Swine Flu in Indonesia : Unfolding the Facts — (Part 5)
Posted on October 7th, 2009 in Global Focus Contagious_Disease, Pandemic, Treatment
Drug-resistant strain virus, a new threat
CDC reported that they found a drug-resistant strain virus of swine flu. It happened in July 2009 at a camp in western North Carolina, where two teenage girls – cabin mates – were diagnosed with the same drug-resistant strain of swine flu. The virus may have spread from one girl to the other, or it’s possible that the girls got it from another camper. It’s also possible that they each developed a resistant strain independently, but that’s unlikely, Moore added.
Both girls had been given Tamiflu before they got sick – as a preventive measure – after an outbreak of swine flu at the camp. They were among more than 600 campers and camp staff treated. There will be more Tamiflu resistant cases. Regardless this virus has mutated or not, Tamiflu itself tend to make the virus become resistant of it. It’s not a good news at all.
While antivirals will certainly be an important component of pandemic control, we should not rely on them too much. Instead, a comprehensive approach based on good surveillance and rapid response with first-line control mechanisms such as antivirals and behavior changes such as social distancing measures, as well as a concerned effort to rapidly produce a potent vaccine, will be the best answer to an influenza pandemic (Halloran et al, 2008).
Now, what could happen in Indonesia, a tropical country, harbour of many influenza viruses, in which these viruses can mutate easily and drugs might be ineffective anymore? If the virus became a resistant strain in North Carolina, what it would be in Indonesia?
H1N1 Vaccine
Face the facts. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.
I wouldn’t refuse using H1N1 vaccine as one of the specific protection, eventhough I don’t see any efficacy result yet. If I’m using this vaccine, I’m not trying to protect myself from H1N1-virus, but at least I don’t want any swine H1N1 virus mutate with H3N2-virus in my body. There’re a few H1N1-confirmed cases in Indonesia who recovered without using H1N1-vaccine.
It’s quite suprising me that using this H1N1 vaccine would turn into a debate. Let’s see here. First there’re two interesting articles about not using H1N1 vaccine in here and here . They issued that swine flu vaccine made them sick and considered the vaccine as a cause of Guilain-Barre Syndrome (GBS). And the contrarians came from two of the commentators in http://nhsblogdoc.blogspot.com who has very interesting answers. Here they are.
Fiona Wallace said…
Copy of a letter I have just sent to the Guardian:
Dear Sir,
I was deeply disappointed to read the piece by Dr Crippen about the introduction of the swine flu vaccine.
The vaccine is the same as that issued every year as the standard ‘flu jab’; the antigen it contains is specific to H1N1, in the same way that last year’s vaccine contained antigens for the expected viral mutations of last winter. There is no reason to anticipate that it will have any greater problems than any previous flu vaccine. It is sad that a practising GP knows so little about a vaccine that the advice he gives publicly (and presumably in his surgery) is quite simply wrong.
Elsewhere a journalist brings up the American vaccination program of the 1970s and spreads further misinformation; the current flu vaccines cannot under any circumstances give you flu; the antigen they contain is dead. I repeat, dead. GBS (Guillain-Barre Syndrome) is a recognised issue with vaccines, however for there to be a risk the rate has to be higher than the general population rate, and the deaths/disabilities from GBS have to be higher than those from influenza, otherwise the risk : benefit ratio shows that you are better to be vaccinated.
This is shoddy reporting and I expect better, from the Guardian at least. I am an emergency physician with extensive experience in managing acute respiratory conditions and will have the vaccine as soon as it is available in my hospital. My first responsibility is to my patients, to reduce the chance of them being infected by me; my second responsibility is to keep healthy so I can provide a good service. I have looked at all the evidence and can unhesitatingly say that vaccination is the appropriate choice.
I have no links to pharmaceutical companies or other relevant conflicts of interest.
Yours sincerely,
Dr Fiona Wallace MB BS(London) MA(Chich)
John, you have lost another regular reader over this. You are just so wrong I don’t know where to begin. I have antivaxxer nurses working in my department and this article has done incalculable damage to my attempts to protect our vulnerable patients by making sure all staff are vaccinated. The flu vaccine is not perfect – what is? It does, however, seem far more sensible to vaccinate than pick up the pieces after rampant influenza in our ever-growing numbers of vulnerable patients. Would you advise the parents of a child having chemotherapy to avoid vaccination for themselves and the child’s siblings? Do you also advise against the yearly flu vaccination on the same grounds, or do you vaccinate and take the cash incentive?
As a side issue, my hospital only has one ventilator. The fewer people in respiratory failure, the happier I will be.
Lanceloat Gobbo said…
You lost me on this one John. All vaccine carry risks and benefits, usually in a very advantageous ratio to recipients. The infamous swine flu vaccine at Fort Dix bears no more resemblance to this year’s swine flu vaccine than any other flu vaccine, beyond the use of the word ’swine’. And as you well know, flu vaccines are always made in a hurry between the appearance of what looks like the main strain in China and it reaching our parts of the world the following winter. Thus far, thus boring; this vaccine looks like any other flu vaccine. But there are some impressive facts about flu vaccines – I read a paper (I think it was in the CMAJ) indicating that among first time recipients that one flu death is averted for every 300 given, a figure that improves to 1 in 200 for those who have had previous shots and have a repertoire of H and N immunities to give partial immunity to other strains. I suspect no other activity I perform as a rural GP in Canada pays off so well in terms of results. Incidentally last year’s seasonal flu vaccine here had a different H1N1 strain in it, which might account for the fact that the current H1N1 is causing so little trouble here. Now I’m generally a fan and don’t mean any disrespect by arguing with you here, but what difference is there between saying “Flu is usually a mild illness and we don’t need a vaccine” and saying the same thing about measles/chickenpox etc etc? What is a reasonable gamble for the individual might make no sense at a population level, where the low mortality rate translates into a large absolute number in a populous country, involves great costs caring for the sick, and where creating herd immunity is desirable.
So please go on being iconoclastic, but bear with me if I point out that random acts of curmudgeonliness aren’t always justified!
Ok, let’s review what all these experts said.
Patricia Doyle PhD : I believe that the so called Swine Flu virus infected the recruits due to the vaccines they were given.
In my opinion : There’re three answers for that. First, it’s not a swine flu vaccine. Second, it could be a live and weakened vaccine, not a dead pathogenic one. There are 2 kind of vaccines : live but weakened cells, and dead pathogenic cells. Third, the strain of the virus has changed. We’ll find out why there’s NO current vaccine for influenza virus. There’s only a past vaccine.
Dr Crippen : Why has the UK government sent letters to neurologists asking them to be on the alert for neurological complications caused by the immunisation?
In my opinion : I’ve never seen swine flu could make GBS, while I’m quite sure that this virus replicated in respiratory system mostly, not in neurological system. If a neurological symptom occured caused by the immunization, it couldn’t come from the germs, but probably the substances (such as alumunium, formaldehyde, fenol, growth media, or others). It needs more researchs on it.
Dr Fiona Wallace : …the deaths/disabilities from GBS have to be higher than those from influenza, otherwise the risk : benefit ratio shows that you are better to be vaccinated.
In my opinion : Where did this statement come from? How can we compare deaths/disabilities from GBS with Influenza, as the pandemic was influenza, not GBS? Of course, the death rate of influenza will be higher and always be higher than GBS. This’s not a scientifical answer, neither a stastistical one. If we found even one GBS case caused by the influenza vaccine, it’s more than enough to declare the risk. Let’s click here for an interesting case report.
Dr Fiona Wallace : My first responsibility is to my patients, to reduce the chance of them being infected by me
In my opinion : If we, the medical doctors, were being infected by this deadly virus, we should stay at home, not wok in hospital or emergency room. If we really want to take care of the patients, we ensure that our patients wouldn’t get any infection from us because we’re the healthy ones, not the infected ones. If we, the medical doctors, has had the vaccine, that’s because we wanted to reduce the chance being infected by our patients. That’s it.
Lancelot Gobbo : And as you well know, flu vaccines are always made in a hurry between the appearance of what looks like the main strain in China and it reaching our parts of the world the following winter.
In my opinion : Let’s see how hurry this virus can be made. There’s a figure that I took from www.influenza.com. You may be surprised to know how long it takes to make a batch of influenza vaccine. Long before one year’s influenza season is over, work is beginning on vaccine for the next year. It seemed ‘hurry’ not suit for influenza virus-vaccine-making-process. It’s a not a current vaccine. It’s a vaccine from the past.
Now, if the outbreak began in Mexico in April 2009, then which vaccines they used in September 2009? I couldn’t tell, may be neither could you. But picture above might tell us the answer.
Related posts:
- Swine Flu in Indonesia : Unfolding the Facts — (Part 6)
- Swine Flu in Indonesia : Unfolding the Facts — (Part 2)
- Swine Flu : Changed Name Turned Into Debate
- WORLD AIDS DAY, WORLD CONDOMS DAY?
- Penyakit-Penyakit Yang Ditularkan Melalui Hewan (III)
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