Sep 11, 2006 (CIDRAP News) – A controlled study of H5N1 influenza patients in Vietnam has provided fresh evidence that explosive viral growth and the resulting cytokine storm, or excessive immune response, account for the often lethal nature of H5N1 disease.The study underlines the importance of early antiviral treatment to stop the viral population explosion. The authors, led by Menno de Jong of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, suggest that treatment to blunt the late-stage immune response should also be explored.”Our observations point to a central role for high viral burden in the pathogenesis of human H5N1 disease and suggest that timely suppression of viral replication should remain the mainstay of treatment of influenza H5N1,” states the report, published online yesterday by Nature Medicine.The study has also prompted experts to mention the possibility of using intravenous antiviral treatment in an effort to move drugs to the sites of viral activity faster than is possible with oral drugs like oseltamivir (Tamiflu).De Jong’s team conducted virologic and immunologic studies on 18 H5N1 patients and eight patients with ordinary seasonal flu (H3N2 and H1N1 viruses) in 2004 and 2005. Thirteen of the 18 H5N1 patients died of the illness. The H5N1 patients presented for treatment an average of 6 days after the onset of illness—well beyond the recommended 2-day window for starting antiviral treatment. The researchers looked for the virus in samples from the nose, throat, blood, and rectum.Among the virologic findings:H5N1 patients had more viral material (viral RNA) in the throat than in the nose, and they had more viral RNA in the throat than patients with ordinary flu had.H5N1 patients who died had the highest levels of viral RNA.Viral traces were found in blood samples from 9 of the 16 H5N1 patients whose blood was tested; viral RNA in blood was associated with high viral loads in throat specimens.Viral RNA was found in rectal samples from 5 of 7 H5N1 patients, and three of these had diarrhea.The researchers also examined the blood levels of seven cytokines and chemokines—molecular messengers that call various kinds of immune cells into action, triggering inflammation. They found that H5N1 patients had significantly higher levels of 6 out of 7 of these substances than seasonal flu patients had. In addition, levels of four chemokines were particularly high in H5N1 patients who died.”Our observations indicate that high viral load, and the resulting intense inflammatory responses, are central to influenza H5N1 pathogenesis,” the authors write. “The focus of clinical management should be on preventing this intense cytokine response, by early diagnosis and effective antiviral treatment.”They add that the limited effectiveness of antiviral treatment in H5N1 patients when started late may reflect the inability of the drugs to stop the cytokine storm at that point. At that stage, they suggest, treatment to limit or change the immune response “has potential benefits.” But they emphasize that the main focus should be on early diagnosis and antiviral treatment.The central question raised by the study, according to infectious disease expert Michael T. Osterholm, PhD, MPH, is, “At what level of viremia does the cytokine storm get triggered? Once that happens, does it matter what the ongoing level of viral activity happens to be? Once the cytokine storm begins, it’s already too late to have any impact with antivirals.”Osterholm, who is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site, said he doesn’t know of anyone who has tried immunosuppressive or anti-inflammatory drugs to stop the cytokine storm in H5N1 patients.”No one knows what the consequences of that might be,” he said. Reducing the immune response could backfire by allowing the virus to run wild, he suggested.Virologist Frederick G. Hayden, MD, said intravenous administration might improve the effectiveness of antiviral treatment in H5N1 disease, according to a Canadian Press report published yesterday.”A potent parenteral agent . . . is really needed and will give us the ability, I hope, to more rapidly control replication in patients with these kinds of severe infections,” Hayden was quoted as saying.Hayden, of the University of Virginia in Charlottesville, heads a World Health Organization research network that plans to assess various treatment regimens for H5N1 patients, the story said. The report said injectable forms of two antivirals—peramivir and zanamivir (Relenza)—are in development.Osterholm said intravenous drugs move into the system faster, but giving drugs intravenously is harder than giving them orally. In a flu pandemic, he said, “Will there be IV bags available? If you give a drug that’s only IV, and then you run out of IV sets, you’ve got a problem.”De Jong MD, Simmons CP, Thanh TT, et al. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nature Med 2006 Sep 10 (early online publication) [Abstract]See also:Nov 16, 2005, CIDRAP News story “Lab study supports idea of ‘cytokine storm’ in H5N1 flu”Oct 11, 2005, CIDRAP News story “Experts cite differences between H5N1 and ordinary flu”Dec 22, 2005, CIDRAP News story “Tamiflu resistance in avian flu victims sparks concern”
Wellington Police Notes for Thursday, April 25, 2013:â€¢12:29 a.m. Thornton L. Rayl, 46, Wellington was arrested and charged with aggravated battery.â€¢12:16 p.m. Injury accident in the 900 block N. G, city involved a vehicle operated by Brian J. Goodrum, 33, Wellington and a pedestrian Lawrence A. Norris, 97, Wellington.â€¢7:34 p.m. Officers investigated a battery by a known suspect in the 400 block N. F, Wellington.
…named after Minister AllicockMinister of Social Cohesion, Dr George Norton; Minister of Public Affairs, Dawn Hastings-Williams; and Minister within the Ministry of Natural Resources, Simona Broomes were among 10 Guyanese awarded by the organisation IChange Nations, for their instrumental roles influencing change in their communities and the country.Tony Games, Patsy Fredricks, George Simon, Robert Frederick Allicock, LorraineMinister of Indigenous Peoples’ Affairs, Sydney Allicock during brief remarks at the IChange Nations Sydney Allicock Global Humanitarian Award ceremony at the Umana YanaPierre, Laura George and Ovid Williams also received awards, along with three other awardees based in the United States – Dr Charles Kinuthia, Margaret Ellis and Erik Kudlis.According to the Department of Public Information (DPI), the award is entitled the “IChange Nations Sydney Allicock Global Humanitarian Award” in honour of Minister Allicock’s commitment to empowering the Indigenous people of Guyana, and his role in ensuring that standards of education and community tourism in hinterland communities are strengthened.During brief remarks at the award ceremony hosted at the Umana Yana, Minister Allicock noted the significance of such an event which honours those who would have worked hard to effect change within their communities and the country.Ovid Williams receiving his award from Ambassador Clyde Rivers, Founder and President of IChange Nations“…We have a lot of persons right here in Guyana who have been making some significant contributions and are not recognised; we need to move away from that mindset. People need to be recognised for their hard work,” he said.He pointed out that it was particularly significant for Indigenous peoples, as their contributions were now being acknowledged.The selection process was not a simple one, according to the Minister, since there were many persons who were deserving of the award. He urged those awarded to keep their shoulders to the wheel and to continue to engender the development of the nation.Ambassador Clyde Rivers, Founder and President of IChange Nations, noted that the organisation was honoured to have the award in Minister Allicock’s name. He remarked that the organisation was especially impressed with the role the Minister has been playing in the development of the Indigenous community.Ambassador Rivers also presented a special award to one of Guyana’s YouthMinisters Sydney Allicock, Dawn Hastings-Williams and Simona Broomes; Ambassador Clyde Rivers, Founder and President of IChange Nations, along with other awardees during the IChange Nations Sydney Allicock Global Humanitarian Award ceremony at the Umana YanaAmbassadors, Dr Astell Collins for his outstanding role in the area of leadership.IChange Nations is an internationally recognised organisation which identifies individuals for outstanding humanitarian work in their respective countries and areas of service.
…as relief efforts continue in affected locationsAs floodwaters recede in several locations across Region Eight (Potaro-Siparuni), the Indigenous community of Kanapang remains under threat, given the reduced access to the area.Guyana Times was on Sunday informed that deploying relief to this community has proved to be a challenge as the roads in the area near the Ireng River were washed away by the floodwaters.The flooding in Kanapang as seen on SaturdayAccording to information received, boats must be utilised to reach the flood-hit village via the Orinduk route. This publication understands that there were also reports of flooding in Cheung Mouth, Region Eight, but communication difficulties have hindered contact with that community.Amerindian Peoples Association (APA) Member Michael McGarrell related to Guyana Times on Sunday afternoon that relief efforts by a number of bodies were continuing to alleviate the flood crisis. He reiterated that some 22 families lost everything as their homes were washed away.“They are really in need of food and clothing. The Amerindian Peoples Association staff has been on the ground since Friday visiting the affected communities; the situation is really grim, we are appealing for more donations,” he noted.He further highlighted that his organisation has been in collaboration with the Region Eight Regional Democratic Council (RDC) officials to take supplies to the affected locations. McGarrell pointed out that the public can donate to the Amerindian Peoples Association, Indigenous Peoples’ Affairs Ministry and the Civil Defence Commission (CDC).Residents in Chenapau get much-needed suppliesThe CDC and the Public Health Ministry, along with several local businesses and organisations, assisted the residents on Saturday morning, delivering food items as well as health-care services. The six main affected areas are Chenapau, Waipa, Kaibarupai and Itabac, Sand Hill Settlement and Kanapang. The water level in these six villages has been receding. Four planeloads of relief supplies were dispatched to Chenapau and Orinduik on Saturday, while relief supplies for Waipa, Kaibarupai and other villages were taken to the villages from the CDC’s Forward Operations Centre at Orinduik.The food items the residents received included farine, cassava bread, rice, tasso, corned mutton/beef, sardines, tuna, salted fish, salted meat, porridge stuff, milk, sugar, salt, Milo, Ovaltine, drink mixes, chowmein/pasta, peas, casareep, crackers and biscuits.Other needed items were identified as tarpaulin, mosquito nets, hammocks, sheets, blankets, towels, toilet paper, disposable napkins, sanitary pads, laundry soap/detergent, bleach, bath soap, matches/lighters, rope, garbage bags, water purification tablets, clothing, reusable plastic eating utensils, buckets and insect repellent.The Public Health Ministry has also dispatched several doctors, nurses, Community Health Workers and Environmental Health Officers to the affected communities. Junior Public Health Minister, Dr Karen Cummings had disclosed that the Ministry prepared flood kits which include antifungal creams, panadol syrup and items to prevent outbreaks in those areas.The CDC had further reported that several villages in Region Seven (Cuyuni-Mazaruni) were also suffering from flooding, but these communities were not as severely affected as their Region Eight counterparts.The flood-hit Region Seven villages included Purima, Kako, Jawalla, Phillipi, Kamarang and Duebamang. Region Seven Regional Disaster Risk Management Systems (RDRMS) and Regional Disaster Risk Management Committee (RDRMC) have been activated.A team was said to have already been deployed to the affected areas to conduct assessments and reconnaissance. Farmland in the main and some residential areas has been flooded in the Region Seven villages. The flooding in both regions has persisted as a result of excessive recent rainfall in the highland regions. Many of the communities are located in mountainous valleys.