Zanamivir, influenza, and meningococcal disease
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7231.378 (Published 05 February 2000) Cite this as: BMJ 2000;320:378
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Editor
Isn't prescribing Zanamivir a bit like playing with fire? Sialic acid
plays a major part in inflammatory (1), rotaviral (2) and cancerous (3)
conditions in animals (4)(5) and humans; is there any risk of 'Zanamivir
influenza inhibition' turning into an epidemic of cancers, H pylori (6)
infections, melanomas (1) and inflammatory conditions plus increases in
animal and human rotaviral outbreaks whilst 'playing about with' sialic
acid activity?
In Traditional Chinese Medicine (TCM) one cannot treat a respiratory
tract condition without recognising the potential for moving that
condition to 'linked areas' which, according to TCM, are the skin, lungs
and large intestine particularly. Sialic acid appears to have an affinity
for conditions affecting epithelial cells (7).
I note that research using Zanamivir for one month in HEALTHY
volunteers (8) realised 75% ADRs in both treated and placebo controlled
(not sure what placebo was used!). I wonder what long term follow-up of
those participants for such conditions as cancers, melanomas, inflammatory
events etc. was planned.
In the UK it is appears that our Department of Health are incapable
of accurately advising the public about 'flu epidemics' - last year we saw
a major 'epidemic' of mycoplasma pneumoniae causing serious mortality and
morbidity problems nationwide, which was reported as 'influenza' by all
major national newspapers and the TV yet the Health Department failed to
correct this misinformation. This year we have seen another 'epidemic of
flu', again misreported by the Department of Health as such and duly
criticised by 'The Royal College of GPs', yet some 'virus' has been
active, perhaps a variety, one of which I was reliably informed as being a
'pertussis-like virus' by a local medical colleague.
Even assuming Zanamivir is 'safe' from any adverse developments
listed above (and one has ensured avoidance of use by those who are
allergic to eggs - much cheap sialic acid is produced (9) by purification
from hens' eggs), with such apparent ineptness and inaccuracy of reporting
on 'flu' existence, how does one ensure that 'influenza treatments' are
only provided for those correctly diagnosed? How does one diagnose then
treat appropriately (in an evidence-based manner) with Zanamivir when it
must be prescribed before test results can be obtained?
Regards
John H.
No competing interests other than a desire for safety, efficacy and
accuracy of an 'evidence-base' for modern medicine.
Refs.
1. Ros-Bullon MR et al; Anticancer Res 1999 Jul-Aug:19(4C):3619-22
2. Kuhlenschmidt TB et al, Adv Exp Med Biol 1999;473:309-17
3.
http://water-cooler.com/WC/patentviewer/patent-4342567.html (Kloppel et
al, 1977, Proc Natl Acad Sci 74, 3011-3013 "reported 2 5-fold increases in
serum sialic acid glycolipids in mice bearing transplantable mammary
carcinomas and 2-fold increases in human carcinoma patients")
4. Mendez E et al, Virology 1999 Oct 25;263(2):450-9
5. Mendez E, Arias CF, Lopez S, J Virol 1996 Feb;70(2):1218-22
6. http://www.uni-kiel.de:8080/Biochemie/kelm/pathogen/ examples.html
7. Krempl C et al, J Gen Virol 2000 Feb;81(Pt2):489-496
8. Arnold S et al, JAMA Vol 282 No. 1 July 7, 1999 "Zanamivir in the
Prevention of Influenza Among Healthy Adults"
Competing interests: No competing interests
Editor - It may seem to be a glimpse of the obvious when Thomas (1)
points out "a doctor's duty is to treat each of his or her patients to the
best of his or her ability". Sadly, Thomas's words need repeating to
remind the profession about the path down which the politicians and
medical leaders are leading us. Changing the words, guidelines for
guidebooks in a title next day in a Sunday newspaper, we have "bonfire of
the inanities. How guidelines are ruining the world of medicine".
In a profession decisions are made based on knowledge, experience, wisdom
and judgement, but with the destruction of our noble profession, dictats,
protocols, audits and guidelines can be carried out by teams of civil
servants obeying laid down instructions.
No wonder Thomas speaks of the ethics of an internment camp, a moral
standard as unacceptable as the poor laws of the 19th Century and rightly
questions the legality of NHS regulations. It is no wonder that patients
are turning to those who are medically unqualified for their care.
Dr P B S Fowler
Consultant Physician
Reference
Thomas PD. NHS regulations are of questionable legality. BMJ
2000:320;378 (5th Feb)
Competing interests: No competing interests
Influenza and meningitis
Our recent observations concur with those of Stephen Green in his
recent letter (1).
We admitted a young Asian male on New Year's Eve with a
short history of influenza-like symptoms, depressed level of consciousness
and a rapidly evolving petechial rash. He was commenced empirically on
appropriate antibiotics immediately on arrival and was well enough to
undergo lumbar puncture the following day, which confirmed Neisseria
meningitidis microscopically. Interestingly his chest radiograph was
abnormal on admission, demonstrating a widespread infiltrate. This
remained abnormal for twenty days despite an extended course of
antibiotics (14 days). The course of his illness was complicated by
pericarditis on day 2, a lymphocytic pleural effusion, prolonged fever
with persisting acute phase
response and para-aortic lymphadenopathy. He was an in-patient for
fourteen days (of which the majority was spent in respiratory isolation),
and would have been detained for longer had he not taken his discharge
against
medical advice. His convalescent influenza A titres were elevated,
confirming a coincident influenza infection.
This case illustrates that an
influenza epidemic impacts on overstretched hospitals both directly
through additional acute admissions and indirectly because of the effect
on the
presentation and manifestations of other infectious disease processes. The
new range of anti-viral agents we now have in our armoury has the
potential to act as the 'finger in the dyke' and reduce both the
predictable caseload and the unforeseen financial burden of influenza
epidemics.'
1. Green ST. Zanamivir may help to fight potential flu epidemic.
BMJ 2000;320:378 (letter 5 February).
Ben G. Marshall
Khulud Al-Majali
Specialist Registrars
Gill Whitfield
Senior House Officer
Philip W. Ind
Claire Shovlin
Consultant Physicians in Respiratory
and General Internal Medicine.
Hammersmith Hospitals NHS Trust, London W12
Editorial note
The patient has given his written informed consent to publication of his case.
Competing interests: No competing interests