18 January 2006
Turkey reports 21st patient with H5N1 this month and WHO is creating regional stockpiles of oseltamivir (anti-H5N1 drug) for developing nations. Is Africa next?
The accelerated pace of H5N1-related events continues. Today (18 January), Turkey reported the 21st patient with H5N1 since the outbreak began this month, with the great majority of patients being under 20 years of age, as was seen during the initial outbreak in 2004 in Vietnam and Thailand. Sequencing of one of the initial H5N1 viral isolates from a patient in eastern Turkey showed not only a change in the receptor-binding region of the virus (of uncertain significance) but also a susceptibility to the older anti-flu drug “amantadine”.
In addition, today the World Health Organization (WHO) Director-General Dr. LEE Jong-wook spoke in Beijing at the opening of the International Pledging Conference on Avian and Human Pandemic Influenza conference. He noted several positive steps that have occurred in Turkey this month. For example, “within one day, patient samples were collected, shipped, and received in the United Kingdom. The results were available within 24 hours. One hundred thousand treatment courses of oseltamivir were delivered within one day after the first cases were confirmed. A team of WHO experts traveled to Turkey within one day of the request by the Government”. He also noted that next week the WHO Executive Board will discuss immediate voluntary compliance with the revised International Health Regulations (IHR), prior to their currently planned June 2007 (17 months from now) “official entry into force”. These new regulations could then apply immediately if flu pandemic began before June 2007.
Yesterday, 17 January, the WHO announced that the company (Roche) that makes oseltamivir (“Tamiflu”) would donate 2 million additional treatment doses (10 tablets per course) to the WHO for a total pledge of 5 million treatment courses. The initial 3 million treatment courses, pledged last August, are to be stored centrally (near Geneva) for a “rapid response stockpile” to be used only at the onset of a pandemic. In contrast, the new 2 million treatment courses (20 million tablets) will be stored in different regions of the world and thus “will allow WHO to rapidly dispatch antiviral medicines to developing countries in greatest need, in the interests of affected nations and global public health” (according to the WHO on their website posting January 17th). In other words, these new regional stockpiles can be deployed now, and then reach patients ideally within hours after new human outbreaks are detected.
The new regional stockpiles of oseltamivir, the only oral drug to treat most patients with H5N1 influenza virus infection, is very welcome news indeed. How decentralized these stockpiles are remains to be seen, but hopefully they will provide rapid access to treatment for patients not only in Asia and parts of Europe, but also in the Middle East and Africa. In my opinion, H5N1 avian influenza will most likely reach Africa and the Middle East, as well as other nations in Asia, before the next pandemic of influenza occurs. Thus, strengthened preparedness for H5N1 avian influenza in Africa and the Middle East is needed now.
The WHO and US-initiated International Partnership on Avian and Pandemic Influenza should take action now to help better prepare nations in Africa where migratory birds that could carry the H5N1 virus are known to travel, including but not limited to nations along the Nile River such as Egypt, Sudan, and Ethiopia.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterterrorism and Emerging Diseases
ER One Institutes, Washington Hospital Center
Co-Director, Master of Science Program in Biohazardous Threat Agents and Emerging Infectious Diseases, Georgetown University School of Medicine, Washington, DC