Don't give up on advanced human bird flu cases -expert
Source: Reuters
(Adds comments on quarantine, paragraphs 9-12) By Tan Ee Lyn SINGAPORE, Dec 12 (Reuters) - An expert who treated numerous bird flu victims in Vietnam has urged doctors not to lose hope with patients who are admitted late to hospital as there is still a good chance that they can survive. The medical community believes anti-virals such as Tamiflu are only effective in fighting the H5N1 bird flu virus if they are administered within 48 hours of the onset of symptoms. But virologist Menno de Jong said this assumption might only hold true for human flu viruses. H5N1 behaves differently from human flu viruses and has been observed to be replicating in its human hosts even on the seventh or eighth day, he said. "In my experience, there is a clear suggestion that there was still virus replication (when we made) a late start in treatment. In four of my patients, there was very rapid clearance of the virus from the throat and all 4 survived," he told Reuters on the sidelines of a conference on avian flu and other infectious diseases in Singapore. "If you can decrease the viral load (with drugs), you can have a good outcome. Even those who are treated late had good results," he told the conference. Anti-virals such as Tamiflu, also known as oseltamivir, were designed to counter common human flu viruses and are thought to be superfluous after 48 hours, when the average person's immune system would have begun fighting the flu attack and blocking the flu virus from replicating. But de Jong, head of virology at the Hospital for Tropical Diseases in Ho Chi Minh City in Vietnam, said Tamiflu could still be used to fight bird flu many days after the onset of symptoms because the avian virus would still be multiplying. The H5N1 virus remains a scourge for birds but experts fear it can cause a pandemic and kill millions of people if it learns to pass efficiently between humans. Many countries and even big companies have begun stockpiling Tamiflu and worked out contingency plans to tackle a pandemic. These include stockpiling food and provisions, building more hospital isolation units and quarantine arrangements. However, an expert at the conference cautioned that the benefits of isolation and quarantine were limited in the case of bird flu, which replicates very aggressively. "Once you detect clinical symptoms (eg. fever), you've already got peak viremia (when virus load in the body is at a peak) for a time and you're shedding virus and infecting people without knowing it," Roy Anderson of the department of infectious disease epidemiology at Imperial College in London told Reuters. "So quarantine and isolation just wouldn't work for influenza A. Everything happens too quickly." H5N1 belongs to the influenza A group of flu viruses. De Jong agreed with many experts that an early start to treatment was still best -- something easier said than done in places such as Vietnam, Indonesia and China. Most of the 258 people who have been infected with H5N1 worldwide since late 2003 lived in rural areas. Of those infected, 154 died because healthcare was unavailable, too far away or the infection was too far advanced by the time they were admitted to hospital. "You have to get very effective treatment as early as possible because you will prevent direct viral damage (to lung and other tissues)," de Jong said. De Jong, who treated 17 H5N1 patients in Vietnam in 2004 and 2005, of whom 12 died, said diagnostic tools were absolutely crucial in rural areas. "If the community has a small lab or regional hospital, probably these patients would have been diagnosed earlier and treatment would have been given early," he said. (Editing by David Fogarty; World Desk Singapore +65 6870 3813; email: el.tan@reuters.com)
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