JAC Advance Access published online on December 19, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh037
© 2003 by The British Society for Antimicrobial Chemotherapy
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Leading article
1 Barts and The London, Retroscreen Virology Ltd, Queen Mary’s
School of Medicine and Dentistry,
327 Mile End Road, London E1 4NS, UK
* Corresponding author. E-mail: m.bush{at}retroscreen.com.
Influenza A and B viruses cause serious medical problems
and social disruption every year in particular countries of the
world. The virus is notoriously fickle and may attack citizens in
say two adjacent countries but not the third. More rarely a global
pandemic virus emerges causing millions of deaths worldwide. The SARS
outbreak has illuminated weaknesses in planning for sudden outbreaks
of disease in a modern society and in particular how panic can grip
and cause intense economic disruption. Many communities in the world are
neither prepared for a global pandemic nor a very acute epidemic
of influenza. The neuraminidase inhibitors (NAIs) are a new class
of antiviral drug targeting a viral influenza enzyme, the neuraminidase,
which acts both to facilitate virus infection of cells by clearing
a passage through otherwise protective respiratory fluids and also
by helping release of the virus by cutting the chemical umbilical
cord which links up the virus to the infected cell. Extensive laboratory
studies of the two molecules zanamivir and oseltamivir have shown
that they block all influenza A and B viruses yet tested and would,
in theory, even inhibit the 1918 pandemic virus. Both drugs can
be used prophylactically to prevent spread of infection in families
and communities where 80-90% protection has been
documented. The therapeutic effects are also strong in adults and
children abbreviating infection, reducing quantities of excreted
virus and reducing antibiotic prescriptions. The drugs have to be
taken within 48 h of the onset of symptoms. Drug resistance is not
a problem at present because although such mutants occur the mutants
are compromised and are less virulent than their drug-sensitive
parents and they spread less easily. The two drugs could be stockpiled
to prepare for an influenza pandemic but, importantly, clinical
and scientific experience need to be gained by using these inhibitors
in the yearly conflagrations of epidemic influenza, which unchecked
do great harm to our communities.
Keywords: antivirals, pandemics, epidemics, respiratory
viruses
A new millennium conundrum: how to use a powerful
class of influenza anti-neuraminidase drugs (NAIs) in the community
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