Flu pandemics

The last few decades have witnessed the spread of new viruses, most notably HIV/AIDS and, to a much lesser extent, SAKS. The prospect of a bird flu pandemic looms on the horizon. In the event of a pandemic, developed countries may possess only sufficient capacity to produce vaccines for domestic use. To ensure an adequate domestic supply, governments may restrict exports ofvaccines by private manufacturers. Restrictions on export of vaccines would in turn create shortages in other countries, particularly those without ample domestic vaccine capacity. This threat, in spite of the empirical evidence indicating that private enterprises are relatively efficient on average (Lichtenberg, Chapter 7), may justify sponsoring public enterprises for vaccine manufacturing in countries with small domestic markets. 

There is evidence that the health and financial externalities of vaccination even extend to the unborn. Relative to other birth cohorts, those in utero during the 1918 flu pandemic demonstrate accelerated adult mortality, increased rates of physical disabihty, reduced educational attainment, lower income, and lower socioeconomic status (Almond 2003). This effect has not been incorporated into cost-effectiveness analyses. 

Centers for Disease Control and Prevention. (2006a). Avian influenza Current situation. Retrieved March 27, 2007 from http //www.cdc.gOv/flu/avian/outbreaks/current.htm animals Centers for Disease Control and Prevention. (2006b). Key facts about avian influenza (bird flu) and avian influenza A (H5N1) virus. Retrieved March 27, 2007 from http //www.cdc. gov/flu/avian/gen-info/facts.htm Centers for Disease Control and Prevention. (2006c). Key facts about pandemic influenza. Retrieved March 27, 2007 from http //www.cdc.gov/flu/pandemic/keyfacts.htm Centers for Disease Control and Prevention. (2006d). Multistate outbreak of mumps—United States, January 1-May 2, 2006. Morbidity Mortality Weekly Report. Retrieved March 27, 2007 from http //www.cdc.gov/mmwr/preview/mmwrhtml/ mm5520a4.htm... 

Historically, influenza has probably always afflicted mankind. Similar viruses affect domestic animals and various epidemics of catarrhal fever were associated with epidemics of horse colds. The close association between humans and horses in previous centuries may have allowed a vertical transmission of influenza from horse to man. However, there is convincing evidence that a similar transmission can occur from the pig (swine flu) to man, and the flu pandemic of 1918-1919 may have started in this way, although an avian origin is probably more likely. Evidence for the transmission of influenza from the pig to other mammals was first obtained by Richard Shope in 1932. He managed to infect various animals with swabs taken from nasal secretion of pigs suffering from swine flu. His proposition, that the pig could be a kind of safe haven (reservoir) for the virus between human epidemics and pandemics, is widely accepted. 

Pandemic spread would presumably bring about 60-80 million deaths worldwide. According to US Homeland Security Council s estimates, 90 million people could be infected in the US alone in case a bird flu pandemic breaks out, of which 45 million will require medical care, 10 million will require hospital admission and 2 million people could die [25]. 

A British government report warns that The health service will be plunged into chaos if Britain is struck by a bird flu pandemic. Faced with a possible 4.5 million victims, demand for hospital beds would outstrip supply and doctors might have to deny treatment to the sick and elderly to save younger, fitter patients [26]. 

Notably, a recent outbreak of mumps (June 2006, Kansas)—a viral, often epidemic disease—is expected to help health officials prepare for an act of bioterrorism or a flu pandemic [34], The Kansas Health and Environment Department had found 761 confirmed or suspected cases of mumps around the state. In dealing with the outbreak, the department for the first time used its incident command system to spread information to agencies around the state. The same system would be used in the event of a natural or intentional disease outbreak. 

Neergaard L (2005). U.S. working on plan for flu pandemic. Associated Press, Washington D.C., October 8. 

It wasn t the bubonic plague, typhoid, smallpox, or AIDS. It was the flu pandemic of 1918. 

World War I and Aftermath Explosives, Chemical Warfere, and the Flu Pandemic... 

This feeble arsenal of drugs, essentially devoid of antibiotics, was no match for the catastrophe that followed on the heels of World War I a flu pandemic (sometimes called the Spanish flu ), arguably the greatest natural catastrophe of the 20th century. It ravaged a world weakened by war with millions of soldiers in transit. The flu killed more than 20 million, while medical science had to humbly recommend rest, lots of fluid, and aspirin as the disease ran its course between 1918 and 1920. 

In the early 21st century there is grave concern over the possibility of a flu pandemic as widespread and dangerous as the flu pandemic that followed World War I. Bird flu, similar to the flu that crossed over into a contagious human flu, recently appeared in Southeast Asia and has, by 2006, been discovered throughout Asia, the Middle East, and Europe. More than 200 humans have died from infection by diseased (domesticated) birds. The flu has not yet evolved into one capable of passing the infection between humans, but the concern is that it is only a matter of time before this happens. Antibiotics did not exist in 1918 to treat the secondary bacterial infections that are associated with flu. The situation... 

The drug oseltamivir (Tamiflu), developed by the companies Gilead and Roche, is a neuraminidase inhibitor. Like the HIV proteases described above, it has enough structural similarity with the enzyme s substrate to bind to the enzyme, but once bound it blocks the enzyme s activity. No-one knows how much oseltamivir might be needed if ever a flu pandemic took hold, but clearly the safest course of action is to stockpile the compound in readiness for such an event. The first manufacturing route to oseltamivir made use of the natural product (-)-quinic acid as a naturally derived starting material. Quinic acid is found in coffee beans, but is not available in sufficient quantities for widespread use. 

The most severe among a list of multifactorial reasons [21] which have induced a medicines shortage, were Quality or availability problems related to active ingredients or to production processes or equipment (e.g. heparin contamination [22] and propofol case [23]) Demand spikes (e.g. oseltamivir following flu pandemic scenarios [24])... 

Vimses are causative agents of many human, animal, and plant diseases. AIDS, SARS, and avian flu are viral diseases, which are nearly daily covered by the headlines in papers and by the news items on radio and television. In 1917—1919 a Spanish flu pandemic killed over 50 million people. The vims involved was most probably a mutation of some avian vims. The Avian flu pandemic (caused by the H5N1 variant) was, by comparison very small, as it has caused only about 150 fatalities. The great crmcem for virologists and epidemiologists is the extremely high mortality rate (over 50 %) of infections with this vims. In the form of vaccines, vimses are inactivated or attenuated so as to prevent diseases in susceptible populations. 

The Russian flu of 1889-1890 was the first of the flu pandemics. It killed about 1 million people. The Spanish flu that broke out in 1918-1919 killed over 50 million people worldwide. The Asian flu of 1956-1958 killed about 2 million people before a vaccine was developed in 1957 to contain it. The Hong Kong flu of 1968-1969—so called because it affected 15% of the population of Hong Kong—had a much lower death rate—only about 750,(X)0 people died—because people who had had the Asian flu had some immunity. Because this was the last worldwide pandemic, public health officials worry that another may occur soon. 

This assessment was made based on historical analogies (the 1918 pandemic and recent influenza outbreaks) and available attempts to predict potential consequences of an avian flu pandemic. See Appendix A. 

Relatively safe. The toxic dose for adults is about 10-30 g, which is many times greater than the dosage in a standard tablet of 300 mg. Both salicylic acid and aspirin can breach the stomach s protective lining, causing bleeding, but aspirin causes much less stomach irritation. Back at the time of the 1918-1919 influenza ( Spanish flu ) pandemic, aspirin was widely used as a medication. 

The Spanish flu pandemic of 1917 to 1919 has been called by some in the pre-HIV age as "the last great plague." The middle estimate of the worldwide death toll was approximately twenty million lives lost to the illness in that era. Perhaps as many as 500 million people had the illness commonly known as "grippe." Although other plagues had higher death rates, in terms of sheer numbers, the Spanish flu pandemic is credited as one of the worst, if not the worst In the United Stales, one person in eveiy four [approximately twenty million cases] became ill with the flu. 

An infected individual would typically show the symptoms of flu, perhaps improve slightly, and then worsen dramatically as pneumonia set in. The Ute Native Americans in Utah were nearly decimated, and some families saw three-quarters or more of their members die as a result There had been flu pandemics before, but none as deadly as this instance. 

Diversity oriented synthesis, which aims to produce a wealth of structural complexity, may prove to be an effective tools of exploring effective routes toward the link between chemistry and medicine.The key synthesis objective is to generate a collection of structurally complex and diverse compounds capable of modulating any biological pathway or process of interest.->1 In this lecture we will present our efforts in the discovery of Neuraminidase inhibitors, a possible drug candidates for Flu pandemics. Furthermore, the enantioselective synthesis of skeletally diverse compounds inspired by natural analogues and related biologically active compounds for many purposes will be presented. 

Arora, R., Chawla, R., Marwah, R., Arora, P., Sharma, R. K., Kaushik, V., Goel, R., Kaur, A., Silambarasan, M., Tripathi, R. P. Bhardwaj, J. R. (2011). Potential of complementary and alternative medicine in preventive mamagement of novel HlNl flu (Swine flu) pandemic thwarting potential disasters in the bud. EvidBased. Complement Altemat. Med. 1-16. 

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