The virus:

A virus is made up of a bundle of familial stuff bounded by a protein and lipid shell. The avian grippe virus, classified as a type A grippe virus, consists of 10 proteins encoded by eight strands of ribonucleic acid. The lipid shell of the virus contains surface proteins that are able to adhere to membrane receptors located in epithelial cells of the respiratory piece of land and lungs of the victim.

When edge to the receptors, the virus is drawn into the cell membrane, blending and traveling through it, after which the shell opens and the RNA is released into the cytol. The genome exists as negative RNA – it must be transcribed before protein synthesis can happen, therefore it translocates to the karyon of the host cell where this written text to mRNA, or positive RNA, occurs. Some mRNA re-enters the cytosol to be translated into the viral proteins, utilizing the host cells ain ribosomal machinery, while some remains in the karyon and is used to synthesize farther transcripts of the negative RNA for the virus ‘s extension. The new viral RNA so moves back into the cytol where it joins with the freshly made proteins to be packaged into new transcripts of the complete virus. The assembly occurs on the interior of the cell membrane, and as the procedure is completed, the virus moves through the cell membrane by exocytosis. The new virus is either released into the air passage to happen another host cell to infect or is ejected in a cough or sneezing and launched to happen a new host. Virus reproduction dominates the cell ‘s machinery and resources to the extent that the host cells die ; it is these dead cells in the air passages that result in the diagnostic rhinorrhea and annoyed pharynx. A really big figure of dead cells in the lungs can ensue in complications taking to decease.

Drug and vaccine action:

Two antiviral medicines, oseltamivir and zanamivir, are likely to be successful in handling grippe caused by the H5N1 virus, but extra surveies are needed to show their current and on-going effectivity. They are Neuraminidase ( N – one of the viral proteins ) inhibitors, which block the release of the freshly formed virions from the septic cells, forestalling spread to other cells. These drugs are merely utile within 1-2 yearss of infection in commanding spread, therefore rely on prompt diagnosing which may non ever be possible given the similarities between symptoms of grippe and other unwellnesss such as the common cold.

A vaccinum has been developed to protect worlds against the avian grippe virus, but due to the low transmittal rate of avian grippe it is has non been used by the general populace. The vaccinum contains an antigen with an adjuvant ( a chemical that stimulates the immune system ) in order to fix the immune system for the virus by hive awaying antibodies to destruct the virus upon infection.

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Spread of the virus:

Most instances of avian grippe infection in worlds have resulted from contact with septic domestic fowl or surfaces contaminated with eliminations from septic birds. The spread of avian grippe viruses from one ailment individual to another has been reported really seldom, and has been limited. Infection of a host cell requires a specific receptor, which birds possess but on the whole worlds do non. It ‘s limited spread from birds to worlds could be accounted to the fact that receptor mutants in some persons or populations can take to ability of the avian grippe virus to adhere – for illustration in the Asian population that suffered an eruption, or to a mutant in the virus.

Mutant:

All Type A Influenza viruses, which includes those that infect worlds and birds, mutate easy because the virus deficiency mechanisms that prevent alterations in its familial codification during reproduction, and are unable to mend any alterations that do occur. As a consequence of these uncorrected mistakes, the familial composing of the virus alterations ( mutant ) during reproduction and the bing strain is replaced with a new mutant virus, decently known as an antigenic discrepancy. These changeless, lasting and normally little alterations in the antigenic composing of Influenza A Viruses are known as antigenic impetus. The danger in antigenic impetus is that Influenza Viruses that are mildly infective can mutate into signifiers that become extremely infective to an increased figure of species, taking to high mortality rates in worlds.

Epidemiology:

History of Avian influenza epidemic:

Outbreaks of avian grippe occurred among domestic fowl in eight states in Asia during late 2003. Over 100 million birds in the affected states either died from the disease or were killed in order to seek to command the eruptions. In March 2004, the eruption was considered to be under control. However in June 2004, new eruptions of the H5N1 virus among domestic fowl and wild birds were reported in Asia. Since that clip, the virus has spread geographically. Human instances of grippe A ( H5N1 ) infection have been reported chiefly in Asia and Africa. There have been 282 instances of confirmed mortality and 467 instances of morbidity caused by the virus.

Preparation for epidemic:

  • Stocking of antiviral drugs is necessary in order to cut down the strain on pharmaceutical companies.
  • Vaccines should be issued to authorities functionaries and healthcare workers in order to keep bureaucratism and wellness services during an avian grippe epidemic.
  • Support of the development of new antiviral drugs. The seasonal grippe has shown new opposition against amantadine and oseltamivir due to mutant.
  • Development of schemes for the stages of the epidemic such as no human-human transmittal and low human-human transmittal.

Oseltamivir

Efficacy/resistance

Due to high rates of mutant and multiple strains of influenza some strains have appeared to be immune to Oseltamivir. The clinical efficaciousness is presently unknown against H5N1.

Supply chain/availability

  • Shikimic acid supply from China is really limited
  • 90 % of all star Pimpinella anisum is already used in Tamiflu industry by Roche
  • Tamiflu has been stockpiled worldwide as 400million doses ( 2006 )
  • Dose dependent supply is required

Vaccines can be stored before the epidemic reaches the UK, nevertheless these vaccinums will non be good matched to the specific strain doing the epidemic. Research shows that mismatched vaccinums may supply up to 30 % defense mechanism against the virus and lower transmittal rates by up to 50 % . A vaccinum designed to aim the exact strain of the virus provides around 70 % protection and can cut down transmittal by 80 % . This information shows that if the full population was vaccinated against the virus, even with a mismatched vaccinum, the already low transmittal rates would be lowered significantly, diminishing the likeliness of the oncoming of a pandemic.

Antiviral drugs have the ability to supply both bar ( chemoprophylaxis ) and intervention of the grippe if administered within 48 hours of the oncoming of symptoms. Antivirals are a utile combination with vaccinums in order to alleviate the strain on the wellness service and lower the economic load of an influenza epidemic. Neuraminidase inhibitors are nevertheless dearly-won due to the deficiency of natural stuff ( leading Pimpinella anisum ) . They have really small inauspicious effects and low grounds of drug opposition, and curative value in diminishing lower respiratory tract complications doing them an ideal solution. Research proves that intervention with neuraminidase inhibitors reduces virus casting, but the full impact on transmittal demands farther probe. Zanamivir suffers from hapless bioavailability and it has to be administered through an inhalator device, doing it hard for mass distribution.

Manufacturing Issues:

Stockpiled vaccinums and antiviral drugs will be used up in the initial period of the epidemic, puting great strain on fabrication. Production of vaccinums via the egg based method stopping points at least six months, so supply of more vaccinums will be in moving ridges of 6 months. This means in the average clip there will be a great dependance on antiviral drugs.

Plant location is critical to guarantee speedy distribution, nevertheless in the current economic crisis the UK is non a favorable location for the investing of pharmaceutical companies. Firms will look to put up production capacities in states where labor is inexpensive and natural stuff is available ; China is extremely desirable for this ground ( big star Pimpinella anisum resources ) .

Timescale of fabricating rel. to epidemic timeframe

Distribution

Workers plan in epidemic

Social Planning Issues

Guidelines should be published in paper format and on the cyberspace available to all members of the population in the instance of an epidemic. A hotline should be set up to inform the populace of to maintain them updated. Advice on which people who should avoid go forthing place should be announced on a regular basis. As per old patterns closing of schools and offices should organize with authorities process. Instruction manuals on how to manage natural domestic fowl and eggs should be published.

  • Wash custodies with soap and warm H2O after contact with natural domestic fowl and eggs.
  • Thoroughly wash film editing boards and utensils with soap and hot H2O.
  • Cook domestic fowl to a temperature of at least 165 grades F.
  • Cook eggs until house.

In order to decelerate the spread of avian grippe in an epidemic biosecurity patterns should be employed by domestic fowl husbandmans.

  • Farmers disinfect their vesture and places every bit good as their farm equipment.
  • They should divide domestic birds and wild birds.
  • Infected birds should be quarantined.

The stockpiled antiviral drugs should be prioritised to be available to the ground forces and constabulary in order to keep jurisprudence and order. Surgical masks should be issued to officers who may be in contact with people who have contracted the virus, as they help forestall the virus from come ining the take a breathing piece of land of the host. Health workers who will more than probably come into contact with patients with the H5N1 virus should be vaccinated and take safeguards such as have oning surgical masks while being on a ward and they should rinse their custodies exhaustively after patient contact

Ethical motives:

When new drugs are manufactured by companies they obtain a patent which restricts other companies from fabricating the drug for a certain period of clip. In an epidemic the authorities may forcefully allow other companies to patented information of the fabrication procedure to make a intervention for avian grippe to run into high demand. However the legality and ethical rule of this behavior may be breached. The company with the patent will lose big amounts of gross which will hold to be reimbursed.

Will it be morally right to publish redresss which have non been wholly tested ( Eg. plasmid based therapy ) . These redresss will hold non been extensively tested for side effects and may do terrible harm to the user. However they do hold their pro ‘s in that they can be manufactured in a 2 hebdomad period to run into demand. The clinical efficaciousness of these interventions will besides be unknown.

The current fabrication works capacity is deficient to provide vaccinums and antivirals in the instance of an epidemic or pandemic crisis. Pharmaceutical companies looking to spread out their capacity should be helped by the authorities with grants in order to accomplish higher end products in return for company trueness in the signifier of free drugs to add to the current insufficient reserve. Should not validated fabrication workss be commissioned depends on the degree of the crisis, agony may be reduced if such workss are allowed to be commissioned nevertheless these production capacities may bring forth ‘bunk ‘ merchandises due to a deficiency of proving of equipment.

Another ethical quandary is raised when sing if the authorities should supply intervention to high hazard groups such as the aged first. Should those in a place of power be allowed to have intervention foremost? This is morally wrong as each life is every bit valuable as another nevertheless during an epidemic the lives of those involved in halting the virus spread are critical to salvage lives and enduring on a larger graduated table.

Bibliography:

hypertext transfer protocol: //www.news.cornell.edu/stories/Oct05/avianflu.thevirus.ws.html

hypertext transfer protocol: //health.howstuffworks.com/bird-flu2.htm

hypertext transfer protocol: //www.medicinenet.com/bird_flu/page3.htm

hypertext transfer protocol: //www.cdc.gov/flu/avian/gen-info/facts.htm

hypertext transfer protocol: //www.ringsurf.com/online/2210-mutation_of_avian_flu_virus.html

hypertext transfer protocol: //www.nature.com/nrd/journal/v5/n12/full/nrd2175.html

hypertext transfer protocol: //docs.google.com/viewer? a=v & A ; q=cache: UsYy1gJ-AJkJ: www.who.int/entity/csr/disease/avian_influenza/Antivirals_their_use_and_availability.pdf+limitation+of+antivirals+avian+influenza+advantages & A ; hl=en & A ; gl=uk & A ; pid=bl & A ; srcid=ADGEESh_vzISuk2y5XnfK9_H9LsuuFtk0YR2MeJ4D1oVY8dGCk4Lq5PfM8VhZomcAvBEtdyiOM-jRf7g6ICwACb5CRq7iN4mRtx0pjnnkxh6lAG81LJ5bmqAXMExFaGotxcb8cxeKmm0 & A ; sig=AHIEtbTAUUarBpYJZGUCHN0Hz9Uq0BUaaw

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