Pneumonia is the baffling disease that has continually plagued American soldiers. Moreover, mysterious pneumonia-like illnesses and breathing problems appear to be striking US troops in greater numbers than the military has identified in an investigation, which also include more deaths, according to survivors and their families.

Pneumonia is simply defined as an infection of the lungs. Many different organisms can cause it, including bacteria, virus, and fungi. Pneumonia can range from mild to severe, and can even be deadly. The severity depends on the type of organism causing pneumonia, as well as age and underlying health. It is a common illness that affects millions of people each year in the United States. Bacterial pneumonias tend to be the most serious and, in adults, the most common cause of pneumonia. The most common pneumonia-causing bacterium in adults is Streptococcus pneumoniae pneumococcus.

Most people who develop pneumonia initially have symptoms of a cold which are then followed by a high fever sometimes as high as 104 degrees Fahrenheit, shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. Patients may become short of breath. Chest pain may develop if the outer aspects of the lung are involved. This pain is usually sharp and worsens when taking a deep breath, known as pleuritic pain. Additional symptoms such as headache, excessive sweating and clammy skin, loss of appetite, excessive fatigue, confusion, especially in older people may also occur.

The viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. Illness can spread when an infected person coughs or sneezes on a person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person.

There is a vaccine for pneumococcal pneumonia, a bacterial infection which accounts for up to a quarter of all pneumonias. Certain groups of people are considered to be at particularly high risk for the development of pneumonia, and the U.S. Centers for Disease Control and Prevention CDC recommend vaccination for these groups. Those recommended groups include

People age 65 or older

People over age two years of age who have problems with their lungs, heart, liver, or kidneys

People over age two years of age with health problems like diabetes, sickle cell disease, alcoholism, or HIVAIDS

Persons over two years of age who are taking any treatments that weaken the body’s immune system

Alaskan natives and some Native American populations

The vaccination is also recommended for persons who have had their spleens removed. Unlike vaccination with the flu shot, the pneumococcal vaccine does not need to be given each year. One dosage of the vaccine is usually sufficient, but sometimes doctors recommend a second dose of the vaccine. People over age 65 who received the vaccine prior to age 65 are generally given a second dose along with people with certain serious medical conditions.

Preventing pneumonia is always better than treating it. The best preventive measures include washing hands frequently, not smoking, and wearing a mask when cleaning dusty or moldy areas.

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Dr. Rajan George Chimigen therapeutic vaccine is used to produce immune responses in a host against infections which are difficult to produce immune responses, by targeting the vaccine to dendritic cells. The Chimigen platform can be extended to develop therapies for difficult-to-treat chronic infectious diseases.

Interviewer Does that mean the Chimigen platform can be used to treat any infectious disease?

Dr. Rajan George Yes, except in cases where the immune system is non-functional, as in the case of HIV.The Chimigen platform can be used to produce either a therapeutic vaccine or a prophylactic vaccine. This depends on the disease target and the antigen plugged into the platform. Some antigens have a use in treating infection, while others have a use in preventing an infection. Either one would be targeted to the dendritic cells. The therapeutic vaccine generates a cytotoxic T cell response. A prophylactic vaccine would generate a B cell response and antibody production.
Interviewer From the way youve described the Chimigen vaccine, it appears potentially useful for many applications beyond Hepatitis B and C. How broad are the applications?

Dr. Rajan George We should be able to use this platform for cancer therapy, depending upon the cancer antigen we use. We can plug in a specific cancer antigen into this platform, and the vaccine targeted to dendritic cells. The dendritic cells would process and present the right antigen, then generating immune responses T &B cell against the cancer. We are also evaluating some bioterrorist viruses, the biological weapons terrorists would use. We just started a project to look at one of those viruses to see if we can come up with the prophylactic vaccines to prevent diseases that would be caused by organism that could be used in bioterrorism.

Interviewer Would the Chimigen vaccine be effective as a prophylactic against avian flu, H5N1?

Dr. Rajan George It could work for bird flu if we just plugged in the bird flu antigen into the platform. Then we can use it as a prophylactic. It generates antibody to generate B-Cell response. You can produce a prophylactic vaccine using this platform. The Chimigen platform is quite adaptable.

Interviewer How high is your confidence level in producing a prophylactic vaccine for the avian flu virus?

Dr. Rajan George My thinking is that it is quite high. I think very highly of having a vaccine like that. But, the ultimate proof has to come from humans. Our HepaVaxx B clinical trial will give us a lot of information on how the technology really works. Until then, our optimism is based on laboratory results.

Interviewer Can you describe what comprises the Chimigen platform?

Dr. Rajan George The platform has two components. The first one is from the infectious agent. The second component is from a murine monoclonal antibody. Part one is fused with a fragment of part two by recombinant technology to produce a new entity, the Chimigen vaccine. We are recombining one thing with another. We have a virus which has certain antigens. We take one of those, and we produce a recombinant molecule with the fragment we have taken from a murine monoclonal antibody. Chimigen is the term we came up with to include the meaning of the full phrase, chimeric antigen. Chimeric means it comes from two different sources. We put them together and create a new molecule. One is from the virus. The other one is from the mouse, the monoclonal antibody. Now we have by recombinant methods produced a protein which is a chimeric protein. Thats the Chimigen vaccine.

Interviewer How do you produce such a flexible vaccine, one that appears capable of treating nearly any infection?

Dr. Rajan George To produce a Chimigen vaccine to treat nearly any infection, we start with an antigen protein from the infectious agent. We fuse it with a fragment called Fc of a mouse monoclonal antibody. This is done using recombinant methods. We end up with a new protein. This protein is made in a cell culture of commercially available insect cells. The protein is produced by the insect cells. From the culture, we purify this particular protein that we made. The insect cell system is just a tool. By virtue of its production in insect cells, the protein attains special properties which are useful in generating better immune responses. Producing this protein in insect cells gives it some very peculiar properties, which are different from our own mammalian proteins. Once we have it coming out of the cell, we purify it and make it really pure. Now we have a protein with the virus antigen murine monoclonal antibody with modified properties. This is a totally new entity.

Interviewer What do you mean when you say, useful in generating better immune responses?

Dr. Rajan George When a person has a chronic virus infection, his or her body ignores the virus and associated proteins. The body treats the virus as part of itself. The body does not recognize this virus as something foreign to it. Therefore the immune system does not attack the virus. But, by combining the virus antigen with a foreign protein such as the murine antibody fragment, the whole chimeric protein now is recognized by the bodys immune system as foreign, different from something of its own. In essence, this is a re-education of the immune system to switch its recognition of the virus from self to foreign.

Interviewer From where did the scientific model come, and does it have similarities to another ViRexx Medical product, OvaRex MAb?

Dr. Rajan George This scientific model arose from discussions among the three lead scientists of the company, Dr. Tony Noujaim, Dr. Lorne Tyrrell, both founders of the company and myself. I am a biochemist by training and the collective thoughts of all of us went into the design of the Chimigen platform. One major similarity between Chimigen and OvaRex is that both involve a murine monoclonal antibody. Another similarity is that both target dendritic cells. The Chimigen model came from thoughts about targeting dendritic cells, but without the use of antibodies. OvaRex is a murine monoclonal antibody against the cancer antigen CA-125. The Chimigen vaccine has a fragment of a murine monoclonal antibody. OvaRex needs the CA-125 antigen in a cancer patient to bind to. The bound complex goes to the dendritic cells. The Chimigen vaccine does not need to look for the antigen in a patient because it already has the relevant antigen built in it.

Interviewer It sounds as though the Chimigen vaccine acts in a similar way to OvaRex in dealing with a hostile threat to the bodys health. How do they differ?

Dr. Rajan George There are similarities and there are differences. OvaRex binds to the antigen CA-125. Then, the CA-125Ovarex complex binds to the dendritic cells. The complex is internalized and processed. The peptides generated from the antigen are presented to the T cells, and the chain of events in the immune system gets stimulated. The activated cytotoxic T cells eliminate the cancer cells which contain the CA125 antigen. In the case of the Chimigen vaccine, the vaccine itself contains the antigen. It goes through the dendritic cell pathway and triggers the CTL response to clear the virus-infected cells. The system also produces antibodies to viral antigens, which bind virus and viral antigens and accelerate their removal. Because of the presence of the murine monoclonal antibody fragment, which is foreign to humans, along with the antigen from the virus, the bodys immune system treats this as a new threat and takes action. That is the immune response.

Interviewer How would this work in treating Hepatitis B?

Dr. Rajan George Developing a treatment for Hepatitis B chronic infection, for someone who already has the infection, would involve re-educating the immune system to react differently than it previously has. The infected person already has this virus and the derived antigens. If you put some more of the same antigens into the person, the persons immune system is not going to know the difference His body is going to say, Well, whats the difference? I already have it. I am not going to do anything with it. The body will ignore it. Thats what is called tolerance. With the Chimigen therapeutic vaccine, we have changed the bodys immune response to the virus.

Interviewer How then have you changed the bodys response to the infection?

Dr. Rajan George In a Hepatitis B chronic infection, lets say I have the infection. My system is tolerating the virus. Its ignoring the presence of the virus. While that is happening, the virus may be causing disease in with my liver. With time, its going to get my liver into trouble and my immune system has not responded adequately to remove the threat. We inject the protein the one we just produced, which we call the Chimigen Therapeutic Vaccine into the HBV chronic carrier, a person who has a chronic hepatitis B virus infection. What happens is when our protein is administered, the dendritic cells are going to look for anything new which enters the body. Those cells are the immune systems first-line surveillance. The dendritic cells are going to see this new foreign protein, and they are going to think that this is different from what was previously inside. Their recognition of the molecule has changed from what it was before. Before the virus protein was recognized as a self protein. Now it is being recognized as a foreign protein. In chronic hepatitis B virus infection, the dendritic cells saw the virus as part of the self of the host, the vaccine changes the recognition of the virus protein as foreign to the host. Because the viral antigen is linked to the fragment of the mouse monoclonal antibody the direct the chimigen to dendritic cells it will enter the dendritic cell and be processed and stimulate an immune response.

Interviewer And after the vaccine injection, what does the body see?

Dr. Rajan George The bodys immune system see a new foreign antigen composed of a portion of the mouse monoclonal antibody linked to the viral antigen. Its a foreign antigen. The new chimigen stimulates an immune response to the antigen as well as the viral antigen. This is very important because the virus antigen was previously being ignored. Now, its being recognized as foreign through linked recognition of the mouse antigen as being foreign.

Interviewer How do the dendritic cells react after they recognize this foreign threat?

Dr. Rajan George The dendritic cells are the sentries of the immune system. They guard what comes in. When they recognize a foreign situation, what does the immune system do? It treats the whole molecule, the whole protein including the virus antigen, as foreign. The dendritic cells chop up this protein into small pieces called peptides. These peptides also are called epitopes. There are T cell epitopes which are smaller, and B cell epitopes which are longer. These small peptides bind to MHC I and activate Cytotoxic T lymphocytes CTLs. The dendritic cells have a system where they put the T-cell epitope on another protein, MHC Class I, and bring it to the surface of the dendritic cell. They are presented as a complex on the surface of the dendritic cell to attract the T-cells. The T-cells come and see this, then get activated. Now, the activation is also specific to the virus protein. There are different varieties of T-cells, but the cytotoxic T-Cells are the most important in eliminating infections that already exist. The activated cytotoxic T-cells are the ones who do the attacking. They are the ones who start killing the virus infected cells.

Interviewer And what about the B Cells?

Dr. Rajan George That is the other side to this story. The dendritic cells can present another kind of peptide epitope. There is a second class of peptides, which are also produced when the protein is chopped up. The dendritic cells stimulate the B-Cells, B-Lymphocytes. And B-lymphocytes produce antibodies. The longer peptides bind to MHC II and activate B lymphocytes B cells. B cells produce antibodies against the peptides. The antibodies are specific to the antigens we put in the Chimigen Therapeutic Vaccine. Antibodies bind to viral proteins that are on the surface of and block the ability of the virus to bind to a target cell to cause an infection and prevent the infection. This is the basis of a prophylactic vaccine. The antigen can bind to the invading virus and form a complex that the body eliminates. The B-Cells produce antibodies against the virus antigen, which we have put in the Chimigen vaccine. What do these antibodies do? The antibodies are specific to the antigen and bind to the viruses because they have the antigen. The system removes the virus by binding with the antibody. Also, the system removes infected cells using cytotoxic T-lymphocytes. Both of these actions are achieved by the Chimigen vaccine.

Interviewer Arent there a lot of antibodies being investigated as therapeutics?

Dr. Rajan George There are a lot of antibodies being investigated as therapeutics. OvaRex is the prime example. Avastin and Herceptin are two others, both of which are doing very well in the market. Another is Remicade, which is used to treat diseases such as rheumatoid arthritis. There are antibodies that are in various stages of clinical development, many are humanized antibodies where you want to avoid an immune response to the antibody. Our chimigen technology is new as we are trying to increase the immune response on a virus or a cancer through linked recognition. It is not found anywhere outside of our laboratories. This approach has not been tried before for chronic HBV or HCV infections.

Interviewer Why would your vaccine work where others have tried and failed?

Dr. Rajan George The reason is because of the novelty of the technology. We are re-educating the bodys own immune system to do the work by using the Chimigen technology. When you inject a xenotypic antibody , that is a non-human antibody that is linked to a specific antigen. The body recognizes the whole molecule as foreign and produces immune responses with both T- and B-Cell immunity. We believe that this enhanced immune response will be helpful in controlling the viral infection in the case of viral chimigens.

Interviewer Much of the research has been within the laboratory. How much of this is hypothetical?

Dr. Rajan George Our experiences so far have been mostly with isolated systems, meaning experimental systems outside of the body. For example, ViRexxs Chimigen vaccine for treating chronic hepatitis B infection is what we call HepaVaxx B. This is waiting to go into Phase I clinical trials. We have done a lot of ex vivo experiments in the lab to evaluate the immune responses it can produce. We showed what we had predicted in theory has been true. We have also done some animal experiments, where the vaccine showed similar effects, again, as predicted. For HepaVaxx B, the animal results are also showing great progress and promise. We believe the Phase I studies will show safety and maybe some immunological data. The advanced clinical trials, Phase II and III, will tell us exactly what happens in humans efficacy with a chronic infection of Hepatitis B. I believe the Chimigen vaccine platform can make a difference in the area of immunotherapy of infectious diseases and cancer. For HCV, there is neither a therapeutic vaccine nor a prophylactic vaccine available in the market right now. Current available therapies are not very efficient, are expensive and have severe side effects. We do need more effective vaccines, both prophylactic and therapeutic, to prevent new hepatitis C virus infections and to eliminate existing infections. It is not an easy challenge but hepatitis C is an important target.

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While preparing a lecture in biochemistry and virology for his graduate students at the University of Alberta in the early 1980s, Dr. Lorne Tyrrell ran across a study just published in the medical journal, Cell. The research by William Mason and Jesse Summers, entitled Replication of Hepatitis B, discussed their study of the hepatitis B virus in infected duck liver.

After studying their duck model theory, Tyrrell speculated if the hepatitis B virus HBV might be susceptible to antiviral agents, and consulted with a colleague, who specialized in nucleoside chemistry. Both medical professors became excited about the possibility of inhibiting the HBV virus with nucleoside analogues. Thus began the infectious disease specialists first leg of a journey, which led to the use of lamivudine as a therapy for chronic HBV infections.

More than 350 million people across the world, especially in Asia, now had new hope, some for their lifelong infections contracted vertically at birth from their mothers. In 2003, the Center for Disease Control estimated 73,000 Americans were infected with HBV, and about 5,000 die each year from sickness caused by HBV. It is reportedly 100 times more contagious than the AIDS virus. Many in North America, who had been infected with the virus from sexual transmission or intravenous drug use, were offered a potentially life-saving therapy.

Licensed in 1998, lamivudine is now used in 120 countries as a standard therapy for chronic HBV carriers. The compound is also used in combination with other drugs, such as protease inhibitors, for HIV therapy. Development rights were licensed to Glaxo Wellcome in 1990, which is now sold under the brand name Epivir. For his pioneering efforts in developing the antiviral agent, Dr. Tyrrell was awarded the gold medal by the Canadian Liver Foundation and the Canadian Association for the Study of Liver in 2000. In 2005, he won the prestigious EnCana Principal Award for his development of the first effective oral medication for Hepatitis B.

HIS UNANSWERED QUESTIONS LAUNCHED A NEW HBV INVESTIGATION

Despite the awards and recognition, questions remained for Dr. Tyrrell about the shortcomings of lamivudine. He was troubled that some viruses would develop resistance to the compound. I was disappointed the sustained viral response was not complete, Tyrrell told us. In April 2003, the Journal of Antimicrobial Chemotherapy published a study in Japan showing, long-term lamivudine therapy is associated with increased emergence of lamivudine-resistant strains of HBV. Researchers concluded in this study, The therapeutic challenge to effectively treat chronic HBV infection continues.

Having screened lamivudine for use in Hepatitis B at Glaxos research lab at the University of Alberta, Dr. Tyrrell was able to observe the immune response of various HBV patients. What really got me interested in doing more work in this area was that we noticed patients, who have an immune response to the virus and take lamivudine, will have a better sustained response rate, Tyrrell explained. A patient with elevated liver transaminases taking lamivudine had a higher probability of a sustained viral response, Tyrrell said with excitement in his voice. In a patient with normal liver enzymes, who gets lamivudine, the virus will go down, but as soon as you stop the therapy, the virus comes right back up. He told us the sustained viral response is only about two to three percent. Only about 30 percent remain free of the virus, about one year after patients have stopped taking lamivudine.

How do you break tolerance? Tyrrell asked himself, hoping to develop a way to stimulate an immune response. All of the patients, he had observed, seemed to be tolerant of the hepatitis B virus. He pondered the dilemma, Was there some way to break tolerance to hepatitis B by stimulating the immune response? Tyrrell studied what others were attempting and wasnt satisfied with the approaches others were taking to stimulate immune response. His ViRexx Medical research team brainstormed about different ways to target the antigen into the dendritic cells.

Thats where we came in with the Chimigen technology, Tyrrell said. The dendritic cells have receptors on their surface that will bind the Fc portion of an antibody. He pointed out a key feature of the Chimigen platform, We used the Fc portion of a murine mouse antibody to hook onto our hepatitis B antigens. This would direct the viral antigens into dendritic cells in vivo. Because the dendritic cells are the sentries of the immune system, they guard what comes in. Recognizing a foreign situation in the murine antibody, it treats the whole molecule including the virus antigen as foreign.

LINK RECOGNITION MAY HOLD THE KEY

Dr. Rajan George, ViRexx Medicals vice president of research and development, told us, The dendritic cells chop up this protein into small pieces called peptides, also known as epitopes. The dendritic cells have a system where they put the T-cell epitope on another protein, MHC Class I, and bring it to the surface of the dendritic cell. They are presented as a complex on the surface of the dendritic cell to attract the T-cells. When the T-cells arrive to inspect the foreign entity, the cytotoxic T-cells are activated. Then, they begin attacking and killing the virus-infected cells.

Research at Tokyos Cancer Institute Hospital, published in 1987 in Nippon Sanka Fujinka Gakkai Zasshi, suggested a feasibility of linked recognition of a virus antigen as a helper in tumor immunity with a target antigen. In the case of ViRexx Medical, Tyrrells team has created a new molecule, called chimigen. The term is shorthand for a chimeric antigen, meaning it is an antigen created from two different sources, part virus and part murine monoclonal antibody.

Dr. Tyrrells work at ViRexx Medical with Dr. George suggested the linked-recognition theory might be the key to breaking tolerance. Dr. George emphasized, The new chimigen stimulates an immune response to the antigen as well as the viral antigen. This is very important because the virus antigen was previously being ignored. That brings us back to why lamivudine had limited success. The immune systems of some HBV carriers failed to recognize the viral infection as a threat to the body. Tyrells ViRexx Medical research team hopes the bodys immune system sees the threat, thus stimulating the immune system, and breaking tolerance. It appears Dr. Tyrell may soon find out whether or not the questions he asked will bring the answers he hoped for.

END OF PART ONE

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Since 1997, and especially since the beginning of 2004, approximately 150 million birds have either died from the disease or been killed to prevent further spread. Nevertheless, this very infectious and deadly virus has spread relentlessly to China, Thailand, Cambodia, Vietnam, South Korea, Japan, Taiwan, Laos, Russia, Indonesia, Mongolia, Kazakhstan, Malaysia, Turkey, Romania, England, Croatia, Macedonia, and other countries. This ongoing geographic extension of the virus is of great concern around the world. It is feared that it will continue to spread to all continents, including the Western Hemisphereand it no doubt will.

Normally, different types of viruses infect just one, or a limited number, of species specific to the particular virus type. The bird-flu virus, however, has infected a large number of birds and animals, including ducks, chickens, turkeys, tree sparrows, peregrine falcons, great black-headed gulls, brown-headed gulls, gray herons, Canada geese, bar-headed geese, little egrets, pigs, clouded leopards, white tigers, mice, domestic cats, crows, magpies, peacocks, blue pheasants, rare eagles, turtledoves, swans, terns, and others. This is another sign of the virulence or destructiveness of the virus.

Researchers, historians, and infectious-disease experts have determined that influenza pandemics global epidemics occur approximately once every 30 years. The most deadly pandemic ever recorded occurred in 1918-19, killing more than 100 million people across the globe in less than two years. Two other much less severe pandemics occurred, one in 1957, when approximately two million people died, and one in 1968, when about one million people died. Because we have already had three pandemics in less than 100 years, we are overdue for another one.

And so this disease-causing virus continues to infect more and more species in more and more countries. In laboratory experiments, it has been shown to be one of the most lethal influenza viruses ever known. In addition, just recently and after 10 years of work, researchers determined that the H5N1 bird-flu virus is genetically more similar to the deadly 1918-19 influenza pandemic virus than to the viruses which caused the much less severe pandemics of 1957-58 and 1968-69.

To summarize the important points so far The bird-flu virus is a very deadly strain of avian influenza called H5N1 that has killed millions of birds; 2 the virus is spreading relentlessly around the world; 3 the virus has infected many species, which is uncharacteristic of most viruses; 4 the virus has been shown to be similar to the most deadly virus ever known, which caused the 1918-19 pandemic; 5 the virus has been shown to be much more deadly in laboratory experiments than regular influenza viruses; and 6 the virus is known to have infected at least 125 humans and killed 64 of them so far, yielding a fatality rate of approximately 50 percent.

The virus continues to kill humans, but at a slow rateit has not yet acquired the capacity to be easily transmissible between humans; humans become infected primarily from sick birds. Because humans alive today have no natural immunity to the H5N1 virus, once it becomes easily transmissible between humans a pandemic or global epidemic will occur. The central question is, when will it exchange enough genetic material with the usual seasonal human influenza-viruses to become more like a human-influenza virusand thus become easily transmissible between people?

Many people believe that the virus will continue to spread around the world until it is present in most or all countriesbefore it will go human become easily transmissible between people. And that may be the case. The pandemic of 1918-19 is thought to have started in Kansas of all places. So it is certainly possible that the coming pandemic could start somewhere else than in Asiaalthough most experts believe it will, in fact, start there. It could start in a country which has not yet been host to the virus.

However, it is most certainly not necessary for the virus to march all the way around the world before a pandemic can begin. The fact that the virus already has spread to more than 15 countries, and to many different bird and animal species, provides the opportunity for it to commingle with a human-influenza virus and create the dreaded human contagion. There is no known reason why this could not happen tomorrow. While it is true that the probability of the switch increases with time, the probability of its happening tomorrow is far from zero.

The flip side to the possibility that the crossover could happen at any time is the fact that the virus has been around at least since 1997 and, as a matter of record, has not yet switched to a deadly human-to-human form. At least a few scientists believe that the virus cant and wont make the switch to a deadly form, possibly ever.

And so we are left with these two very different possibilitiesat any time, and as soon as tomorrow, the virus could mutate into a deadly form, readily transmissible between peopleor it might never transform itself into such a form. There appears to be much more evidence for the former and, presumably, that is why the vast majority of scientists and governments are scrambling to prepare for the worst.

This situation is analogous to living on the Gulf Coast during the beginning of hurricane season. Residents there have been through it before, but most of the time the storms are not too severe and the people can get by without too much hassle. However, there have been rare severe storms that have been devastating. Some day another hurricane is coming, and it appears that it might well be a Category IV or even V by the time it strikes land. However, thats not certainno one can say for sure, and no one knows exactly when it will strike land. So what should the residents do? What should the residents have done before hurricane Katrina?

The coming bird-flu pandemic might be mild and it might not come for years. On the other hand, it might be severe and it might start tomorrow. The U.S. Government Accountability Office GAO has said, While the severity of the next pandemic cannot be predicted, modeling studies suggest that its effect in the United States could be severe. We should also be mindful that the pandemic could come at any time, even before the virus methodically marches around the globe. No matter how advanced science has become, we still can not predict when the switch will occur; it is currently unknowableand that does not mean it will come later, in a predictable fashion. As Miguel de Cervantes admonished, Forewarned, forearmed.

Bradford Frank, M.D., M.P.H., M.B.A.
The Frank Group
P.O. Box 138
Lakewood, NY 14750

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There are over 100 strains of avian flu, but most of them do not infect humans. The current strain H5N1 can infect humans, but not easily. The number of cases of avian flu in humans in the current outbreak is very small, and almost all have come about by direct contact with infected or dead birds something that most of us are unlikely to experience. So far, the spread of H5N1 virus from person-to-person has been rare and has not continued beyond one person. In fact according to The Times London, 23rd March 2006 only 184 confirmed cases have been reported worldwide so far from this strain, with 103 deaths. These have been in Cambodia, China, Indonesia, Thailand, Vietnam, and most recently, several cases in Turkey.

What the authorities are much more concerned about is the strain mutating into a variation that can be transmitted between human beings, rather than just from bird to human. This has been designated as influenza AH5N1. Humans do not have any resistance to this strain, because these viruses do not commonly infect humans. If a strain developed that could infect the human population, a pandemic would be likely with many people being infected and dying. The 1918 Spanish flu is estimated to have killed 50 million people worldwide. At least four of the eight genes of H5N1 avian flu now contain mutations seen in that deadly strain.

Jeffery K. Taubenberger, a molecular pathologist at the Armed Forces Institute of Pathology in Rockville, USA has said

“These H5N1 viruses might be acquiring the ability to adapt to humans, increasing their pandemic risk … there is a suggestion there may be some parallel evolution going on.”

Scientists still do not understand completely how a bird virus becomes a human virus, but H5N1 is already showing some of the mutations necessary for it to become a human flu, but at the moment, in spite off all the panic, there is no pandemic flu strain.

Research in the Netherlands and the USA has shown that while human influenza viruses are able to bind with receptors in the windpipe, H5N1 binds only much deeper inside the lungs. This makes it more difficult for the virus to infect humans, because the virus is less likely to reach the inner lungs than the windpipe. The H5N1 virus is also less likely to spread from human to human. Coughing and sneezing easily transmits viruses that have multiplied in the windpipe, but not those located deep in the lungs. If H5N1 manages to mutate so that it can replicate in the upper respiratory tract, a pandemic becomes more likely. Scientists are constantly monitoring the virus for this mutation.

So should we be concerned? There have been many scares over the years that have not come to anything, and this could turn out to be one of those too, but it is worth taking some sensible precautions rather than just relying on the scientists to find a powerful enough solution. Having a strong immune system has to be the first line of defence. Eating a good diet, taking exercise, getting plenty of sleep, and reducing stress can all lead to a stronger immune system that can fight more effectively against the bugs of this world and any dangerous mutations.

References
Daily News Central Bird Flu on Similar Evolutionary Path as 1918 Killer Virus

Centers For Disease Control & Prevention Key Facts About Avian Influenza Bird Flu and Avian Influenza A H5N1 Virus

The Times London 21 January 2006 and 23 March 2006

The Guardian London 1 March 2006

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Some infected people have developed abnormal clotting profiles resulting in excessive bleedingwhich was a frequent clinical symptom in the deadly so-called Spanish influenza of 1918-19, which killed more than 100 million people worldwide. Indeed, bird flu shares a number of disturbing characteristics with the 1918-19 influenza virus. These two viruses have, in fact, recently been shown to be similar genetically. And in a recent laboratory experiment with mice, the 1918-19 virus was found to produce 39,000 times more viruses four days after infection than the regular seasonal human flu strain. The 1918-19 virus killed 100 percent of the mice that were infected with it, compared to none of the mice infected with the regular flu strain. With a current case fatality rate, or death rate of approximately 50 percent in humans, bird flu is obviously also a very deadly disease.

There are only a few reports in the medical literature describing the clinical features of bird flu in humans. The clinical spectrum of H5N1 infection ranges from asymptomatic infectionwhere the person doesnt even know he or she is infectedto fatal pneumonia and multiple organ failure. Some infected individuals develop liver or kidney dysfunction, and there were two children who died from the virus that came to medical attention because of diarrhea and seizures related to encephalitis infection of the brain. However, the most common presentation is one of fever, cough, and trouble breathing. Approximately 70 percent of patients also have diarrhea, and a few patients have had only gastrointestinal symptoms such as stomach ache, vomiting, and diarrhea and no breathing problems.

Deaths have generally been in normally healthy people. The first report in the medical literature of deaths from bird flu was on 12 patients living in Hong Kong. Their median age was nine years, with a range of one to 60 years. All presented with fever, and eight had symptoms or signs of upper-respiratory infections five had clinical and X-ray evidence of pneumonia when first diagnosed. Gastrointestinal GI symptoms, including stomach pain, vomiting, and diarrhea, were present in eight patients. There were a total of five deaths one died with Reyes syndrome, which is associated with taking aspirin in children.

In a study of 10 patients in Vietnam with laboratory-confirmed avian influenza H5N1, the mean age of the patients was 13.7 years. For eight of the patients, there was a clear history of either direct handling of poultry chickens or ducks or exposure to sick poultry in the week before the onset of illness. All presented in January 2004 with cough, shortness of breath, and fever, and seven had diarrhea; none had myalgia muscle acheswhich is often found in the regular seasonal flu. Notably, oseltamivir Tamiflu was administered to five patients, four of whom died treatment was probably started too late for the medication to be effectiveit must be given within 48 hours after onset of symptoms to be effective. In total, eight of the patients died, for an 80 percent case fatality rate or death rate.

As is apparent from the descriptions above, the presenting symptoms of individuals with bird flu are very similar to the symptoms of the normal seasonal flu. Infections caused by either the bird-flu virus H5N1 or the seasonal influenza virus can be completely asymptomaticthat is, cause no symptoms at all. Fever, cough, malaise feeling ill, and gastrointestinal symptoms are common to both infections. Excessive bleeding occurs only with bird flu, but currently this symptom doesnt appear to be common. Difficulty breathing is more common with severe cases of bird flu, not seasonal flu. Runny nose and sneezing are found only with colds or allergies.

The cough in either type of infection is what is referred to in medicine as nonproductivemeaning there is no sputum brought up when coughing, or if any sputum is brought up, it is white in color. This type of cough is characteristic of upper respiratory viral infections. As either type of infection progresses or worsens, tissues may be damaged, disrupting the normal structure and function of the infected cells. This in turn may allow bacteria to grow and also cause damage. When this happens following a viral infection, it is referred to as a secondary bacterial infection. When this occurs, the color of the sputum characteristically turns yellow or green. If this happens, antibiotics are indicated to treat the bacterial infection. Antibiotics are not indicated in the treatment of viral infections, because they dont work.

It is safe to assume that during a bird-flu pandemic, most individuals who become infected with the bird-flu virus will either be asymptomatichaving no symptomsor their illness will not be severe enough to require hospitalization. The small percentage who do become seriously ill will have to be hospitalized, and treated with either of the two antiviral agents available, oseltamivir Tamiflu or zanamivir Relenza. A smaller subset of that group will develop life-threatening complications such as acute respiratory distress syndrome ARDS, which requires treatment with a mechanical ventilator, a respirator.

Some individuals may develop other serious complications such as liver failure, kidney failure, neurological problemssuch as seizures, paralysis, psychiatric problems such as delirium or psychosis, or bleeding problems. However, it is reasonable to predict that most people infected with the virus will not die and will not have significant residual symptoms, although a small percentage will.

Bradford Frank, M.D., M.P.H., M.B.A.
The Frank Group
P.O. Box 138
Lakewood, NY 14750
www.AvoidBirdFlu.com

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Multiple Sclerosis MS affects the central nervous system or the brain and spinal cord areas in the body. Believed to be an autoimmune disorder, MS is a condition where the patients immune system produces antibodies against their own body. These antibodies and WBCs white blood corpuscles are then directed against proteins in the myelin sheath. The myelin sheath is made up of fatty substances that protect the nerve fibers in the spinal cord and brain. This attack usually results in injury and swelling to the myelin sheath and ultimately to the surrounding nerves. The injury leads to scarring or sclerosis in multiple areas of the central immune system, thus damaging the nerve signals and control muscle coordination. The disease also eventually impairs vision and muscular strength.
The nature of MS is unpredictable and it can vary in severity from person to person. While some patients who suffer from the said disease only experience mild illness, other MS cases can also lead to permanent disability. Treatments for MS can help in modifying the course of this illness while relieving symptoms.
Determining the real cause of MS still remains elusive even if scientists have already learned a great deal about MS in recent years. It is known that MS is a form of autoimmune disease — one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger such as a virus infection.
Pain and spasticity are two of the most common symptoms from which people with MS suffer. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements. A recent survey of members by the MS Society found that 54 reported pain as a current symptom, while 74 reported experiencing spasticity. The importance of these symptoms is not simply because of their frequency, but also because of the impact they have on the patient’s daily life. As the disease progresses, so does the spasticity, resulting in muscle spasms, immobility, disturbed sleep, and pain. Disability resulting from spasticity often forces patients to need extensive nursing care.
Pain can be caused by a variety of factors including spasticity itself, in addition to neuronal damage due to the disease process. Not uncommonly, it may be musculoskeletal in origin, arising as a result of abnormal posture following the disability caused by MS.
There are several treatment options for MS. However, one medication that was commonly cited by different and numerous research is called Baclofen. This medication can help decrease the spasticity of MS patients. Baclofen is a muscle relaxant commonly used to decrease spasticity related to spinal cord injuries, or other neurological diseases such as MS.
Spasticity is caused by an imbalance of electrical signals coming from the spinal cord through the nerves to the muscle. This imbalance causes the muscle to become hyperactive, resulting in involuntary spasms. Baclofen works by restoring the normal balance and reducing muscle hyperactivity. In this way, it allows for more normal muscle movements.
Baclofen, also known under the brand name Lioresal, can be taken as a pill or delivered directly into the intrathecal space, an area in the spine. The space contains the cerebrospinal fluid CSF which surrounds the spinal cord and nerve roots. Most often, MS patients receive intrathecal baclofen, since oral Baclofen can cause unpleasant side effects. Since the medication does not circulate throughout the body, only tiny doses are required to be effective, therefore the side effects are minimal. Through intrathecal Baclofen it will deliver the right drug right to the target spot in the spinal cord.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision the MS patient and the doctor will make. Skeletal muscle relaxants such as Baclofen are used to relax certain muscles in the body and relieve the stiffness, pain, and discomfort for MS patients. However, these medicines do not take the place of rest, exercise or physical therapy, or other treatment that a doctor may recommend.

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