On Tamiflu and bird flu

In his article, The overuse of Tamiflu in treating avian flu (The Jakarta Post, Dec. 3), Iwan Darmansjah questions the wisdom of stockpiling Tamiflu, generic name oseltamivir. This is a question many people have asked, first because an influenza pandemic is not an ordinary flu and second because of the 140 cases (all in Asia) of H5N1 infection confirmed by WHO, a very small number were treated with oseltamivir and the clinical benefits remain unknown.

The writer also questions the efficacy of Tamiflu in influenza A and B infections, and the safety of Tamiflu. Two large data sets presented in September at the second European Influenza Conference in Malta (www.eswi.org) address unequivocally these questions.

A large U.S. study of more than 176,000 patients showed that oseltamivir significantly reduced the risk of pneumonia by 32 percent and of death by 91 percent. Additionally, in Canadian patients with laboratory-confirmed influenza (A or B) requiring hospital admission, oseltamivir reduced the risk of death by 68 percent.

Elsewhere, a recent large-scale study examined the effectiveness of oseltamivir in protecting family members who had come in contact with a person infected with flu: oseltamivir protected about 80 percent of contacts from flu infection.

Regarding the reported 12 deaths in Japanese children treated with Tamiflu, the FDA Advisory Committee affirmed on Nov. 27 (surely after the writer submitted his article) the safety of Tamiflu in children. This was followed on Dec. 2 by the confirmation of the Japanese Pediatric Society, which established no links between the deaths and Tamiflu.

It was also reported that of the 24.5 million people in Japan who have used Tamiflu since 2000, 11.6 million (47 percent) were children. The death rate under Tamiflu (1/1000,000) was lower than the rate of mortality in children infected with influenza (2/1000,000).

Given its beneficial effects on the treatment and prevention of influenza, the prevention of complications and hospitalizations, and on overall patient mortality, WHO experts and others around the world have decided there is definite wisdom in stockpiling oseltamivir as part of governmental pandemic preparedness plans.

In Asia and in Indonesia the plan should also focus on better monitoring of backyard farm hygiene and the large live-bird markets, which are probably behind all the infection cases so far.

Back to the medical side, Iwan Darmansjah mentioned rightfully that half of the deaths in the case of an avian flu pandemic would be due to Streptococcus pneumonia bacteria, the most common variety causing bacterial pneumonia and for which a vaccine exists.

He talked about the antibiotherapy aspect of the management but what about vaccination? With the threat of avian flu growing, another debate is open: how wise would it be to recommend pneumococcal vaccination? If envisageable, priority of use must be established and availability secured.

What do Indonesian experts think? The question is perhaps worth a local study.

AIT-ALLAH MEJRI
Jakarta