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Global death toll from H1N1 influenza higher than previously reported: between 200,000 and 400,000 

MD-FM Thursday November 28, 2013

  

Sarah:

MD FM — Medical News from around the world with Peter Goodwin.

 

Segment 1: Between 200,000 and 400,000 deaths attributable to the 2009 H1N1 outbreak 

 

PETER:

Hello, and with me is Sarah Maxwell. To begin with: the 2009 swine flu outbreak may have killed at least 10 times more people than originally estimated by the World Health Organization, that’s according to findings published in PLoS Medicine….

 

SARAH:

That’s right, the new estimate, based on mortality data, is that 200,000 people were killed by the influenza pandemic, and this figure is apparently conservative, since it only accounts for respiratory deaths in the year 2009. The actual mortality rate might even reach 400,000. What’s more, the majority of deaths were in young people:

 

SIMONSEN:

“Normally with flu, you have people in their 70 and 80 years old dying, here, all the deaths we are talking about are in people that are mostly younger adults. So this is a lot of jumbo jets full of people, if you think about it, 200,000 people. That’s a very big toll in terms of years of life lost.” 

 

SARAH:

That was lead study author Lone Simonsen, from George Washington University, in Washington DC. These findings are based on mortality data from 26 countries, and they show the Americas were most severely affected, while European countries, New Zealand and Australia were more or less spared…

 

SIMONSEN:

“The important thing we should take away is that when we gage the pandemic severity in the future, we should pay attention to the fact that it can be felt differently in different parts of the world. This time around, we did get early reports from Mexico that was severe, and Argentina... But many Europeans were wondering what all the fuss was about because they couldn’t feel the impact! And nobody thought that both could be true. When we show these slides, the european researchers’ jaws drop because they just hadn’t expected that. So what we learned from this pandemic is that the death toll can be very heterogeneous. It can be felt like 20-fold worse in some countries than in others.” 

 

SARAH:

Lone Simonsen, from Washington DC, and senior co-author, John Paget, told us they are now trying to figure out what might explain these regional differences…

 

PAGET:

“That’s the big question now, we are going to try and establish what factors could explain these differences. One, which we are pretty sure about, is the age structure. So in countries with lots of young people, you had higher mortality impacts. But we are also looking at other factors, like what viruses circulated the season before, so we’re in the midst of that project.”

 

SARAH:

Dr John Paget, from the Netherlands Health Institute for Health Service Research.



SEGMENT 2: Antiviral drugs improved survival in children with ’flu up to 48h after symptom onset.


PETER:

For children critically ill with influenza, antiviral drugs, given within 48 hours after symptoms appear, can improve survival. That’s according to a study published in Pediatrics that analyzed data on nearly 800 children, hospitalized with confirmed cases of flu. Those treated with neuraminidase inhibitors, up to 48 hours after symptom onset, were less likely to die.



SEGMENT 3: Metformin boosts survival in patients with type-2-diabetes who have cancer.

 

PETER:

For patients with diabetes, metformin can not only reduce the risk of developing cancer, but new data reported in The Oncologist shows it also appears to increase survival in diabetic patients with cancer.

 

SARAH:

Yes, that’s the finding of a meta-analysis looking at about 13,000 patients in 20 observational studies over the last three years. It showed that for patients with type 2-diabetes who also had cancer, taking metformin was associated with 30 to 40 per cent prolonged survival compared to those on other types of diabetic medication.

 

PETER:

There’s been a lot of epidemiological data recently supporting the idea that metformin has an anti-neoplastic effect, and these new data look very impressive.  I wonder what the mode of action might be?

 

SARAH:

Well, clearly it’s not just the anti-diabetic effect because neither insulin nor other drugs for diabetes are associated with a lowering of cancer risk. The lead study author Dr Ming Yin told MD-FM it was because metformin increases insulin sensitivity and other studies suggest that circulating insulin does play a role in cancer development, and he said there’s evidence it could also act directly to inhibiting cancer cell proliferation and promote cancer cell death.

 

PETER:

And metformin is cheap and also tried and trusted… So is the finding for any type of cancer? 

 

SARAH:

Well Dr Yin said it might be a little too early to apply this across the board:

 

YIN:

“At least for colorectal cancer and pancreatic cancer, we can see that the metformin treatment is very effective and for these types of patients, we encourage to use metformin in the treatment regimen, if there’s no contraindication to metformin, like heart disease, severe heart failure, renal disease or liver disease… But it may be too premature to say if every type of cancer should be treated with metformin, because in our study we also found that, especially in lung cancer, the effect of metformin was not very conclusive.”  

 

SARAH:

Dr. Ming Yin, from the Geisinger Medical Center in Danville, Pennsylvania. He added that trials are now underway to see whether metformin could also reduce mortality in patients with cancer, irrespective of their diabetes status.

 

 

SEGMENT 4: Multivitamins and selenium delay disease progression in ART-naïve patients with early HIV. 

 

PETER:

For patients with HIV who are treatment-naïve and in the early stages of their disease, long-term supplementation with multivitamins and selenium delayed disease progression...

 

SARAH:

Yes, the risk of immune decline appeared to be lower in patients who were treated with a combination of vitamins: B, C and E + and selenium, over two years. Micronutrient deficiencies usually appear even before the symptoms of HIV and they’re known to influence immune function and accelerate disease progression…

 

PETER:

And previous studies have shown that supplementation can also reduce disease progression and mortality during the late stages of HIV and in pregnant women, haven’t they?

 

SARAH:

Yes, but this new study reported in JAMA is the first to look at their effect in the early stage. Nearly 900 patients with HIV in Botswana, were randomized to receive either: selenium alone, multivitamins alone, both of these together or placebo. And benefits were only found in those who got the combination. Lead study author Marianna Baum said that when the community doesn’t have enough access to anti-retroviral drugs patients with HIV should be given multivitamins with selenium as soon as possible after diagnosis:

 

BAUM:

“Although most countries now provide antiretroviral medication, there are still many challenges, particularly for providing the medication in the early stages of the disease. So providing some alternatives to slow HIV disease progression will allow additional time for healthcare systems to prepare resources for timely HIV intervention.”

 

SARAH:

That was Dr. Marianna Baum, from Florida International University in Miami, who told us it wasn’t clear yet whether micronutrients could improve outcomes in patients already on anti retroviral therapy.

 

SEGMENT 5: After fecal transplantation, patients remain susceptible to C. Difficile reinfection long after symptoms disappear. 

 

PETER:

Although fecal transplantation has been reported to resolve diarrheal symptoms of Clostridium Difficile infection in just a few days, a new publication has shown that patients remain at high-risk of recurrence for several months, so they need to avoid antibiotics….

 

SARAH:

Yes it seems you have to protect your transplant from attack by antibiotics so it can get on with its work of helping restore a healthy, functioning, intestinal bacterial mix, and this takes some time. The study published in PLoS One followed 14 patients for up to a year after successful fecal transplantation for C. difficile infection. Stool samples were collected from donors and receivers before transplantation during the weeks and months that followed. Senior study author Dr. Florian Fricke:

 

FRICKE:

“The disease itself is associated with a significantly reduced diversity in the microbiota. Now the treatment, in general, reverses these trends but, what we show now by looking at the microbiota, is that they in fact still change over a long time: up to four months after the fecal transplantation we see significant changes in the microbiota. So they feel normal but, in fact, they are not yet normal, and are still on a process of a slow recovery that probably takes several months to fully occur. So they are probably at a much higher probability to get another recurrence of Clostridium Difficile infection if they have to take antibiotics again, than patients who had never had the disease.” 

 

SARAH:

That was Florian Fricke, from the University of Maryland in Baltimore. He said patients need to be followed up even longer, to find out what happens long-term. You could potentially find that adverse factors could be transferred from the health fecal donor along with the good ones.



IN BRIEF 1: Anti-IL-17A monoclonal antibody: first targeted therapy success in active ankylosing spondylitis.

PETER:

Finally, in brief: the anti-IL-17A monoclonal antibody “secukinumab” rapidly reduced signs of active ankylosing spondylitis and was well tolerated, according to a randomized phase II study with 30 patients published in The Lancet. At week six, response estimates were 59% in patients on secukinumab, versus only 24% for those on placebo. The authors say this is the first targeted therapy as an alternative to tumour necrosis factor inhibition to reach its efficacy endpoint.

 

IN BRIEF 2: Gold standard tests for vitamin D levels might not be suited for Black-Americans.

 

PETER: 

While most African-Americans are assessed as being vitamin D deficient, many of them might actually have healthy vitamin levels and could end up taking supplements unnecessarily. That’s according to a study published in the New England Journal of Medicine. The authors found that tests used to measure vitamin D levels don’t reflect genetic differences that give African-Americans just as much bio-available 25-hydroxyvitamin D as whites, even though the total level is lower.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye!

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