Threat Of 'Superflu' Rampage As Mutant Viruses Resist Drugs

The drive to fight deadly flu pandemics with special antiviral drugs risks creating an untreatable "superflu", the head of -Britain's public health watchdog has warned.

Sir William Stewart, the chairman of the Health Protection Agency, warned that the widespread use of antiviral drugs to treat illnesses, including bird flu and seasonal influenza, is causing- viruses to mutate into drug-resistant- forms.

He claimed that drug-resistant viruses now represented as big a threat to public health as antibiotic-resistant superbug bacteria, such as MRSA. His comments come as bird experts were once again placed on alert for cases of avian flu returning to Britain with migrating birds.

The autumn migration of waterfowl triggered the spread of the deadly H5N1 virus into western Europe and Britain for the first time last year, as the disease spread rapidly in wild birds trying to escape the cold weather. A dead swan discovered in Fife, Scotland, in April this year, was the only bird flu case to be found in a wild bird in Britain.

Officials at the Department of Health confirmed that, last week, it received the last of its stockpile of 14.6 million doses of the antiviral drug Tamiflu, which will be used if bird flu mutates into a human flu pandemic.

But Sir William, a former chief scientific adviser to the Government, fears that the drug will be useless if the flu virus develops resistance to it during the mass medication that would be necessary in a pandemic.

"With pandemic flu, once it develops antiviral resistance in one area, it is likely to spread quickly," he told The Sunday Telegraph. "One of our concerns is that we get Tamiflu-resistant strains emerging.

"Unfortunately, it is unknown if Tamiflu will be effective when pandemic flu emerges and how long it will be effective for. Anti-viral resistance is becoming as big a problem as antibiotic resistance." Sir William stressed, however, that it was better to have stocks of antiviral drugs that helped patients fight non-resistant flu strains than no drugs at all to protect the population.

Meanwhile, last night, bird experts warned that the spectre of bird flu infecting flocks in Britain would return this winter, as ducks and swans migrated south over the coming months.

The H5N1 virus spread rapidly through bird flocks in 15 European countries, including Turkey, France, Germany, Italy, Austria and Denmark, after last year's winter migration. Cold weather from the east forced the birds to move west as they sought food.

"The risk from bird flu is likely to be as great this year as it was, at its height, last year," said Dr Bob McCracken, of the British Veterinary Association. "We have to ensure that wild birds arriving in the UK are being monitored."

The Department for Environment, Food and Rural Affairs has also launched a revised strategy to screen migrating wild birds for bird flu, including stepping up sampling for the disease in areas that have high numbers of migrating waterfowl. It has also placed orders for 10 million doses of avian influenza vaccine for poultry.

Health officials fear that if the H5N1 virus combines with human flu it could create a new strain that would cause a pandemic. Government predictions suggested that up to 700,000 people could die in such an outbreak.

Concerns that a pandemic flu virus might develop resistance to Tamiflu emerged last year, after reports from Vietnam that H5N1 virus was showing signs of decreased sensitivity to the drug.

Figures from the World Health Organisation also show that approximately 0.4 per cent of adult seasonal flu cases and 5 per cent of child cases treated with Tamiflu have already developed immunity to the drug.

Prof Jeremy Farrar, an expert on flu virus drug resistance at Oxford University, said it was essential that more flu drugs were developed if doctors were to fight a pandemic.

"We need more than one or two drugs available so we can combine them to prevent resistance, or to have alternatives if resistance develops to the first-line therapy," he said.

A spokesman for Roche, Tamiflu's maker said resistance to the drug was "extremely rare".

Killer flu, of whatever strain, has since the 1970s been recognized both as inevitable, and the #1 biological threat to the United States. It is a vicious, murderous disease, and has almost unpredictable possibility for human mortality. It has maintained between a 50 and 60% mortality rate, and there are no documented cases of "mild" infection.

On average, about 30,000 Americans die every year from typical influenza. If avian flu mutates to a Human to Human (H2H) strain, anywhere from 300,000 to 5 Million Americans could die, and an equal number could have permanently scarred lungs.

Officially, the WHO world mortality estimates by their top epidemologist was ordered reduced from 300 Million to only 3 Million. This was done with no scientific justification.

Already, the disease has been proven to cause the "cytokine storm" effect in the lungs, an overreaction of the immune system to the virus which results in severe lung damage, with blood and fluid entering the lungs, and oxygen deprivation to the entire body. This cytokine storm effect may actually be more lethal than the disease itself. For this reason, healthy young people with strong immune systems may have a far higher mortality rate than everyone else.

Once a sample of the actual H2H virus has been obtained, in the US it will take six months to produce 30 Million vaccinations. This is peak production, enough for 1 in 10 Americans.

Because of the serious potential of the avian flu, the vaccination scheme has been modified so that instead of vaccinating the very old, very young and infirm, the emphasis will be on school aged children most likely to spread the disease, and outbreak areas.

Other critical medical supplies in the US are manufactured on a "push" basis with almost no reserves. For example, the US has about 102,000 ventilators, 100,000 of which are needed for a typical flu season. In surge production it is unlikely manufacturers would be able to produce more than a small number more, in time.

The two major advantages that we have today, that we did not have during the 1918 Spanish flu, is a good awareness of public hygiene and good electronic communications.

In the last few years it was discovered that hand contamination, not coughing and sneezing, was by far the greatest means by which colds and flus are spread. It is now calculated that if you are out in public during an epidemic, if you wash your hands or use hand sanitizer about six times a day, you reduce your chances of catching a disease by almost 60%.

This is especially important because a typical cold or flu virus needs far more contamination to infect most people, because they have limited immunity. But since there is no known immunity to avian flu, much less virus is needed to cause an infection that will overwhelm the immune system.

The reason avian flu has not become H2H yet is because other than in internal organs, it concentrates in the lower trachea, rather than the upper trachea and sinuses, which is typical. Thus it is harder to get on the hands with coughing and sneezing. For it to adapt only needs one or perhaps two mutations.

Electronic communications will do much to prevent the spread of the disease. Even small communities can set up phone banks to systematically call every residence in their town or city, both to spread information and to determine if emergency medical and mortuary services are needed.

It is still not known how many animals may act as vectors of the disease. Certainly wild and domestic foul, which could wipe out much of our chicken and turkey industry. Dogs have been proven to catch and die from the disease, and pigs are also known to carry most flus.

The disease may last as long as two years, coming in two "waves". Entire communities may be missed, and some could almost be wiped out.

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