Spanish flu cases in 1918-1920 suggests transfusions might help in pandemic

[Guest guest]

John J. Treanor, MD, says,

 

" Although many logistical hurdles exist, controlled clinical studies

done now will probably pay a considerable dividend when the pandemic

begins, " Treanor says. " We can, should, and must explore these issues

about serotherapy now, in advance of the pandemic. "

 

 

Transfusions---hmmm-- sure could speed things up, but no thanks...

UncBob

 

 

 

 

 

Analysis of Spanish flu cases in 1918-1920 suggests transfusions

might help in bird flu pandemic

 

Transfusions with blood products taken from people who had recovered

from Spanish influenza may have reduced risk for death and improved

symptoms of hospitalized patients who contracted Spanish influenza

complicated by pneumonia. Early treatment was superior to later

treatment.

 

Researchers studied medical literature published shortly after the

1918 Spanish flu pandemic and found eight relevant studies.

 

Similar transfusions might be useful in treating victims of a bird

flu pandemic, especially in light of the problems with existing

vaccines and treatments, say authors of the Spanish flu study. They

say that a single recovering bird-flu patient could donate " a weekly

volume of plasma sufficient to treat multiple patients with H5N1

influenza. "

 

The article " Convalescent Blood Products for Spanish Influenza

Pneumonia: A Future H5N1 Treatment? " will be published in the Oct.

17, 2006, print edition of Annals of Internal Medicine and is

available at http://www.annals.org/cgi/content/full/0000605-

<http://www.annals.org/cgi/content/full/0000605->

200610170-00139v1. An accompanying editorial is available at

http://www.annals.org/cgi/content/full/0000605-200610170-00140v1.

<http://www.annals.org/cgi/content/full/0000605-200610170-00140v1.>

 

Spanish flu (H1N1) and bird flu (H5N1) are subtypes of influenza A

virus. The Spanish flu pandemic in 1918 to 1920 killed between 20

million and 100 million people worldwide.

 

The World Health Organization (WHO) says that a bird-flu pandemic is

a serious possibility today. As of August 24, 2006, 241 cases of

confirmed avian flu A/(H5N1) have been reported to WHO, resulting in

141 deaths.

 

WHO says H5N1 virus is widespread in birds, particularly poultry

which seems to be the source of the Asian infections. Widespread

prevalence of the virus in birds increases the chance of

transmission from bird to human. When human cases become

transmissible from human to human, a flu epidemic begins. If it is

virulent, it will spread fast. If there are no effective antiviral

drugs available, it will spread faster.

 

WHO says the world is not prepared to handle a bird-flu pandemic.

Vaccines to prevent the particular flu strain of the pandemic will

take time to manufacture and distribute after the first outbreaks.

 

Current recommended treatment is hospitalization and treatment with

an antiviral drug, but studies of bird flu outbreaks in Asia have

found that 30 percent to 80 percent of patients treated this way

have died.

 

And WHO says the manufacturer of the most currently used drug

(oseltamavir) does not have capacity to fill existing orders

immediately. During an epidemic, antiviral agents, antibiotics and

other medications may be rationed or not available to the most

severely ill patients.

 

The WHO says that most developing countries will have no access to

vaccines and antiviral drugs throughout a pandemic.

 

So the authors of the Spanish flu study believe blood product

therapy has promising implications for the current situation.

 

The study has important limitations: the number of studies was

small, the number of patients was small, and assignment to treatment

or controls was not random, blinded or placebo-controlled; dosages

and definitions were not standardized; disruptions caused by World

War I probably affected medical personnel available to record data

as well as exacerbated the spread of the disease; and wartime

censorship may have affected publication of existing research. (The

name " Spanish flu " came from the fact that Spain was not a partner

in World War I and its press was freer to report details of the

pandemic than press in combatant countries who did not want reveal

information about deaths and sickness to enemies.)

 

The authors call for convening a body of experts " to consider H5N1

plasma therapy and to make recommendations for a research strategy

and possibly treatment guidelines if therapy is required before the

research is completed. "

 

John J. Treanor, MD, says, in an accompanying editorial, that the

idea that " passive serotherapy " might be useful in treating H5N1

virus infection has precedence in other viral diseases such as

chicken pox, rabies and hepatitis A and B.

 

Treanor, of the infectious disease division of the University of

Rochester Medical Center, identifies concerns with logistics, such

as the ability to obtain, classify and prepare the blood materials

in the midst of an outbreak, and missing information, such as

whether people who recover from H5N1 infection actually develop high

levels of an antibody or what is the most effective level of

antibody or appropriate dose of plasma needed to achieve success in

infected patients.

 

" Although many logistical hurdles exist, controlled clinical studies

done now will probably pay a considerable dividend when the pandemic

begins, " Treanor says. " We can, should, and must explore these

issues about serotherapy now, in advance of the pandemic. "

 

http://www.eurekalert.org/pub_releases/2006-08/acop-aos082806.php

<http://www.eurekalert.org/pub_releases/2006-08/acop-aos082806.php>