US Emergency Declarations Raise Pandemic Concerns Recombinomics...

US Emergency Declarations Raise Pandemic Concerns
Recombinomics Commentary 22:43
October 29, 2009


New York Gov. David Paterson has declared a state of emergency because of the rise in swine flu cases.

The executive order means that far more health care professionals - including dentists - will be permitted to administer vaccines with only brief training. The order is needed to suspend provisions of state law.

New York officials said the number of vaccine doses is also being increased. The federal government is ramping up availability of the vaccine, allowing the state to order twice as many doses as a week ago, a trend that's expected to continue.

The above comments describe the declaration of a state of emergency in New York, which follows President Barack Obama's declaration for the entire country. Although these announcements are said to be anticipatory and an attempt to streamline treatment, evidence is mounting that these steps are in response to a rapidly accelerating spread of H1N1, leading to school closings, hospitalizations, and deaths, which are straining the health care system.

Nationally, the declaration is designed to reduce red tape associated with treatment and to increase drugs under regulatory review, such as Premavir, which is currently in clinical trials as an IV treatment for influenza. However, like Tamiflu, H274Y seriously reduces the effectiveness of the drug, increasing concerns that widespread H274Y will seriously impact antiviral treatment, leading to more hospitalizations and deaths.

The latest CDC weekly report describes two patients that developed H274Y resistance in the absence of documented Tamiflu treatment. One patient is under investigation, while no linkage was established for anther. These two patients are in addition to transmission in North Carolina and Hong Kong which appear to be unrelated to Tamiflu treatment in the contact. This evolutionarily fit pandemic H1N1 parallels development of resistance in seasonal H1N1.

This week there was a dramatic increase in deaths in the United States and Canada, and this trend is being reported across the northern hemisphere.

The explosion in cases, hospitalizations, and deaths are outpacing the vaccine distribution, due in part to a realization that viral yields are lower than forecast. Delivery numbers projected for mid-October have now been pushed back to mid-November, and some countries are unconvinced that one shot will provide protection, so two shots are planned, raising concerns of more delays in the vaccine roll-out, as well as a delay in the date of protection.

Meanwhile, the CDC has reported a low reactor isolate, indicating the virus is evolving away from the vaccine. The initial CDC report was not detailed, and there was no mention of low reactor sequences in the latest report, raising concerns that such isolates are increasing. Similar, sequences from Germany and Austria were just released by Mill Hill, which were also characterized as low reactors. However, the associated HA sequences has a deletion leading to a truncated HA of 189 amino acids, so the viablilty of these isolates is unclear.

However, the rapid spread of H1N1 and the associated strain on health delivery systems is cause for concern, and may have precipitated the recent emergency declarations.