MONDAY, Nov. 25, 2013 (HealthDay News) — Kids near death because of severe flu infection have a better chance of survival if they are given antiviral medications early in their treatment, researchers say.
Children treated with antiviral drugs called neuraminidase inhibitors (NAIs) within the first 48 hours of serious flu symptoms developing are significantly more likely to survive, according to a study published online Nov. 25 in the journal Pediatrics.
“The benefit was more apparent for the most severely ill children, who required a ventilator to help with breathing,” said co-author Dr. Janice Louie, chief of the influenza and respiratory diseases section at the California Department of Public Health’s Center for Infectious Diseases.
In children rendered critically ill by the flu, treatment with NAIs reduced their risk of dying by 64 percent, the study found.
Researchers found that in recent years, however, fewer than two-thirds of severely ill children received NAIs while hospitalized for the flu.
Dr. Octavio Ramilo, a professor of pediatrics at Ohio State University, said a flu-stricken child who is sick enough to go to the hospital needs to receive antiviral therapies immediately.
“The minute you come to the hospital, we [should] start you on antiviral therapy,” said Ramilo, who also is chief of infectious diseases at Nationwide Children’s Hospital in Columbus, Ohio.
Doctors usually advise children with the flu to rest, drink lots of liquids and, if needed, use over-the-counter drugs to ease symptoms such as fever or congestion. But some people develop serious complications such as pneumonia that require hospitalization.
The study focused on nearly 800 patients younger than 18 who were treated in intensive-care units for the flu between April 2009 and September 2012.
Only 3.5 percent of kids who received NAI treatment during the first 48 hours ended up dying, the researchers found. By comparison, 9 percent of kids died who received NAIs between day eight and day 14 of their illness, and 26 percent died who received the medication after day 14.
Overall, 6 percent of kids treated with NAIs died from the flu, while 8 percent of kids died who didn’t receive the medication.
Despite these numbers, hospitals appear reluctant to use NAIs when treating kids sick enough from the flu to require hospitalization.
About 90 percent of kids in the ICU with the flu received NAIs during the 2009 H1N1 flu pandemic, the researchers found. Only 63 percent of kids, however, received NAIs in the years following the pandemic.
“I’m not at all sure why that percentage was so low,” said Dr. Rich Whitley, professor of pediatric infectious diseases at the University of Alabama at Birmingham. “There’s no good reason for that.”
Cost shouldn’t be a factor, Louie said. “The cost of oseltamivir, the most commonly prescribed NAI, is approximately $7 per pill,” she said. “The usual treatment course is one pill twice a day for five days, for a total $70.”
The drug’s side effects also should not be an issue. The main side effects are nausea and vomiting, which are much more common in children but occur in less than 10 percent of patients.
The explanation might be that smaller hospitals that treat fewer cases of the flu do not have the same level of experience and sense of urgency as hospitals that regularly deal with flu outbreaks, Ramilo said.
“If you work in a big teaching hospital, then you see these cases more often,” he said. “The [doctors] think about it right away.”
Some doctors also may not suspect flu when they start treating a very sick child. “Many clinicians may not initially consider influenza as a possible cause of respiratory illness or pneumonia, especially when it occurs outside of the peak of the influenza season,” Louie said.
Another problem could be that intravenous forms of the antiviral medications currently are not available, Ramilo said. Kids have to take them by mouth, and very sick kids often are administered the medication via a tube snaked through their nose and down their throat.
Although this study lends hope for treating critically ill children, Ramilo and Whitley said flu shots remain the first and best line of defense against the flu.
“Children need to be immunized just like adults need to be immunized,” Whitley said. “It’s still the best approach we have to prevent influenza.”
Currently, Tamiflu is offered to everyone in the United Kingdom who shows sings of infection with swine flu. More than 150,000 people were treated with the drug during the last week of July alone. Combined with these figures, the current study reinforces fears that the drug is being drastically over-prescribed.
“The National Pandemic Flu Service has been a great success, and was needed to take the pressure off general practitioners (GPs),” said Peter Holden, the British Medical Association’s primary swine flu expert. “But the threshold for getting Tamiflu should be quite high. For patients who are not in the high-risk groups — such as pregnant women, people with bad asthma or with suppressed immune systems — this virus typically causes mild symptoms and does not require a course of Tamiflu. Patients in the at-risk groups should be referred to their GP, who will use their clinical judgment.”
The first study, published in the journal Eurosurveillance, examined side effects in 85 London schoolchildren who had been preventively treated with Tamiflu in April and May after one of their classmates was diagnosed with swine flu. Forty-five of these children, or 53 percent, experienced at least one side effect. Twenty-nine percent of children experienced nausea, 20 percent experienced stomach cramps or pain, and 12 percent had trouble sleeping. Almost 20 percent experienced at least one neuropsychiatric side effect, such as nightmares, strange behavior or an inability to think clearly.
Similar results were found in a second study, conducted on schoolchildren in the South West.
The researchers noted that 20 percent of adults treated with Tamiflu also experience nausea or vomiting.
Sources for this story include: www.timesonline.co.uk.
Now comes word that the same problem has happened with antivirals. A new study by a team of University of Colorado at Boulder (CU-Boulder) and Ohio State University researchers shows the avian flu virus(an influenza A subtype dubbed H5N1) is quickly developing resistance to a major class of antiviral drugs. In fact, the researchers documented this trend in more than 30 percent of the virus samples they tested.
The group of antiviral drugs known as adamantanes, one of two classes of antiviral drugs used to prevent and treat flu symptoms, have long thought to be a strong weapon against avian or bird flu if it attacks humans. But according to a CU-Boulder statement released to the media, resistance to adamantanes has developed and it appears to be linked to Chinese farmers adding the drugs to chicken feed to try to prevent the flu in the birds.
The study, just published online in the journal Infection, Genetics and Evolution is the first to show H5N1 flu drug resistance to adamantanes has developed through novel genetic mutations. This research on the mutations in combination with the use of Google Earth to visualize geographic distribution of the avian flu “provides a framework for analysis of globally distributed data to monitor the evolution of drug resistance,” the researchers said in their press statement.
The researchers note there is also resistance of the avian flu virus to the second, newer class of antiviral drugs that includes oseltamivir (a prescription drug sold as Tamiflu ), although it is not yet prevalent or caused by genetic mutations. But that could happen in the future, and happen quickly. The new research suggests that widespread antiviral drug use can accelerate the evolution of drug resistance in viruses, and could cause resistant strains of bird flu to emerge and spread rapidly.
Many governments, businesses and health organizations around the globe have plans to stockpile the anti-viral drug Tamiflu in order to prepare for a potential pandemic flu outbreak that may mutate enough to infect humans. But in the researchers’ media statement, Daniel Janies, senior author of the study and an associate professor of biomedical informatics at Ohio State University, said the results of the new research should serve as a warning to people who think Tamiflu is the “magic bullet” for bird flu.
“We can’t necessarily say what we’ve seen in adamantanes is predictive of what will happen with Tamiflu. But in the larger dynamic, perhaps it serves as a cautionary tale,” he said. “Fighting infection is an arms race, and if we’re not smart about how we use our arms and understand the evolutionary implications, then we will have ongoing and accelerating problems with drug-resistant microorganisms.”
First found in China in 1996, avian flu, also frequently called bird flu, has spread throughout Asia and to India, Russia, Pakistan, the Middle East, Africa and Europe by carriers that include poultry and migratory waterfowl. While avian flu is not highly communicable to humans at present, experts are worried future evolution of this subtype or other subtypes, or genetic changes in the flu, could make an avian influenza strain highly contagious. According to the Centers for Disease Control (CDC), an bird flu pandemic could likely infect 15 percent to 35 percent of the U.S. population and kill millions.
What’s the best way to avoid all types of flu and strengthen your immune system to fight infections? Eating a nutrient dense diet, regular exercise, optimum exposure to sunlight and frequent hand washing when you’ve been in public places are common sense strategies that can help. Moreover, many natural substances have been shown to have anti-viral properties. For example, research by South Korean scientists published in the journal Antiviral Research found green tea was effective against all flu viruses tested. Garlic has also been documented in several studies, including Venezuelan research published in the “Immunopharmacology and Immunotoxicology” journal, to have a strong antiviral powers and Israeli scientists reported in Antiviral Research that cranberry juice fights both bacterial and viral infections.
About the author
Sherry Baker is a widely published writer whose work has appeared in Newsweek, Health, the Atlanta Journal and Constitution, Yoga Journal, Optometry, Atlanta, Arthritis Today, Natural Healing Newsletter, OMNI, UCLA’s “Healthy Years” newsletter, Mount Sinai School of Medicine’s “Focus on Health Aging” newsletter, the Cleveland Clinic’s “Men’s Health Advisor” newsletter and many others.
The researchers tested F. assa-foetida samples acquired from a Chinese herb store in Taipei against samples of H1N1 influenza, then compared the plant’s effectiveness with that of the prescription antiviral drug adamantine. The researchers found that the herbal medicine proved more effective at killing H1N1 in the laboratory than the prescription drug.
A number of influenza strains, including some varieties of H1N1, have shown great success in evolving resistance to adamantine.
The tests were conducted before the outbreak of the H1N1 variety known popularly as “swine flu,” and therefore the results may not apply to that strain. The next step is to test F. assa-foetida against influenza viruses that are actually infecting humans or other animals.
“Overall, the present study has determined that sesquiterpene coumarins from F. assa-foetida may serve as promising lead components for new drug development against influenza A (H1N1) viral infection,” the researchers wrote.
The study was funded by the Taiwanese National Science Council and Department of Health.
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