On Tamiflu and bird flu

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