Guest:  Dr. Christopher Leroy Maloney, ND

10/6/09 streaming on weru.org

Questions for the show

1.  What is the flu? Signs and Symptoms?

Common cold:  viral respiratory illness.  The idea of being chilled causing the illness.

Flu:  shortened form of influenza.

Influenza:  viral respiratory illness

Fatigue, nasal catarrh, fever,

2.What is the Swine flu? Signs and Symptoms?

All non italicized information is direct quotes from http://www.cdc.gov/h1n1flu/qa.htm  I have bolded information I think is particularly relevant

Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.

Most patients who have had 2009 H1N1 virus infection have had a self-limited respiratory illness similar to typical seasonal influenza.

As of September 12, 2009, 99% of circulating influenza viruses in the United States were 2009 H1N1 influenza (previously referred to as novel influenza A (H1N1)). Among people who become infected with 2009 H1N1, certain groups appear to be at increased risk of complications and may benefit most from early treatment with antiviral medications. Approximately 70% of persons hospitalized with 2009 H1N1 influenza have had a recognized high risk condition.

CDC October 2, 2009

•The 2009 H1N1 influenza virus is the predominant influenza virus in circulation in most countries worldwide.

•The epidemiology of disease caused by 2009 H1N1 influenza in the Southern Hemisphere is very similar to that described in the United States in the spring of 2009.

•There have been no significant changes detected in the 2009 H1N1 influenza viruses isolated from persons in the Southern Hemisphere as compared to viruses isolated from persons in the Northern Hemisphere.

•As of October 2, 2009, WHO reported that more than 10,000 2009 H1N1 influenza isolates worldwide were tested and found to be sensitive to oseltamivir, an antiviral medicine used to treat influenza disease. Only 28 2009 H1N1 isolates tested have been found to be resistant to oseltamivir – 11 of these isolates were detected in the United States.

3.  Who is at risk for flu? swine flu?

One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.

4.  Should we get vaccinated?

CDC September 29, 2009, 11:30 AM ET

What are the plans for developing 2009 H1N1 vaccine?

Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a 2009 H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete.  Candidate vaccines will be tested in clinical trials over the few months. 

When is it expected that the 2009 H1N1 vaccine will be available?

The 2009 H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials

Will the seasonal flu vaccine also protect against the 2009 H1N1 flu?

The seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu.

4.  Do you or anyone in your family get vaccinated for the flu?

Grandparents do.  One has a high risk illness.  None of us do.  I do not work if I have the flu.

How long can an infected person spread this virus to others?

People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

5.  Would you recommend flu vaccination to any of your patients? What about the pneumonia vaccination for the elderly?

Curr Top Microbiol Immunol. 2009;333:431-51.Links

Vaccines for pandemic influenza: summary of recent clinical trials.Keitel WA, Atmar RL.

Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, 280 One Baylor Plaza, Houston, TX 77030, USA.

The emergence of influenza A/H5N1 viruses in Asia has raised concerns about their potential to cause pandemic disease. Because vaccination is the primary strategy for the prevention of influenza, efforts are in progress to develop safe and immunogenic vaccines against these viruses and other potential pandemic influenza strains. Results of initial studies indicated that subunit influenza A/H5N1virus vaccines were poorly immunogenic, and that high dosages were needed to induce seroresponses in the majority of subjects. Addition of aluminum-containing adjuvants resulted in variable effects on the immunogenicity of H5 vaccines, but in general, clinically meaningful effects have not been observed. Intradermal immunization was not associated with significant enhancement in one study. More recent studies indicate that oil-in-water adjuvants significantly enhance immune responses when compared with nonadjuvanted preparations containing the same dosage of H5 or H9 hemagglutinin. In addition, these formulations elicit higher levels of cross-reactive antibodies vs. different H5N1 clades. Several whole-virus vaccines have been demonstrated to stimulate high frequencies of responses at relatively low dosages; however, direct comparisons with subunit vaccines have not been made. Finally, candidate live attenuated vaccines are under evaluation in clinical trials. The results of these and future trials will help to identify formulations and immunization regimens for various populations, and will better prepare us to address the threat of both pandemic and interpandemic influenza.

PMID: 19768418

How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?

With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu.  However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.

Will two doses of vaccine be required?

The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older. This is slightly different from CDC’s recommendations for seasonal influenza vaccination which states that children younger than 9 who are being vaccinated against influenza for the first time need to receive two doses. Infants younger than 6 months of age are too young to get the 2009 H1N1 and seasonal flu vaccines.

What will be the recommended interval between the first and second dose for children 9 years of age and under?

CDC recommends that the two doses of 2009 H1N1 vaccine be separated by 4 weeks. However, if the second dose is separated from the first dose by at least 21 days, the second dose can be considered valid.

N Engl J Med. 2003 May 1;348(18):1747-55. Links

Comment in:

N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4.

N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4.

N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4.

N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4.

N Engl J Med. 2005 Oct 27;353(17):1860-1; author reply 1860-1.

Effectiveness of pneumococcal polysaccharide vaccine in older adults.Jackson LA, Neuzil KM, Yu O, Benson P, Barlow WE, Adams AL, Hanson CA, Mahoney LD, Shay DK, Thompson WW; Vaccine Safety Datalink.

Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. jackson.l@ghc.org

BACKGROUND: Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of community-acquired pneumonia. In a large population of older adults, we assessed the effectiveness of the pneumococcal vaccine. METHODS: In this retrospective cohort study, 47,365 Group Health Cooperative members 65 years of age or older were assessed over a three-year period. The primary outcomes were hospitalization because of community-acquired pneumonia (validated by chart review), pneumonia in patients who were not hospitalized ("outpatient pneumonia," determined from administrative data sources), and pneumococcal bacteremia. The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional-hazards models, with adjustment for age, sex, nursing-home residence or nonresidence, smoking status, medical conditions, and receipt or nonreceipt of influenza vaccine. RESULTS: During the study period, 1428 cohort members were hospitalized with community-acquired pneumonia, 3061 were assigned a diagnosis of outpatient pneumonia, and 61 had pneumococcal bacteremia. Receipt of the pneumococcal vaccine was associated with a significant reduction in the risk of pneumococcal bacteremia (hazard ratio, 0.56; 95 percent confidence interval, 0.33 to 0.93) but a slightly increased risk of hospitalization for pneumonia (hazard ratio, 1.14; 95 percent confidence interval, 1.02 to 1.28). Pneumococcal vaccination did not alter the risk of outpatient pneumonia (hazard ratio, 1.04; 95 percent confidence interval, 0.96 to 1.13) or of any case of community-acquired pneumonia, whether or not it required hospitalization (hazard ratio, 1.07; 95 percent confidence interval, 0.99 to 1.14). CONCLUSIONS: These findings support the effectiveness of the pneumococcal polysaccharide vaccine for the prevention of bacteremia, but they suggest that alternative strategies are needed to prevent nonbacteremic pneumonia, which is a more common manifestation of pneumococcal infection in elderly persons. Copyright 2003 Massachusetts Medical Society

PMID: 12724480

7.  What course of treatment do you recommend to patients with the flu?

Sambucol (code SAMB8 from Emerson 1800 654 4432)

Phytochemistry. 2009 Jul;70(10):1255-61. Epub 2009 Aug 12. Links

Elderberry flavonoids bind to and prevent H1N1 infection in vitro.Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS.

HerbalScience Group LLC, 1004 Collier Center Way, Suite 200, Naples, FL 34110, USA.

A ionization technique in mass spectrometry called Direct Analysis in Real Time Mass Spectrometry (DART TOF-MS) coupled with a Direct Binding Assay was used to identify and characterize anti-viral components of an elderberry fruit (Sambucus nigra L.) extract without either derivatization or separation by standard chromatographic techniques. The elderberry extract inhibited Human Influenza A (H1N1) infection in vitro with an IC(50) value of 252+/-34 microg/mL. The Direct Binding Assay established that flavonoids from the elderberry extract bind to H1N1 virions and, when bound, block the ability of the viruses to infect host cells. Two compounds were identified, 5,7,3',4'-tetra-O-methylquercetin (1) and 5,7-dihydroxy-4-oxo-2-(3,4,5-trihydroxyphenyl)chroman-3-yl-3,4,5-trihydroxycyclohexanecarboxylate (2), as H1N1-bound chemical species. Compound 1 and dihydromyricetin (3), the corresponding 3-hydroxyflavonone of 2, were synthesized and shown to inhibit H1N1 infection in vitro by binding to H1N1 virions, blocking host cell entry and/or recognition. Compound 1 gave an IC(50) of 0.13 microg/mL (0.36 microM) for H1N1 infection inhibition, while dihydromyricetin (3) achieved an IC(50) of 2.8 microg/mL (8.7 microM). The H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu; 0.32 microM) and Amantadine (27 microM).

PMID: 19682714

Microbiol Immunol. 2009 Feb;53(2):66-74. Links

Effects of Clinacanthus siamensis leaf extract on influenza virus infection.Wirotesangthong M, Nagai T, Yamada H, Amnuoypol S, Mungmee C.

Faculty of Pharmaceutical Sciences, Chulalongkorn University, 254 Phayathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand. mali.w@chula.ac.th

Ethanolic extracts of 20 medicinal plants were screened for influenza virus NA inhibition and in vitro antiviral activities using MDCK cells in an MTT assay. The vaccine proteins of influenza virus A/New Caledonia/20/99 (H1N1), mouse-adapted influenza virus A/Guizhou/54/89 (A/G)(H3N2) and mouse-adapted influenza virus B/Ibaraki/2/85 (B/I) were used in the NA inhibition assay, and mouse-adapted influenza viruses A/PR/8/34 (H1N1), A/G and B/I were used in the in vitro antiviral assay. The results of the in vitro antiviral assay indicated that the A/G virus was the most susceptible and an extract of the leaf of CS possessed the highest in vitro anti-A/G virus activity (41.98%). Therefore, the A/G virus and the CS extract were selected for studying in vivo anti-influenza virus activity. BALB/c mice were treated with CS extract (100 mg/kg per day, 5 times) orally from 4 hr before to 4 days after infection. CS extract elicited significant production of anti-influenza virus IgG(1) antibody in BAW and increased mouse weight compared to oseltamivir (0.1 mg/kg per day) on day 19 or water on days 17-19 of infection. Moreover, CS extract produced a higher anti-influenza virus IgA antibody level in BAW compared to oseltamivir, and a tendency towards an increase in anti-influenza virus IgA compared to water was shown. The results suggest that CS extract has a protective effect against influenza virus infection.

PMID: 19291089

Immunopharmacol Immunotoxicol. 1996 May;18(2):193-208. Links

In vivo anti-influenza virus activity of Kampo (Japanese herbal) medicine "Sho-seiryu-to"--effects on aged mice, against subtypes of a viruses and B virus, and therapeutic effect.Nagai T, Urata M, Yamada H.

Oriental Medicine Research Center, Kitasato Institute, Tokyo, Japan.

When aged BALB/c mice (approximately 6 months old) were treated with a Kampo (Japanese herbal) medicine "Sho-seiryu-to (SST)" (1 g/kg, 10 times) orally from 7 days before to 4 days after the infection and infected with mouse-adapted influenza virus A/PR/8/34 (H1N1 subtype) by nasal site-restricted infection, replication of the virus in the broncho-alveolar cavity was efficiently inhibited at 5 days after infection in comparison with water-treated mice. The antiviral IgA antibody in the broncho-alveolar wash of the SST treated aged mice increased significantly. When mice (7 weeks old) were administered orally with SST (1 and 2 g/kg, 7 times) from 4 days before to 3 days after the infection and infected with mouse-adapted influenza virus A/Guizhou/54/89 (H3N2 subtype) or B/Ibaraki/2/85, replication of the viruses in the nasal cavity and lung were significantly inhibited at 4 days after infection in comparison with control mice. When mice infected with influenza virus A/Fukuoka/C29/85 (H3N2) before 14 days were secondary infected with A/PR/8 virus and administered orally with SST (1 g/kg, 5 times) from 2 h to 5 days after the secondary infection, replication of the virus in both nasal and broncho-alveolar cavities were significantly inhibited at 5 days after the secondary infection in comparison with water-treated control. Oral administration of SST (1 g/kg, 18 times) from 7 days before to 14 days after vaccination followed by secondary nasal inoculation of influenza HA vaccine (5 micrograms/mouse) at 14 days after the first vaccination significantly augmented nasal antiviral IgA antibody and broncho-alveolar and serum antiviral IgG antibodies. These results suggest that SST is useful for influenza virus infection on aged persons and for cross-protection of subtypes of influenza A viruses and influenza B virus. SST is also useful for the treatment of influenza virus infection on human which has a history of influenza virus infection and/or influenza vaccination.

PMID: 8771367