infection. This comes from an earlier observation that in some infections it is the inflammatory response of the human body that does the harm rather than the infection itself. This has been suggested especially in the few infections that have taken place with avian influenza type A(H5N1). There are also animal studies supporting this.(2-4) As well as such theory this hypothesis is support by a number of observational studies that suggest taking statins (which are taken on an anon-going basis to reduce cardiac risk) is associated with a better outcome from a number of infections.(3,4) However observational studies are notorious for coming up with findings that look attractive but later turn out to be due to confounding and certainly there are studies that do not support the hypothesis.(5) One of which is described below. Surprisingly the paper does not feature inexpensive antibiotics as the most obvious drug to have available in resource poor countries.
1. Oshitani H, Kamigaki T, Suzuki A. Major issues and challenges of influenza pandemic preparedness in developing countries. Emerg Infect Dis. 2008 Jun Available from http://www.cdc.gov/EID/content/14/6/875.htm
2. Butler D. Cheaper approaches to flu divide researchers. Nature. 2007 Aug 30;448(7157):976-7.
3. Fedson DS. Confronting an influenza pandemic with inexpensive generic agents: can it be done? Lancet Infect Dis. 2008 Sep;8(9):571-6. Epub 2008 Apr 15.
4. Fedson DS. Statin protection against influenza and COPD mortality. Chest. 2007 Oct;132(4):1406; author reply 1406-7.
5. Smeeth L, Douglas I, Hall AJ, Hubbard R, Evans S. Effect of statins on a wide range of health outcomes: a cohort study validated by comparison with randomized trials. Br J Clin Pharmacol. 2009 Jan;67(1):99-109. Epub 2008 Nov 5.
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<cite cite="http://ecdc.europa.eu/en/health_content/sciadv/090226_sciadv.aspx">ECDC Health Content</cite>Meeting the challenge of influenza pandemic preparedness in developing countries
Fedson DS. ?Meeting the challenge of influenza pandemic preparedness in developing countries?. Emerg Infect Dis. 2009 Mar; [Epub ahead of print]
Description:
This paper highlights the difficulties that developing countries face in preparing for an influenza pandemic suggesting that approaches applicable in rich countries will not suffice to protect the population since supplies of vaccines and antiviral agents cannot be used. Instead, a bottom-up perspective is analysed, paying particular attention to the potential use of less expensive generic agents especially ?statins?, that either modify the host response to influenza virus or act as antiviral agents.
The author points out if a pandemic emerges within the next few years, all countries will depend on egg-derived inactivated influenza vaccine, but this approach will not succeed in the developing world. Even if limited supplies of vaccines were produced for developing countries, there is still not an international mechanism in place to pay for and distribute the vaccines.
The ?bottom-up? approach that this paper claims for is based on existing healthcare workers and institutions and the use of inexpensive and widely available generic agents that may have intrinsic antiviral activities (or modify the host response). Statins are especially mentioned citing retrospective studies suggest that outpatient ?statins? for instance, can reduce pneumonia mortality rates by half, although the author notes these observational studies must be cautiously interpreted until more clinical trials are readily available to reinforce these results. It is pointed out that ?statins? and PPAR agonists have anti-inflammatory and immunomodulatory activity Used alone or together, it might benefit patients during an influenza pandemic. The paper also mentions other agents like chloroquine. Many of these agents are currently being produced as generic drugs in developing countries; they are inexpensive, can be produced in big amounts and could be stockpiled in a similar manner to that of classical antivirals, being available for use in the population from the very first day of occurrence of a pandemic.
ECDC comment ? (24/02/2009):
This is continuing a theme started by Oshitani et al (1) but then goes onto a controversial areas about whether statins and other agents that among other actions modulate inflammatory actions will reduce the disease that follows influenza infection. This comes from an earlier observation that in some infections it is the inflammatory response of the human body that does the harm rather than the infection itself. This has been suggested especially in the few infections that have taken place with avian influenza type A(H5N1). There are also animal studies supporting this.(2-4) As well as such theory this hypothesis is support by a number of observational studies that suggest taking statins (which are taken on an anon-going basis to reduce cardiac risk) is associated with a better outcome from a number of infections.(3,4) However observational studies are notorious for coming up with findings that look attractive but later turn out to be due to confounding and certainly there are studies that do not support the hypothesis.(5) One of which is described below. Surprisingly the paper does not feature inexpensive antibiotics as the most obvious drug to have available in resource poor countries.
1. Oshitani H, Kamigaki T, Suzuki A. Major issues and challenges of influenza pandemic preparedness in developing countries. Emerg Infect Dis. 2008 Jun Available from http://www.cdc.gov/EID/content/14/6/875.htm
2. Butler D. Cheaper approaches to flu divide researchers. Nature. 2007 Aug 30;448(7157):976-7.
3. Fedson DS. Confronting an influenza pandemic with inexpensive generic agents: can it be done? Lancet Infect Dis. 2008 Sep;8(9):571-6. Epub 2008 Apr 15.
4. Fedson DS. Statin protection against influenza and COPD mortality. Chest. 2007 Oct;132(4):1406; author reply 1406-7.
5. Smeeth L, Douglas I, Hall AJ, Hubbard R, Evans S. Effect of statins on a wide range of health outcomes: a cohort study validated by comparison with randomized trials. Br J Clin Pharmacol. 2009 Jan;67(1):99-109. Epub 2008 Nov 5.
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