More about hypervirulent avian influenza: Is the world now better prepared?
Christophersen, Olav Albert
- Publisher: Microbial Ecology in Health and Disease
Microbial Ecology in Health and Disease
(issn: 1651-2235, eissn: 1651-2235)
The World Health Organization (WHO) no longer regards the Spanish flu pandemic as a worst case scenario as the basis for contingency planning, as to how to meet a possible pandemic with hypervirulent H5N1 influenza. The worldwide fatality rate among confirmed cases has increased from 43% in 2005 to 69% in 2006, while in Indonesia it was 82% in 2006. What the world now needs to be prepared for is a pandemic with something that is equally as transmissible as ordinary influenza virus, but which may have a case fatality rate of 80% or more, if not treated with therapeutic methods much better than those available today (i.e. treatment methods that have not been sufficient to hinder the average case fatality rate from climbing to as much as 82% in Indonesia in 2006). Not only are current treatment methods not efficacious enough, but the situation is also very far from satisfactory as regards vaccine development and production which means that the world must still be considered to be almost totally unprepared, if a pandemic with hypervirulent H5N1 influenza should start tomorrow. A very detailed description of new experimental work is given to make it possible to understand better some of the main elements of the attack strategy used by the enemy so that this ‘military intelligence’ information can be used as the basis for a hopefully more rational strategy of defense. The enemy neutralizes a system used for very early detection of invasion with RNA viruses, leading to total or partial immobilization of associated early response defensive weapon systems. The proposed defense strategy comprises two elements: 1) keeping the patient alive until rescue forces (i.e. a good adaptive immune response) can arrive, and 2) making it possible for the rescue forces to arrive as soon as possible. Some tactical principles and weapons that may be used for defense purposes are also proposed, partially on the basis of animal experiments with both lethal influenza and other highly lethal viruses. A main challenge is to reduce pulmonary inflammation causing alveolar edema without simultaneously hindering the development of a good adaptive immune response. Several practical suggestions are given as to how this possibly might be done. However, it is imperative that the suggested new defense strategy (or therapeutic strategy) should be tested as soon as possible both in experimentally infected animals and in spontaneously occurring human cases of hypervirulent H5N1 influenza.