25 October 2008

H5N1 influenza v. bacterial infections

when i was an undergrad, i wrote the culminating paper for my history major on the 1918 spanish influenza pandemic, and how it and the first world war shaped the formation of the united states public health infrastructure. it was pretty fun to research, and i have a special place in my heart for the 1918 flu after poring over heartbreaking newspaper headlines on microfiche for months.

so, it was with great delight that i learned of the lead editorial in the october journal of infectious diseases. the piece is a commentary on an article in the same issue, in which researchers re-examined the causes of death during the pandemic. the research put a spotlight on pneumonic infectious in flu victims - not novel diagnoses, but a reality long overlooked. morens et. al. found that a large majority of deaths were due to opportunistic pneumonia - in fact, only 4% of influenza victims died without a bacterial infection. indeed, many were on the verge of fighting off the flu when they contracted the bacteria. the attack of an opportunistic bacteria brings to mind the more recent experience of an HIV patient - once under seige, the human body is at great risk from other eager bugs.

this has very real implications for current global health priorities. since H5N1 reared its ugly head with an intention to stay in 2003, pandemic priorities have been focused on preventing the virus from crossing over into a highly human-friendly strain. the findings of the article suggest that we should be exerting a lot more effort into preparing for a massive need of antibiotics. it is rather likely that the outbreaks of 1957 and 1968 were so much less likely because of the availability of antibiotics. given recent breaks in our stockpile system, there is a great need to focus on this area.

i'm made much more hopeful by this view on pandemic influenza. chalk up another "thanks" to dr. koch.

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