A Simple Precaution
Indonesia is far from the only country that failed to contain the bird flu virus. For example, the highly pathogenic strain of H5N1 just made its reappearance in Qinghai, China (see Blog 10), just as it did last year in Xiniang Province.[1] In Russia, by April of this year, H5N1 had already killed more than a million birds, not even counting the culls.[2]
But what I keep reading about the situation in Indonesia is a lot more uncomfortable. Here is one example. It took a while to sink in, and I had to read it again:
"Any chance of containment was absolutely hopeless," says Andrew Jeremijenko, who until March was head of influenza surveillance at the US Naval Medical Research Unit 2 in Jakarta. "If this was a test to see whether Indonesia could contain a virus, then they just failed miserably." (Butler 2006)[3]
Now what?
What should I tell my family and friends? If there is hard evidence that H5N1 or any other bird flu virus has become easily transmitted among us, it is not public. It looks to me like some health officials are trying to find ways of playing down the implications of clusters of human-to-human transmission, especially in Indonesia and Turkey.[4]
Perhaps the time has come to make some first preparations, just in case. As they say, if you hear the thunder it may be too late to start building the ark. What would be useful, even if H5N1 never became a more serious threat? I think this is a good time to get vaccinated against pneumonia -- the bacterial kind. Here is why.
Influenza’s one-two punch
Influenza can cause damage as a viral disease and as a Trojan Horse for secondary bacterial infections. When it infects the respiratory tract, the flu virus causes direct damage to the cells that line the breathing tubes. These cells protect us by moving microbes and other particles upward to be swallowed. They also play a part in the immune response. Farther down in the lungs, the virus can cause viral pneumonia.
When the viral infection severely damages the respiratory tract lining, it no longer protects against the bacteria that are around. The result is bacterial infection and, often, bacterial pneumonia. Streptococcus pneumoniae, sometimes called pneumococcus, is the most feared of the pneumonia-causing bacteria.
A quick look back
During the 1918 H1N1 influenza pandemic, more persons appear to have died from the secondary bacterial pneumonia than from the initial viral infection.[5]
One reason the influenza pandemics of 1957 and 1968 were mild by comparison was due to good control of bacterial pneumonia with antibiotics. Erythromycin, various penicillins, and other antibiotics were effective against the major bacterial culprits that, at the time, had not yet developed resistance. Since those days, overuse of antibiotics has contributed to widespread bacterial resistance, and a flawed economic model of medical care has contributed to insufficient deployment of new antibiotics.[6],[7] Even if they were still fully effective, antibiotics may be hard to get in case of a pandemic.
Get vaccinated
At this time, no effective vaccine against H5N1 is in sight, but there is an effective vaccine against the majority of secondary bacterial infections.
“There are 2 vaccines for preventing pneumococcal infections. One, called Prevnar and manufactured by Wyeth Vaccines, is for children. Prevnar is a 7-valent (containing antigens from 7 serotypes of S. pneumoniae bacteria) pneumococcal conjugate, vaccine. The other, called Pneumovax and manufactured by Merck, is a 23-valent vaccine for older children (older than 2 years) and adults. Neither vaccine is a substitute for influenza vaccine, but each can help prevent some common complications of influenza.”
(CDC, 2004)[8]
If you are over 65, are engaged in patient care, or belong to other high-risk groups, you should have been vaccinated already anyway. It’s fast, easy, has to be done only once about every five years, and affords protection against pneumococcus pneumonia regardless of virus type.[9] All in our family are vaccinated or have made appointments to do so.
[3] Butler D.
Pandemic 'dry run' is cause for concern. Indonesian bird-flu cluster rings alarm bells.
Nature 1 June 2006;441(7093):554-555.
doi:10.1038/441554a; Published online 31 May 2006
[4] http://www.recombinomics.com/News/06050601/H5N1_Phase_Evolution.html
[6] E.g., Clarke T.
Drug companies snub antibiotics as pipeline threatens to run dry.
Nature. 2003 Sep 18;425(6955):225.
[7] Infectious Diseases Society of America
Bad Bugs, No Drugs. White Paper.
Alexandria, VA: July 2004
http://www.idsociety.org/pa/IDSA_Paper4_final_web.pdf
[8] CDC, Centers for Disease Control and Prevention.
Questions and Answers from the November 22, 2004 Audio Conference 2004-2005 Guidelines:
Influenza Vaccine/Antivirals for Persons Living with HIV/AIDS.
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