Scott McPherson's Web Presence

I have been a vocal advocate for the mass stockpiling of the antiviral inhalant Relenza, or zanamivir, for some time.  The idea of giving first responders pills to take just doesn't seem to be the right way to go.  The idea is to try and prevent influenza in those first responders, and a 45-day course of a pill a day sounded a little excessive.

Relenza is not as effective as Tamiflu when you have the flu, because it is hard to inhale the medicine deep into the lungs, where, for example, H5N1 likes to go.  But a convenient inhaler in a container that can fit into a utility pocket -- NOW we're talking proactive, easily-administered antiviral dosages!

Yesterday's Bloomberg article regarding the effectiveness of a more potent version of Relenza, manufactured by a Japanese company, should help to promote Relenza as a must-have antiviral in everyone's stockpile -- if your stockpile includes preventing bird flu as well as limiting its symptoms.  I can tell you that my antiviral stockpiling has switched from acquiring any more Tamiflu, to acquiring Relenza.  And, of course, the state antiviral programs under the federal deal with Roche mandate a default 80/20 split between Tamiflu and Relenza.  So for those states who elected to participate in the HHS program, 20% of your stockpile includes Relenza.  Get those dosages out quickly to your first responders whenever the pandemic starts.

Longer-Acting Relenza Fights Flu as Well as Tamiflu (Update1)
By Jason Gale

July 31 (Bloomberg) -- Daiichi Sankyo Co.'s longer-acting version of GlaxoSmithKline Plc's flu drug, Relenza, was as effective as a course of Tamiflu, a patient study found.

The safety and efficacy of a single dose of the inhaled medicine was ``statistically indistinguishable'' from a twice-a- day dose of Roche Holding AG's Tamiflu taken for five days, said Melbourne-based Biota Holdings Ltd., which is developing the drug with Japan's Daiichi Sankyo. The study, involving ``several hundred'' patients with seasonal flu, was the second of three stages of human trials usually needed for regulatory approval.

The companies plan to start final-stage tests in Japan, Taiwan, Hong Kong and South Korea by the Northern Hemisphere winter, Biota said in a statement today. If approved, the medicine could provide a new treatment for flu, a disease causing 250,000 to 500,000 deaths worldwide a year. Previous studies also showed the medicine fights the H5N1 version of bird flu, which world health officials say might set off a lethal pandemic.

``If it's successful, then it would be a very useful drug,'' Scott Power, an equities analyst with ABN Amro Morgans Ltd. in Brisbane, Australia, said today by telephone. He rates Biota's shares ``buy.''

Biota gained 2.5 Australian cents, or 3.6 percent, to 72.5 cents on the Australian Stock Exchange. Power expects the shares to reach A$1.30 within the next 12 months.

Shares of Daiichi Sankyo, Japan's third-largest drugmaker, increased 80 yen, or 2.6 percent, to 3,190 yen on the Tokyo Stock Exchange at 11 a.m. local time.

Governments worldwide are stockpiling anti-flu medicines, including Tamiflu and Relenza, to reduce the severity and spread of disease in the event of a pandemic. A treatment that's taken only once, rather than twice a day for five days, would reduce the amount of medicine needed to be kept on hand, Power said.

Daiichi's experimental medicine, known as CS-8958, is in the same class of antiviral as Tamiflu and Relenza, which works by preventing flu viruses from spreading from infected cells.

http://www.bloomberg.com/apps/news?pid=20601101&sid=aDCmbqrVxu3M&refer=japan

I am sure Chinese PR types are absolutely apoplectic with concern over the proMED reports coming out of Wanjiakou Village, Xiaoguan Town, Wensind City, Shandong Province.  Apparently, some sort of hemorrhagic fever has broken out there.

Details are sketchy to say the least, but according to the proMED report's citation, it spread quickly and at least three villagers are dead.  A half-dozen or so are in treatment.  The first death, a man, turned dark purple and began bleeding from his mouth, nostrils, ears and eyes before he died.

Naturally, the villagers are extremely shaken by the experience. 

the person who sent the alert is Dr. Stephen O. Cunnion, the national security health policy director for the Potomac Institute for Policy Studies.  Lest we glodd over that info, proMED reminds us that it was none other than Dr. Cunnion who first sounded the alarm bells to proMED on a curious respiratory disease in 2003 that later became known as SARS.  So Dr. Cunnion is at least battling 1.000 on his disease alert front.

We will see what transpires.  ProMED lists the odds of hantavirus being the culprit at 57%, and Crimean-Congo Hemorrhagic Fever at less than 1%.

Hopefully it is NOT some new and dangerous disease.

As you know all too well, I have not been blogging much on avian flu lately.  there are several reasons, the top three being the relative lack of news on the H5N1 front; the ability of my blogging colleagues to report on these in a timely and professional manner, rendering my posts on the same topics nothing more than redundant; and my focus on my "day job" as CIO for a Florida agency.

And let me assure you I am working on a very long and important series of flublogs. 

But occasionally things happen that just make me so mad, I have to speak out.  And so today, I am calling on the US Navy, the CDC and the WHO to get NAMRU-2 the Hell out of a clearly ungrateful Indonesia and get it to some place that welcomes it.  Like, ironically, Vietnam.  Or Australia, which would probably be easier to get samples to anyway. 

There is little doubt that Indonesia is politically sliding the way of pain-in-the-neck nations such as Iran, North Korea and Venezuela.  Now I know that the United States is a ripe target for ridicule.  We have done things around the world that the average American is not proud of.  But I am sick and tired of America being kicked in the groin by nations that we are trying to help.  From a health perspective, the nation doing most of the kicking these days is Indonesia. 

People have posted replies to my earlier blogs regarding Indonesia, asking me to be patient and to understand that if the US pulls out of any medical support for Indonesia, it will harm the Indonesian people.

Those pleas need to be vectored toward the real source of potential hardship:  The Indonesian government.  They are the ones harming their own people, and the United States cannot and should not be held responsible for what other nations deliberately do to their own people. 

Back to the title of the blog.  It is time to close the doors on NAMRU-2, and to relocate it somewhere else.  It is time to bring closure to this whole sad story.  Put NAMRU where it is appreciated, not condemned by some paranoid schizophrenic regime. 

Speaking of paranoid schizophrenic regimes: Last night, I watched the film The Last King of Scotland, and was mesmerized by the Oscar-winning performance of Forest Whitaker as Idi Amin.  Today, as I write this blog, I am haunted by that film.   How a charismatic person could lead a nation to ruin and mass death is so sad.  And we see several other nations and entire regions of the planet where government madness, fueled by anti-Western sentiment, is destabilizing this planet.  Supari and the Indonesian government overall would be wise to remember that the West wants to help, but its patience is not infinite, nor should it be. 

There was good news contained within the bad news coming from Indonesia this week.  The good news was that Indonesia will, indeed, continue to report bird flu deaths within some sort of usable timeframe.  As you recall, the Health Ministry had decided not to publish bird flu deaths within helpful timeframes but, instead, to roll up the death tolls and announce them on some sort of months-long schedule.

While I am not ready to call this week's announcements a reversal, it is welcome news and hopefully will eventually be proven to be a reversal of a disastrous policy.

The bad news, of course, was the announced new death toll, and in particular the deaths of two women.  The Health Ministry confirmed what we already suspected was an H5N1-related death -- a 16-year-old girl from South Jakarta  -- who was confirmed dead of H5N1 on May 14.  the second death was a 34-year-old woman from Banten province, who was pronounced dead on June 3.

The virus continues to strike lethally at younger persons, and women continue to be especially hard-hit.

The next story also confirms our deepening concern about the status of things in the archipelago nation of 18,000 islands.  A Reuters story of today validates/vindicates our belief that H5N1 is frequently and dangerously diagnosed as something other than flu.  Thus, we can assume rationally that the actual infection rates from H5N1 are many times higher than what has been reported.  Here's the story:

Bird flu mistaken as dengue and typhoid in Indonesia

Fri Jun 20, 2008 2:11pm IST

By Tan Ee Lyn

KUALA LUMPUR (Reuters) - Some cases of human bird flu in Indonesia have been variously misdiagnosed as dengue fever and typhoid, resulting in the late administration of drugs, a leading doctor in the country said on Friday.

Indonesia has had the highest number of human H5N1 cases in the world and while mortality rates are around 60 percent in other places, the figure is highest, or at 81 percent, in Indonesia.

Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Indonesia, told an infectious disease conference in Kuala Lumpur that misdiagnoses and the late administration of drugs were partially responsible for the high mortality rates.

"It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia, typhoid and upper respiratory tract infection because of similar clinical features (symptoms)," Giriputro said.

Indonesia has had 135 confirmed human H5N1 cases from late 2003 to May 2008 and 110 resulted in deaths. The country reported two more confirmed cases this week, but these were not reflected in Giriputro's figures.

Oseltamivir, otherwise known by its brand Tamiflu, is considered the drug of choice against bird flu and Giriputro said fatalities mounted the later the drug was administered.

The survival rate was very high when Tamiflu was given less than 2 days after the onset of symptoms, but that plunged the later the drug was given.

"It's best if given less than 24 or 36 hours after the onset of symptoms," he told Reuters later.

While rapid test kits are now used to diagnose the disease in animals, Giriputro said these tools were much less reliable in people.

"It depends on the viral load (in samples taken from patients)," he said, adding that test results could turn out negative even if the person was infected with H5N1, simply because there was not enough virus in samples taken. (bold mine)

In a bid to reduce the death rate, the Indonesian government has begun distributing Tamiflu to health centers in areas where H5N1 cases have occurred.

"When doctors see influenza-like illnesses and where there is evidence of contact with sick poultry, then they give Tamiflu (without waiting for laboratory results)," Giriputro said.

© Thomson Reuters 2008. All rights reserved. Users may download and print extracts of content from this website for their own personal and non-commercial use only.

http://in.reuters.com/article/health/idINKLR31511520080620?pageNumber=2&virtualBrandChannel=0

Dr. Henry Niman and others have warned for years that the hasty administration of Tamiflu without first taking necessary samples causes false negatives and hinders accurate reporting of human H5N1 cases.  This new report from the Boots On The Ground confirms this in a decisive and final way.  It lessens the viral load and allows H5N1 to "fall under the radar" of reporting.  Likewise, Dr. Giriputro has also declared -- on and for the record -- that quick test kits are unreliable for use as the "last word" on whether or not H5N1 is present in someone.

So what can we deduce from all this? 

First, there are many, many, many more unreported cases of human H5N1 than we see in the press.  This may be a "DUH" to us, but it is important to see this in the global media.  And it is equally important that we are vindicated in that venue as well.

Second, we are unable to get some important viral changes mapped, because these people are getting Tamiflu and testing negative.  that may be good in terms of living, which is always nice, but it does mean that any genetic changes in the virus from these people are going undetected. 

Third, Indonesia is a human incubator of H5N1, and we must continue to monitor the situation there 24/7/365, preferably with the full assistance of the Indonesian government.

Screw it.

I am going to tell it like it is, and never look back.

The Indonesian government's self-inflicted death wish has reached intolerable proportions.  The most recent disclosure from Indonesian Health Minister and Court Jester, Siti Fadillah Supari, means Indonesia has reached the Tipping Point between political recklessness and geopolitical suicide.  Or maybe future homicide.

For those unfamiliar with recent developments:  Indonesia has announced it will no longer report bird flu deaths as they happen.  Instead, they will roll up the data and grace the rest of the world with reports every six months or so, or whenever the muse strikes them, or when a goat is slaughtered and the entrails are spread over the government's fax machines and computers.

This means Iran -- Iran! -- is more transparent than Indonesia.  It means China is more transparent.  It means Hell has frozen over.  It also means that for the rest of us, we will not know that an epidemic has started there until it is probably too late to do anything except batten down the hatches and pray.

It has gotten to the point that an ad hoc union of flu bloggers is trying to take more decisive action to bring someone -- anyone -- in the Indonesian government to his or her senses and stop this Supari woman before she dooms not just her nation, but the entire world, to disease and death.  Supari couldn't be jeopardizing the world's health any worse than if she bottled up a few sick people from Tangerang and flew them to Los Angeles.

So here are a few random ideas.  I appeal to my colleagues to use their resources to see if we can accomplish a few things and to add to this list within their own blogsites. 

1. First, let's have somebody ask John McCain and Barack Obama to sign a joint letter to the Indonesian president, expressing their regret and indignation at the government's policies.  If Indonesia knows that both presidential candidates will not stand for this Tomfoolery, and it is a bipartisan effort, it has to count for something. 
2. Second, let's start having some serious travel advisories about any travel to Indonesia.  The US, Britain, Australia (especially Australia, since Bali is to Australia what Disney World is to America) and other nations can all issue joint travel warnings, discouraging people from any travel to Indonesia.
3. Third, let's contact our local Congressman or -woman and Senator, asking them to write the White House and hammer for decisive action.  It is surprising just how few letters it takes to activate a slumbering Congressperson.
4. Fourth, and also within those letters, let's press for UN action against Indonesia.  A nicely-worded UN resolution should do the trick. 
5. Fifth, pull NAMRU the Hell out of Jakarta and put it where it is wanted.  Someplace like Vietnam or Thailand or South Korea would be just great.
6. Sixth, pressure American-led corporations to cancel all Indonesian conferences, including Bali.  Ask everyone to refuse to attend any multinational or multigovernmental conference that is booked in Bali or Jakarta.
7. Seventh, ask the WHO to begin applying the pandemic threat level to individual nations.  I have frequently called upon the WHO to raise the pandemic threat level from Phase Three to Phase Four.  Let's rethink this and take a Homeland Security approach to things.  As DHS applies the terrorism threat level to sectors such as the aviation sector, let's apply a Phase Four warning to Indonesia.
8. Eighth, let's do everything possible to empower doctors, scientists, researchers, reporters and bloggers to get the real story out of there.  Maybe we need a Bloggers Corps to go into Indonesia and teach bloggers how to post their stories and blogs anonymously and without detection by government censors.
9. Ninth, let's hope we have Boots on the Ground, James Bonds armed with Q-Tips and vials, ready to covertly swab the epithelial cells of suspected bird flu patients, and spirit the samples out of Indonesia via submarine.
10. Tenth, pull all US-bought antivirals out of the country.  Today. Save the Tamiflu for our own people.  After all, if the Indonesian government is willing to play Russian Roulette with a loaded gun regarding the health of the entire world's population, they obviously don't care one whit for the safety of their own people.

I am out of ideas.  Let's hear from you!