Antiviral for all with chronic disease

Courtesy by: nationalmultimedia.com

The 2.4 million people in Thailand suffering from chronic diseases such as asthma, heart disorders, paralysis, diabetes, cancer and kidney transplant would be given antiviral drugs without having to undergo lab tests for type A (H1N1) virus first, the Public Health Ministry announced yesterday.

The move comes after it was reported that most deaths from swine flu in Thailand were of people with underlying disease.

Yesterday, the ministry reported 211 new cases, bringing the number of swineflu cases in the country to 2,925. Three more deaths were reported, lifting the total number of fatalities to 14. Among the new cases, 180 were students and 10 were medical workers.

Of the three new victims, one was a traffic policeman based at Bang Na police station. He succumbed to kidney complications yesterday at the Police Hospital.

The second victim was a 45-year-old man who suffered a high fever for five days before seeking treatment on Monday. He died on the same day.

The third victim, a student from Maha Sarakam province, died from a new strain of the virus at a hospital in Khon Kaen. The youngster had recently come to Bangkok to sit for an exam, before developing a high fever and succumbing to the flu on Wednesday.

In a bid to cut down the deaths, the Department of Disease Control’s spokesperson Dr Kamnuan Ungchusak said doctors nationwide should start giving patients with underlying diseases the oseltamivir drug immediately if they show any flu symptoms.

“Patients with chronic disease should seek medical treatment and receive the antiviral drug as soon as they develop flulike symptoms or have a high fever. Doctors should not wait for lab results to confirm the infection first,” he said.

Kamnuan explained that people with underlying health problems were at higher risk of getting a severe form of the influenza and developing further complications.

Department of Medical Service’s director general, Dr Rawat Witsaruthvej said only 20 out of the 2,000 patients infected with the new virus showed severe flulike symptoms. Of these, 15 already have preexisting conditions such as obesity, heart disease, kidney, leukaemia or thalassemia, while some were also pregnant.

He said eight patients with underlying disease were in critical at the hospital. The doctor said most deaths were caused because the patients were tardy in seeking treatment.

“We found that most patients who have died from the new virus chose to stay at home for six days after developing flulike symptoms instead of immediately seeking treatment,” he said.

The World Health Organisation’s regional director for Southeast Asia, Dr Samlee Plianbangchang, said pregnant women and young children appeared to be facing a higher risk.

He was speaking at a regional consultation on Pandemic H1N1 2009: Strengthening Country Capacity for Pandemic Preparedness attended by 68 health experts from eight countries in the region.

Meanwhile, director general for the Government Pharmaceutical Organisation, Dr Vithit Atthavejkul said his agency would produce another 10 million oseltamivir tablets, bringing the country’s stockpile to 15 million. Of these, 10 million tablets will be distributed among the 2.4 million patients with chronic diseases. GPO will also start producing a new vaccine after it receives the seed vaccine virus from WHO on July 16.

The organisation expects to produce 2.8 million doses per month of the new vaccine and should be ready to distribute it by November.

To give people access to essential medication and flu vaccines, the National Health Security Office (NHSO)’s secretarygeneral, Dr Winai Sawasdivorn said the NHSO board will approve Bt300 million for the purchase of a new vaccine to deal with the pandemic next year. However, he said, he was not sure the NHSO could purchase two million doses of vaccine as requested by the Public Health Ministry.

Meanwhile, Dr Samlee said the biggest concern was the reassortment of the virus. If people with seasonal flu are further infected by the typeA (H1N1) virus the two viruses could genetically combine to create a more virulent and severe infection.

“This is the time for seasonal influenza and we should be well aware of this phenomenon and protect ourselves from ordinary flu,” he said. Plus, the avian flu (H5N1) virus, which has been prevailing in the region, could further complicate the situation.

“Further reassortment can take place with a coinfection of H1N1 and H5N1 viruses,” he warned. “We have to make sure that the avian influenza is under proper control.”

Influenza viruses, in general, are highly unstable and can easily undergo genetic mutation that in turn can either make them milder or more severe. In this regard, the typeA (H1N1) virus is no exception.

“This is something we have to keep in mind when dealing with the influenza viruses,” Samlee said.

The Public Health Ministry expects 200,000 to 300,000 people to be infected with the new virus by the end of this month. The mortality rate of the pandemic in Thailand is 0.4 per cent, which is equal to the figure in the United States.

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Cost of examination for the 2009 influenza charged by private hospitals

Bt1,000

Initial screening test: to determine whether it is common flu Type A or B:

Bt3,000Bt4,000

Blood test to determine whether it is the 2009 influenza

Bt5,000Bt5,500

Blood tests with a positive result, come with medication included

Source: The Private Hospital Association

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World Health Organisation: Alert levels depending on scale of outbreak

Level 1: Fatality rate at 0.1 per cent of all confirmed cases

Level 2: Fatality rate at 0.10.5 per cent of all confirmed cases; Thailand’s rate is now at 0.4 per cent

Level 3: Fatality rate at 0.51 per cent of all confirmed cases

Level 4: Fatality rate at 12 per cent of all confirmed cases

Level 5: Fatality rate over 2 per cent of all confirmed cases; all public gatherings and activities are required to be cancelled, as happened in Mexico, where the outbreak is thought to have originated.