September 22, 2005
2 Studies Find Flu Treatments Fall Far Short
By ELISABETH ROSENTHAL


International Herald Tribune


ROME, Sept. 21 - Just as governments around the world are stockpiling
millions of doses of flu vaccine and antiviral drugs in anticipation of a
potential influenza pandemic, two new surprising research papers to be
published Thursday have found that such treatments are far less effective
than previously thought.


"The studies published today reinforce the shortcomings of our efforts to
control influenza," wrote Dr. Guan Yi, a virologist at the University of
Hong Kong, in an editorial that accompanied the papers. The two studies
were published early online by The Lancet, the London-based medical
publication, because of their important implications for the coming flu
season.


In one paper, international researchers analyzed all the data from patient
studies on the flu vaccine performed worldwide in the last 37 years and
discovered that vaccines showed at best a "modest" ability to prevent
influenza or its complications in elderly people.


"The runaway 100 percent effectiveness that's touted by proponents was
nowhere to be seen," said Tom Jefferson, a researcher in Rome with the
Cochrane Vaccine Fields project, an international consortium of scientists
who perform systematic reviews of research data.


"There is a wild overestimation of the impact of these vaccines in the
community," he said. "In the case of a pandemic, we are unsure from the
data whether these vaccines would work on the elderly."


In the second paper, researchers from the Centers for Disease Control and
Prevention in Atlanta found that influenza viruses, particularly those from
the dreaded bird flu strain, had developed high rates of resistance to the
only class of cheap antiviral drugs available - drugs mainly used to treat
flu once patients have caught it. These resistance rates have increased
rapidly since 2003, particularly in Asia.


"We were alarmed to find such a dramatic increase in drug resistance in
circulating human influenza viruses in recent years," said Dr. Rick Bright
of the disease control centers. "Our report has broad implications for
agencies and governments planning to stockpile these drugs for epidemic and
pandemic strains of influenza."


Before 2000, almost no virus was resistant to the drug Amantadine. By 2004,
15 percent of influenza A viruses collected in South Korea, 70 percent in
Hong Kong and 74 percent in China were impervious. During the first six
months of 2005, 15 percent of the influenza A viruses in the United States
were resistant, up from 2 percent the year before. All human cases of the
bird flu A(H5N1) strain - which is still extremely rare in humans - have
been resistant, the researchers said.


The immediate implications of these finding are most ominous for the
developing world, because wealthier nations have been stockpiling newer and
vastly more expensive antiviral medicines, like Tamiflu, which are
effective against the disease but still under patent.


Even so, the research is alarming because it demonstrates how quickly and
unexpectedly flu viruses can become impervious to medicines once they are
put into common use, as they would be in the case of a pandemic. Also, at
their best, antiviral medicines do not cure influenza. They reduce
transmission of the disease and lessen somewhat the symptoms and
complications in people already infected, including the high rate of
associated pneumonias.


Called for comment, Dick Thompson, a spokesman for the World Health
Organization, said that the group could neither support nor deny the
findings of the analysis of vaccine studies at this point, noting only that
some specialists criticized the researchers for "not including some
important past studies" in their sample.


But the problem of resistance "is a finding that is being discussed widely
within the flu world and will bear careful monitoring," he said, noting
that he was not aware of any country in the developing world that had been
able to stockpile the newer drugs.


Anticipating a possible flu pandemic caused by a variant of the bird flu
virus - which belongs to the influenza A group - countries have been
aggressively buying antiviral medicines and contracting to purchase a flu
vaccine against that strain, even though it is still under development. The
United States has ordered $100 million worth of vaccine, and Italy $43
million worth, for example.


The current bird flu virus does not spread easily - if at all - from human
to human, and so has little potential to become a worldwide human scourge.
But the World Health Organization has warned that it could acquire that
potential through a couple of common biological processes, and that
countries should prepare for a possible wave of serious influenza.


The fact that the vaccine study showed that inoculations have had only a
modest effect in the elderly is particularly worrisome, because this is a
group that tends to suffer high rates of complications and deaths from the
disease and vaccination is the standard practice. In people over 65, the
vaccines "are apparently ineffective" in the prevention of influenza,
pneumonia and hospital admissions, although they did reduce deaths from
pneumonia a bit, by "up to 30 percent," the study says.


"What you see is that marketing rules the response to influenza, and
scientific evidence comes fourth or fifth," Dr. Jefferson said. "Vaccines
may have a role, but they appear to have a modest effect. The best strategy
to prevent the illness is to wash your hands."


In terms of antiviral drugs, 30 countries have placed huge orders for
Tamiflu, the most popular newer more expensive antiviral medicine, said
Martina Rupp, a spokesman for Roche, the Swiss company that makes it. The
Dutch Health Ministry has ordered five million doses, enough to treat
one-third of the population. Britain has ordered supplies to treat 15
million.


Researchers speculate that one reason resistance rates to the older,
cheaper antiviral drugs jumped so much starting in 2000 - and skyrocketed
after 2002 - is that doctors in Asia started prescribing the drugs far more
widely after the advent of bird flu in 1997 and sudden acute respiratory
syndrome, or SARS, in 2002.


No Mutation Seen in Fatal Virus


The New York Times


HONG KONG, Sept. 21 - A woman's death from avian influenza in Jakarta, the
capital of Indonesia, has caused alarm there, but genetic tests here on
virus samples from the woman showed on Wednesday that the virus had not
mutated in ways likely to make it more of a threat to people.


The virus in the woman, who died early this month, "seems like a virus that
has gone directly from birds," rather than from person to person, said Dr.
Georg Petersen, the World Health Organization representative in Jakarta.
The deaths of two girls with flulike symptoms this week in Jakarta have fed
public concern there. But Dr. Petersen said that laboratory tests would be
needed to conclude whether the girls had been infected with the A(H5N1)
virus.

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