H5N1

US: An economic cure for pandemics

Via The New York Times, a May 4 article: An Economic Cure for Pandemics. Excerpt:

Protection against communicable diseases is a core example of a public good, as is basic scientific research, which can yield new ideas that may be spread at very low additional cost. 

(In contrast, Medicare, which is publicly financed, has some elements of a public good, but any particular expenditure tends to benefit an individual receiving treatment, rather than being spread over a number of beneficiaries.) 

One obvious step forward would be to exempt biomedical research from cuts of the current federal budget sequestration. Research and development grants are a way to pay potential innovators up front — an important move, as an innovator can’t always charge high-enough prices for the value of its remedies when they’re actually needed. 

If a pandemic became a major issue in the United States, demand for remedies would surge far beyond the level associated with a typical seasonal flu outbreak, and permitting high prices would be unpopular — and perhaps unfair. The threat of contagion also makes it crucial to spread the net of protection as widely as possible, which again suggests low prices. 

Yet it is crucial to have some reward system in place for medical innovators. Well in advance of a pandemic, research needs to be done, and vaccine capacity and drug distribution facilities need to be built up. In the H.I.V./AIDS crisis, for instance, the United States was caught flat-footed — and an appropriate response has taken decades, in part because we were not prepared. 

Without government financing for such public goods, the capacity wouldn’t be there if a new pandemic produced a surge in demand. This would amount to an institutional failure.

Zhong Nanshan on the efficacy of Tamiflu in fighting H7N9

Via a Chinese website, kaiwind.com, a May 3 Google translated Xinhua report: Zhong Nanshan: the incidence of avian influenza within 5 days using Tamiflu can reduce severe. Excerpt:

Guangdong Province, the prevention and control of H7N9 avian influenza team leader Zhong Nanshan, human infection with the H7N9 avian influenza within 5 days of onset Tamiflu can significantly reduce severe. 　　

Guangdong Province, 2 emergency meeting of the province of human infection of H7N9 avian influenza prevention and control of the Group of Experts on the second working meeting, Zhong Nanshan, pointed out that the current clinical studies have shown that the incidence within 5 days of Tamiflu and other neuraminidase inhibitors will significantly reduce into the probability of severe, early diagnosis, early treatment, early use of antiviral drugs is to reduce the severe cases and the key to reducing mortality. 

In the present circumstances, especially in patients with influenza patients with a history of poultry exposure early use of Tamiflu and other neuraminidase inhibitors, the use of corticosteroids is not recommended. In addition, shortness of breath patients into severe symptoms, clinicians to be vigilant and timely identification and found severe cases, severe cases should be immediately transferred to conditionally designated hospital to treat the.

Potential new drug found in the treatment of severe influenza

Via Digital Journal: Potential new drug found in the treatment of severe influenza. Excerpt:

As the H7N9 bird flu virus continues to spread through China, scientists at the University of Maryland School of Medicine have reported the discovery of a new drug to aid in the treatment of severe influenza infection. 

Scientists operating out of the University of Maryland School of Medicine may have uncovered a breakthrough drug in the treatment of the most dangerous and deadly influenza infections. 

The discovery of the novel treatment was reported first in the journal Nature and picked up by Science Daily and demonstrates how the drug, known as Eritoran, functions in mice. In the studies, mice were given a lethal dose of influenza virus and were shown to have fully recovered after Eritoran as administered. 

Aside from being able to reverse what would otherwise be a deadly outcome, Eritoran was shown to work for up to six days after the initial exposure to the influenza virus. Current anti-viral drugs are effective only within two days of initial infection, and most patients are not seen by doctors in time for anti-viral treatments to be viable. 

Seasonal influenza kills between 250,000 and 500,000 people worldwide annually. 

The drug's promise comes amid the backdrop of a deadly new bird flu strain emerging out of China. The H7N9 virus has claimed 27 lives in China, and experts believe it will emerge around the world. 

"We are at the start of a very long haul with H7N9," Professor Angus Nicoll from the European Centre for Disease Prevention and Control (ECDC) said, according to a Reuters report on the possibility of the virus making its way to Europe. 

It is unclear whether or not Eritoran could be effective against coronaviruses.

Branswell: Researchers devise drug cocktail for coronavirus

Via The Edmonton Journal, Helen Branswell of The Canadian Press writes: Researchers devise drug cocktail for coronavirus. Excerpt:

When a new disease emerges, scientists and physicians hope something that's already in the medicine cabinet can be used to treat it. 

A new study suggests for the novel coronavirus, that may be the case. 

Scientists from the U.S. National Institute of Allergy and Infectious Diseases are reporting that a combination of two existing drugs may be useful in treating the new virus, which has emerged from countries in the Middle East. 

The cocktail is made up of a generic antiviral drug called ribavirin and interferon alpha 2b, a synthetic version of a protein made by the human immune system. 

The work is preliminary; the drug cocktail was tested in two types of monkey kidney cells, not in live animals or people. 

But virologist Vincent Munster, one of the authors, says testing in macaque monkeys is already underway and a scientific paper spelling out the results should follow this one shortly. 

These initial results are published in the journal Scientific Reports.

Beer yeast turned into cheap malaria drug in Gates-funded study

Via The Star: Beer yeast turned into cheap malaria drug in Gates-funded study. Excerpt:

Baker’s yeast, commonly used to make beer and bread, can be engineered to produce a key ingredient for malaria drugs, according to researchers who say the method offers a new way to boost needed supplies. 

Anti-malarial medications save millions of lives, yet the supply of the sweet wormwood tree, the source of the most effective treatment, artemisinin, can fluctuate year to year, creating shortages. The study published Wednesday by the journal Nature, and funded by the Seattle-based Bill & Melinda Gates Foundation, describes how the new process boosts production of artemisinic acid by almost 16 times the amount of previous approaches. 

“Prior to this, nobody had been able to get a high level production of artemisinin,” Chris Paddon, a study author, said in an interview. “This is a big genetic engineering breakthrough.” 

Paddon, principal scientist for Amyris Inc., an Emeryville, Calif.-based renewable chemicals and fuels company, said the intellectual property rights for the process described in the paper have been donated for nonprofit use in order to boost production. 

The process resulted in 25 grams of commercially usable artemisinic acid concentration per litre, compared with previous methods that led to 1.6 grams per litre. Artemisinic acid is then converted into the drug artemisinin, which is combined with other anti-malarial treatments to ensure the parasites that cause the disease are cleared. 

Sanofi, the Paris-based maker of Lantus insulin, will start using this method beginning tomorrow to produce semi-synthetic artemisinin, Paddon said. 

Malaria kills a child in Africa every minute, according to the Geneva-based World Health Organization. The disease is spread through mosquitoes infected with the Plasmodium parasite, which multiply in the human liver, attacking red blood cells. It strikes about 216 million people each year and kills about 655,000.

H7N9: Hong Kong well stocked with antiviral drugs

Via the Hong Kong government website, a near-textbook quality crisis communication: HK well stocked with antiviral drugs. The authorities don't play down the threat, they catalogue their resources, and they convey the impression that they are not messing around. Excerpt:

The Hospital Authority is well prepared to fight any local H7N9 outbreak, with a stock of 18 million doses of Tamiflu and other medicine.   

This was the message from its Chief Executive Dr Leung Pak-yin today, briefing the media on the authority’s preparedness for any avian influenza outbreak in Hong Kong.   

The authority has adopted an early identification, testing and isolation strategy in fighting the H7N9 virus.   

Dr Leung said they plan to curb any spread of the virus by isolating infected patients and their close contacts.   

Chief Infection Control Officer Dr Dominic Tsang said patients in emergency wards will be isolated once clinical symptoms are found and risk assessments made. Medical staff with protective gear will notify the management and take patient specimens to the Public Health Laboratory Services Branch and the hospital laboratory for testing.   

In recent weeks many suspected H7N9 cases have been ruled out after four hours, he said, adding the authority will continue to conduct swift tests.   

Authority Director (Cluster Services) Dr Cheung Wai-lun said if there is an outbreak of the disease, the authority will reduce non-emergency and appointment services to alleviate the pressure on emergency, medical, and paediatrics wards.   

More outreach teams will be sent to elderly centres to reduce hospital admissions by their residents, and designated clinics will be assigned for fever patients.   

The authority has 5,300 doctors and 21,800 nurses, he said, adding it can deploy more manpower by recruiting retired and part-time medical staff.

Health agencies around the world should be watching China (especially Hong Kong) and taking copious notes. All this will be on the final exam, whether the exam is on H7N9 or some other threat.

US: Drug may be major advance against malaria

Via ScienceBlog.com: Drug may be major advance against malaria. Excerpt:

Scientists at Oregon Health & Science University and the Portland VA Medical Center have developed a drug that may represent one of the world’s best hopes for treating and preventing malaria — a disease that kills more than one million people each year. 

The scientists have described the drug, and its effectiveness against mice infected with malaria, in the March 20 issue of Science Translational Medicine, an interdisciplinary journal of the American Association for the Advancement of Science. 

The drug — called ELQ-300 — “is an exciting compound as it ticks a number of boxes necessary in a next-generation antimalarial,” said Dr. Timothy Wells, the chief scientific officer for Medicines for Malaria Venture, a Swiss non-profit that is leading the scientific fight against malaria and that helped fund the research leading to ELQ-300. 

“It has potential to become part of a combination therapy that could cure patients, prevent infection and block the transmission of malaria — all at low-doses — which means fewer and smaller pills for patients, at a lower cost. Provided a formulation can be developed, ELQ-300 holds great promise to become a tool to help shrink the malaria map.”

Zambia: Dying on a prayer

Via Think Africa Press.com: Dying on a Prayer: Preachers tell Zambians to Stop Taking ARVs. Excerpt:

Over the past few years, Zambia, which has one of the heaviest HIV/AIDS burdens in world, has managed to reduce its HIV/AIDS rate and make promising progress in the areas of diagnosis, treatment and care. But while there have been some heartening national advances in combating HIV/AIDS in Zambia, a worrying trend has been developing in the southern town of Choma. 

Over the past year, there has been an increase in the number of people with HIV/AIDS who have stopped taking their medication there. Health workers in the area cite the growing presence of ‘prophets’ as the main reason behind this. Some preachers in the area have been claiming to be able to heal HIV/AIDS through prayer and holy water, and been urging congregants to prove their faith by abandoning their prescribed drugs. Only then will God heal them, they are told. 

The perceived power of prayer 

Christianity is a huge part of many Zambians’ lives and the Christian church is a very powerful institution in the country. In recent years, Pentecostalism in particular has exploded on the continent, and with it the teaching of the so-called ‘prosperity gospel’ – also called the ‘health-and-wealth gospel’ or the ‘faith gospel’ – which claims faith and donations will be rewarded by God here on earth. The idea is that God wants to bless his followers, and that these blessings need only be ‘unlocked’ through prayer and demonstrations of faith, which often entail large monetary offerings to the church. 

An off-shoot of this thinking is the idea that those who pray for healing must also prove that they trust in God’s power by rejecting medical aid. Congregants are sometimes asked to go as far as to burn their medication. 

Many preachers also style themselves as prophets anointed by God, thus removing the possibility for criticism from their congregation; any doubt or complaint against him would, by this line of thinking, be a doubt or complaint against God himself. Furthermore, given that the literacy rate is low in the area, pastors are often the only source of Christian teaching. 

It is important to note, however, that not all Choma’s pastors preach the same message. On a recent visit, I witnessed how the leader of one local church now makes an unusual announcement every Sunday. Before he opens the Bible, the preacher declares that he has an announcement to add, and that this is the most serious of them all: “There is not, and has never been, a cure for AIDS”, he says. 

The church goes quiet as he continues: “If you are HIV positive, you can take medication called ARVs…Some people claim to have found the cure for AIDS and they want to sell it to you. It is not true. If you are HIV positive, take ARVs.” 

But for opportunists, the combination of low literacy and high potential for profit has made the church an attractive option – contributing to a trend that can be seen in a number of countries across Africa. Paul Gifford notes that Africa’s economic situation “has made of the church a road to status and professional or economic advancement”, while Reverend Timothy Njoya claims that “over 90% of the clergy in Kenya today have no call at all”. “They come to the ministry because they could not have achieved a better career [elsewhere]”, he says. 

Television in Africa has much to do with the growth of the prosperity gospel. ‘God-channels’ are numerous and widely watched, since they are often one of the few options available. They feature regular sermons on giving and receiving ten-fold, and the performance of healing miracles and exorcisms. 

The preachers on these channels – TB Joshua of Nigeria being a prominent example – are often seen as celebrities in Zambia, attracting followers because of their fame, money and influence. The desire among some clergy to emulate them is one reason for the emphasis in many churches on healing, and especially on healing AIDS, since this is considered highly impressive.

US: Stockpiling a smallpox drug

Via The New York Times: U.S. Stockpiles Smallpox Drug in Case of Bioterror Attack. Excerpt from a bizarre report:

The United States government is buying enough of a new smallpox medicine to treat two million people in the event of a bioterrorism attack, and took delivery of the first shipment of it last week. But the purchase has set off a debate about the lucrative contract, with some experts saying the government is buying too much of the drug at too high a price. 

A small company, Siga Technologies, developed the drug in recent years. Whether the $463 million order is a boondoggle or a bargain depends on which expert is talking. The deal will transform the finances of Siga, which is controlled by Ronald O. Perelman, a billionaire financier, philanthropist and takeover specialist. 

Smallpox was eradicated by 1980, and the only known remaining virus is in government laboratories in the United States and Russia. But there have long been rumors of renegade stocks that could be sprayed in airports or sports stadiums. Experts say the virus could also be re-engineered into existence in a sophisticated genetics lab. 

As part of its efforts to prepare for a possible bioterrorism attack, the government is paying more than $200 for each course of treatment. 

Siga argues that the price is a fair return on years of investment. And Robin Robinson, director of the Biomedical Advanced Research and Development Authority, part of the Department of Health and Human Services, the overseer of the contract for the drug, Arestvyr, defended the size of the order and the price paid. He said that two million doses was the amount analysts predicted would be needed to contain a smallpox outbreak in a large city and that the whole country would require 12 million, along with vaccines. 

The price, he said, was arrived at through federal purchasing guidelines and was “fair and reasonable” compared with the price of other commercial antiviral drugs, which he said ranged from $108 to $7,364. 

But when stockpiling a smallpox drug was first proposed in 2001 after the Sept. 11 and anthrax attacks, it was expected to cost only $5 to $10 per course, said Dr. Donald A. Henderson, who led a government advisory panel on biodefense in the wake of those attacks. Dr. Henderson was a leader in the eradication of smallpox in the 1960s and is now at the Center for Biosecurity at the University of Pittsburgh Medical Center. 

Dr. Richard H. Ebright, a bioweapons expert at Rutgers University, said there was little need for so much Arestvyr since the country has raised its stockpile of smallpox vaccine to 300 million doses now, up from only 15 million in 2001. 

“Is it appropriate to stockpile it? Absolutely,” he said. “Is it appropriate to stockpile two million doses? Absolutely not. Twenty thousand seems like the right number.” 

Vaccines are normally given before an infection to prevent a disease, while antivirals like Arestvyr are given after virus infections, to treat them. Smallpox has such a long incubation period that the vaccine can prevent disease even if it is given as late as three days after infection. Arestvyr may also prevent infection if given early enough, but that has not been proven. 

Dr. Eric A. Rose, the president of Siga and a vice president of Mr. Perelman’s holding company, MacAndrews & Forbes, acknowledged that the drug cost little to make, but said the price being charged for a patented drug was a bargain compared with AIDS antiretrovirals that cost $20,000 a year and cancer drugs that cost more than $100,000 a year.

Leishmaniasis drug fails a fifth of patients

Via Nature News & Comment: Leishmaniasis drug fails a fifth of patients. Excerpt:

One in five people treated for a serious form of leishmaniasis in Nepal relapse after a year. The finding, published in Clinical Infectious Diseases last month, is “an alarming signal” for campaigns to eliminate the neglected disease, say researchers. 

Leishmaniasis, which is caused by the parasitic microorganism Leishmania donovani and spread by female sandflies (Phlebotomus argentipes), is endemic in 88 countries, of which 72 are developing, according to the World Health Organization (WHO). 

The disease causes skin ulcers, swelling of spleen and liver, and erosion of the mucous linings of the nose, mouth and throat, and can be fatal if left untreated. Nine out of ten cases of the most severe form, visceral leishmaniasis, also known as kala-azar, arise in Bangladesh, Brazil, India, Nepal or Sudan. 

The orally administered drug miltefosine emerged as the treatment of choice a decade ago, taking over from injections of the highly toxic, antimony-based drug sodium stibogluconate, which had started showing failure rates of 65% in India’s northern state of Bihar. 

But reports are now emerging of miltefosine failure, which scientists worry will narrow down the pipeline of drugs available for treatment. 

Relapse rate 

In the latest study, a team of researchers from Belgium, Nepal and the Netherlands identified 187 cases of visceral leishmaniasis in Nepal, of whom 120 were treated with miltefosine. Six months after treatment with miltefosine, 10% of cases had relapsed; after a year, that had doubled to 20%. 

All patients responded well to treatment at first, but cure rates dropped from 82.5% six months after treatment to 73.3% after 12 months. Relapse was most common in children under 12 years old. 

The cause of the relapses is unknown: they were not attributable to fresh infections; to co-infection with HIV, which reduces the host’s immunity; to low drug quality; to poor adherence to the treatment regime; or to drug resistance in the parasite.