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August 29, 2005

Donation of 3 million treatments of oseltamivir to WHO will help early response to an emerging influenza pandemic


Today, the World Health Organization (WHO) welcomes Roche's donation of three million treatment courses of the antiviral oseltamivir to a WHO international antiviral stockpile. WHO would use this stockpile to respond quickly to an emerging influenza pandemic.
(I-Newswire) - As part of its work to prepare for, detect and mitigate the impact of an influenza pandemic, WHO is creating an international stockpile of antiviral drugs for rapid response at the start of a pandemic. In an agreement signed today, Roche has committed to providing three million treatment courses ( 30 million capsules ) of oseltamivir ( Tamiflu ) to WHO, which would be dispatched to people in greatest need at the site of an emerging influenza pandemic. Oseltamivir could help to reduce illness and death, and when combined with other measures, could potentially contain an emerging pandemic virus or slow its national and international spread. If it reaches the site of an outbreak quickly, an antiviral stockpile could especially help people in poorer countries. "Right now, many wealthy countries are creating their own stockpiles of antivirals. However poor countries simply cannot afford to do this. If a flu pandemic were to emerge in a poor country for example, these drugs could be flown quickly to the centre of a potential pandemic," said Dr LEE Jong-wook, Director-General of WHO, during an influenza news conference today in Geneva. "We urge other countries to help us build up the international stockpile." The WHO stockpile is meant to complement other measures of international and national preparedness, including any national stockpiles. WHO is carefully monitoring the ongoing avian influenza outbreaks in parts of Asia, Russia and Kazakhstan. WHO warns that these and other outbreaks could evolve into a global influenza pandemic if the avian influenza virus changes into a form which could transmit easily between people. The longer the current avian influenza strain ( H5N1 ) continues to circulate, the greater the possibility that people will be infected with H5N1, and therefore the greater the risk that the virus will adapt to people and trigger a pandemic. Should a pandemic strain emerge, slowing its spread will be vital as this could buy valuable time to produce vaccines against the virus and introduce other emergency measures. Antivirals, used intensively in an area where a pandemic is emerging, combined with other measures such as quarantine and isolation, could help to delay spread. Roche has agreed to reserve three million treatment courses ( 30 million capsules ) for up to five years. The first one million treatment courses ( 10 million capsules ) will be ready early next year, with the remaining two million ( 20 million capsules ) ready before mid-2006. The timing and severity of a flu pandemic is uncertain, but experts predict a pandemic will occur. Therefore WHO continues to urge countries to develop preparedness plans. Planning must include international cooperation between wealthy and poor countries to reduce the opportunity for national and international spread, and to reduce the death, illness and social disruption which have been a feature of all previous influenza pandemics. Overview of the present situationOutbreaks of highly pathogenic H5N1 avian influenza in poultry are now known to have begun in parts of South-east Asia in mid-2003. These outbreaks have been historically unprecedented in their geographical size and the number of birds affected. So far, around 150 million birds have died during the outbreaks or been destroyed as part of the containment effort. While some of the initially affected countries have successfully contained the disease in poultry, the virus is now considered entrenched in many parts of Viet Nam and Indonesia and in some parts of Cambodia, China, Thailand, and possibly also Laos. To date, human cases have been confirmed in four countries: Viet Nam, Thailand, Cambodia, and Indonesia. During early August 2005, highly pathogenic H5N1 avian influenza was confirmed in poultry in parts of Siberia, Russia and in adjacent parts of Kazakhstan. Both countries have reported deaths of migratory birds in the vicinity of poultry outbreaks. These events mark the first detection of highly pathogenic H5N1 avian influenza in the two countries. Last week, avian influenza of the H5 subtype was confirmed in dead migratory birds in Mongolia. No human cases have been reported in conjunction with any of these newer outbreaks. Assessment of the pandemic threatWHO considers the present risk of a pandemic great, but unpredictable in terms of its timing and severity. All conditions for the start of a pandemic have been met save one: changes in the virus that would make it contagious among humans, thus allowing easy and sustainable human-to-human transmission. The likelihood that this will happen is a matter of opportunity and probability. The expanding geographical range of the virus increases opportunities for human cases to occur and these, in turn, increase opportunities for the virus to improve its transmissibility. The fact that the virus is now endemic in poultry populations in several countries increases the probability that this will occur. In response to the pandemic threat, WHO has recommended a series of strategic actions to be undertaken by affected and at-risk countries, by WHO, and by the international community. These actions are phase-wise according to escalating levels of risk, and pertain to the present pre-pandemic situation, the first emergence of a contagious virus, and the declaration of a pandemic and subsequent international spread. In the present situation, recommended strategic actions aim to reduce opportunities for human infection ( by controlling the outbreaks in poultry and avoiding contact between humans and infected birds ), and to strengthen the early warning system. Experts anticipate that a virus with improved transmissibility will announce itself in the form of clusters of human cases, closely related in time and space. Surveillance and reporting systems in all countries experiencing outbreaks in birds need to be strong enough to detect such clusters of human cases. Internal stockpile of antiviral drugsIf the first signs of improved transmissibility are picked up quickly, there is a chance that rapid intervention, involving mass prophylactic administration of antiviral drugs, might contain the pandemic at its source or at least delay international spread, gaining time to intensify preparedness. An international stockpile of antiviral drugs is needed for this purpose. The prospect of halting a pandemic at its source or delaying its international spread is attractive, but untested, as no attempt has ever been made to alter the natural course of a pandemic. Successful intervention requires that at least 5 conditions be met: -- The first viruses that show an ability to sustain transmission among humans will not yet be highly contagious. -- The emergence of such viruses will be limited to a small geographical area. -- The first clusters of human cases caused by the virus will be rapidly detected and reported. -- Antiviral drugs will be rapidly mobilized from the stockpile, made available to the affected population, and administered to sufficiently large numbers of people. -- Movement of people in and out of the area will be effectively restricted. Given the unpredictable nature of influenza viruses, it is impossible to know in advance if the first two conditions will be borne out in reality when a pandemic virus emerges. The remaining conditions require excellent surveillance and logistics capacity in the initially affected area, combined with an ability to enforce movement restrictions. While mass intervention with antiviral drugs has no guarantee of success, it nonetheless needs to be undertaken as it represents one of the few preventive options for an event with predictably severe consequences for every country in the world. As drugs in the stockpile can also be used for treatment purposes, having such a stockpile provides the best guarantee that populations affected at the start of a pandemic and thus in greatest need will have drugs available for treatment. Once the virus has become fully contagious, its spread to all parts of the world is considered unstoppable. However, some non-medical interventions, such as quarantine, movement restrictions, and the banning of public gatherings, could potentially delay introduction of the virus to new areas. Vaccines, if available early enough and in sufficient quantities, can reduce the high morbidity and mortality typically experienced during influenza pandemics. http://www.who.int

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Posted by dymaxion at August 29, 2005 01:59 PM

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