Posts Tagged H5N1

Bless You (Again)!

This time we are talking about flu, not cute primates with upturned noses. It’s that time of year again, at least in the southern hemisphere, and there are a few simple precautions you can take to help you through.

As previously mentioned in Vaccination 101 there are lots of different flu viruses that, unlike leopards, do change their spots regularly. This makes it impossible to control all of them with a single vaccine. However, each year the World Health Organisation recommends which three flu strains to stick in the current year’s vaccine, and I certainly recommend getting it. It stops you feeling miserable and may even save your life. If work places displayed any common sense they would vaccinate all their employees for free. The savings in sick leave taken would surely compensate for the cost of the vaccination. But you don’t have to be vaccinated if you don’t want to. Your plane won’t be shot down, you won’t be rounded up and forcibly jabbed and you won’t be stopped from travelling and infecting other people.

The trouble with flu viruses is they get around, fast. It is estimated that, if a new flu strain emerged in Europe, it would hit Australia in four to eight weeks, despite our relative isolation from the rest of the world. While the H1N1 flu turned out to be relatively benign (only killing 0.03% of the people it infected) it did hit 70 million people. The H5N1 flu has killed 60% of its victims but has only infected 600 people (http://www.who.int/influenza/human_animal_interface/EN_GIP_20120607CumulativeNumberH5N1cases.pdf). Because it targets receptors in the lower respiratory tract it is harder to spread but more deadly. Unfortunately it would not take many mutations for H5N1 to start spreading like H1N1. Then we’ll see who thinks vaccination is a waste of time.

Apart from receiving a needle the best form of prevention has been discussed previously. Boring though it sounds, here it is: wash your hands, with soap, regularly. Flu viruses survive in the air for up to an hour, on hands for five minutes, on soft cushions for 20 minutes and on hard surfaces for 24 hours. So, every time your flu sufferer touches anything they will also be applying a liberal dose of virus. When you then touch the same surface, or shake that hand, you also receive a helping of virus. Alternatively use alcohol wipes on your hands. Monk wasn’t nearly as crazy as he was made out to be in his TV series.

Depending on your level of paranoia you could also avoid crowded areas such as public transport, classrooms and offices, as these all have lots of possibly contagious people and minimal air movement. Stay away from small children and keep at least two metres between yourself and your infected colleagues.

Unfortunately the time when people are most contagious and shedding the most virus is a day or two before they develop symptoms. They will remain contagious for about another four days after symptoms start, so do yourselves, and the rest of the world, a favour. Stay home and finish that book, win that Playstation Stanley Cup or watch all those episodes of Get Smart you always promised yourself you would. And, in the words of Sergeant Phil Esterhaus from Hillstreet Blues, “Let’s be careful out there.”

Dr. F. Bunny

And if you’re still not convinced see: http://www.sbs.com.au/news/article/1667868/Deadly-flu-season-hits-Australia-hard

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Vaccination 101

“Just one question, what is Immobilo and how does it work?”

“Actually that’s two questions.”

“He’s bright. I like that.” (Get Smart, Episode 8, Our Man in Leotards).

So, what is vaccination, and how does it work?

All life forms, from humans down to earthworms, have some kind of internal defence system used to ward off unwanted invaders such as bacteria, viruses, fungi and parasites. In vertebrates these are the white blood cells. There are two main types. One group produces antibodies, while the others wander around killing trespassers directly. In most cases antibodies don’t kill invaders by themselves but incapacitate them in such a way that the killer cells have an easier time of it.

The thing about the antibody producing cells is that they have memories, quite long memories in some cases. If the same enemy pops up subsequent to an earlier defeat they move into action much faster and produce antibodies earlier than before. In this way they get on top of the infection before the infection gets on top of them. It is this memory that is exploited by vaccination.

All invaders have proteins on their surface that the white blood cells recognise as being foreign and not belonging in the body. When they detect these proteins they swing into action. There are two types of vaccines. Killed vaccines contain the proteins but the agent is dead. Modified live vaccines also contain the proteins but the agent is still alive. It has been rendered incapable of causing disease but, because it is alive, provokes a more vigorous longer lasting response

Once the vaccine is administered antibodies are produced and the white blood cell memory kicks in. In that way if they encounter the real disease in the future they swing into action earlier and prevent disease from happening. This is why vaccines work to prevent disease but are not of much use once the disease has taken hold.

Unfortunately white blood cell memory is very specific and will only recognise one particular version of a disease causing agent. That is why we need a different flu vaccine each year. Flu viruses are covered in one of 16 different proteins called haemagglutinins (H) in combination with one of nine different proteins called neuraminidases (N), hence H1N1 (swine flu) or H5N1 (bird flu). Unfortunately the cells that recognise H1N1 ignore H5N1 or any of the other flu combinations. The discovery of a protein present on all flu viruses may finally lead to the development of a universal flu vaccine that will protect against all flu viruses. The same holds for cold viruses. Every time we catch cold we are infected with a brand new virus the body has not seen before. When our family catches cold and we avoid it this may be because we have already contracted that virus at a prior point.

Unfortunately vaccines are not 100% effective, and can occasionally cause side effects. As Monty Python’s “Life of Brian” tells us, “We’re all individuals”. Consequently we all react differently, with some people achieving better protection than others. Getting vaccinated while we are sick will decrease its effectiveness because our white blood cells are otherwise occupied. People with compromised immune systems will also not respond well to vaccination. Unfortunately some people have adverse reactions to vaccines. These are rare and usually mild but can occasionally be quite severe. It doesn’t happen often and, as vaccine technology improves, will continue to become rarer, but that is no consolation for the people who are affected.

It is these sorts of events that help fuel a lot of the anti-vaccine hysteria. Presumably these people are genuinely concerned about the negative effects of vaccination and whether or not they actually work.

It has been said that improved hygiene and nutrition are responsible for the decline in diseases, not vaccination. Like any war victory comes from employing multiple strategies. Vaccination is just one of those strategies. When used in concert with better food and sanitation it can play a major role in decreasing the incidence of diseases, but it can also be very effective on its own. As an example, in the early 1990s there were about four million chicken pox cases annually in the US, a country with good hygiene and nutrition. After the introduction of a chicken pox vaccine in 1995 the incidence of chicken pox had dropped by 85% by 2004 (http://www.historyofvaccines.org/content/articles/top-20-questions-about-vaccination). Confusingly anti-vaccinationists trot out figures showing an increase in the incidence of certain diseases post-vaccination. When confronted with contradicting tables of figures it is very difficult to make an informed decision. Who do you believe?

Unfortunately the anti-vaccinationists haven’t done themselves any favours by supporting various bizarre conspiracy theories. One of my favourites revolves around the plane crash in Smolensk that killed the Polish president two years ago. Apparently the plane was shot down because Poland was the only country not to buy H1N1 vaccines (http://www.bing.com/videos/search?q=polish+plane+crash+conspiracy&docid=4880706944237728&mid=42F5E38BA6E30AFB445942F5E38BA6E30AFB4459&view=detail&FORM=VIRE4). Even though smallpox has been officially eradicated from the world we are still getting reports that it is alive and well and causing disease in India (http://vactruth.com/2011/03/28/news-of-smallpox-outbreak-in-india-raises-fear/). The exciting thing is that, with the assistance of vaccination, a second disease has now been made extinct. Rinderpest, a scourge of cattle farmers for thousands of years, is no more. Perhaps the greatest blow to anti-vaccination credibility was the manipulation of evidence by a physician in an attempt to show that vaccination caused autism. His paper was withdrawn from the medical journal in which it was published and he was struck off the Medical Register for falsifying results (http://en.wikipedia.org/wiki/MMR_vaccine_controversy).

I will admit to being biased, because I am medically trained, but I have seen first-hand evidence that vaccinated animals mount an immune response and resist disease challenge. Given the rather dubious information put out by the anti-vaccinationists I prefer to be on the side supported by credible evidence and will continue to vaccinate myself, my family and the animals in my care. Not to do so would be irresponsible in my view.

Dr. F. Bunny

How disease occurs is an interesting and extremely complex subject. For pandemics to take off multiple factors need to take place. To better understand these interactions I can recommend a board game called “Pandemic”. Uniquely, players battle not against each other but against four diseases raging across the globe. They must find a cure and wipe out the diseases before they extinguish humanity’s light. Conversely, if you prefer your medicine on the dark-side there is an interesting phone app called “Plague”. In this game you take the part of the disease. You must mutate your organism to enhance its transmission, resistance and lethality. Both games provide insight into how difficult it is for a disease outbreak to start and, once started, how hard it can be to stop it in its tracks.

 

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