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HOUSE CALL WITH DR. SANJAY GUPTA
Bird Flu Threat To National Security; Probenecid Could Stretch Tamiflu Supply
Aired November 5, 2005 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
TONY HARRIS, CNN ANCHOR: Good morning, everyone. Now in the news, in about an hour, the Summit of the Americas will end. While President Bush posed with leaders of North, Central and South America, demonstrators set fires and broke windows.
More than 1,200 cars have burned in Paris suburbs since rioting began last week. Church leaders in France are now planning a peace march after nine days of violence that began when locals blame police for the deaths of two teens who were accidentally electrocuted while running from police.
Take a good look at this man. Charles Victor Thompson is a death row inmate in Texas, but somehow he managed to just walk away from a jail in the Houston area. U.S. marshals are offering a $10,000 reward for information that would get Thompson back behind bars.
Betty and I will be back at the top of the hour with a live report from Iraq on the allied offensive underway this morning. HOUSE CALL takes a closer look at the bird flu threat. And it begins right now.
DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Good morning. Welcome to HOUSE CALL. I'm Dr. Sanjay Gupta. You're going to want to watch this whole next half hour. We're discussing the avian flu from all the angles from preventative vaccines and drugs, to warning signs you need to be looking for.
Plus, are there dangers in your own backyard? We're going to talk with the experts. We're going to answer your questions.
Let's start with President Bush's announcement this week.
GUPTA (voice-over): Take a look at the newest threat to our national security, H5N1 or the bird flu virus. Now it's been smoldering in Asia for years, killing millions of birds and causing 62 human deaths.
In humans, the flu is still confined to Asia, but infected birds are cropping up all over Europe, possibly even Canada where they're investigating a recent spate of bird deaths.
GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: If the virus were to develop the capacity for sustained human to human transmission, it could spread quickly across the globe. Our country has been given fair warning of this danger to our homeland and time to prepare.
GUPTA: And time is crucial because if the global bird flu epidemic would happen, and no one's saying it is for sure, it could kill tens of millions of people.
Faced with that possible disaster, the Bush administration is asking for $7.1 billion to fight a health crisis that right now doesn't even exist here.
Bird flu in humans was first detected in 1997 in Hong Kong. That year, six people perished. As the cases mounted over the years, so did the frightening facts. Of every two people that gets bird flu, one dies. The best protection we have against that is a vaccine, but we won't have that in the foreseeable future.
(on camera): See, the issue is that once the vaccine is created, a new problem might arise. The virus might change and the new vaccine might not work as well. Maybe not at all. So the president wants to spend some of that money on vaccine technology to try and speed up the whole process.
(voice-over): Another part of the plan will be obtaining more medicines like Tamiflu, which could stem the symptoms of bird flu, but not stop them, which brings us to the most important part of the Bush plan, surveillance. Specifically in Asia. That is stopping the disease at the source.
The Bush plan does look ahead to the possibility of bird flu crossing our own borders. The implications? Huge. Quarantines imposed by federal and state governments having to deal with massive shortages of isolation beds and respiratory equipment.
IRWIN REDLENDER, DR., COLUMBIA UNIVERSITY: Right now, we have the makings of a pretty good idea of where we want to go. We just don't know yet how we're going get there.
GUPTA: And getting there is exactly what the government hopes this new plan will do since many experts believe it's not a matter of when, but if a pandemic flu will strike.
A CNN poll this week shows the majority of people, 62 percent, believe bird flu will make it to the United States. And while we at CNN have been getting lots of questions on bird flu, 75 percent of those polled say they're not worried about becoming a victim themselves.
So here to sort of through this avian flu is Dr. Anthony Fauci. He's director of National Institute of Allergy and Infectious Diseases. He's also America's point man on the bird flu threat. He's been briefing the president. He's been briefing Congress.
Doctor, first of all, welcome back to the show.
DR. ANTHONY FAUCI, NIAID DIRECTOR: Thank you very much. Good to be here, Sanjay.
GUPTA: Thank you. Quite simply, how real is the risk of an avian flu pandemic?
FAUCI: It's quite real. We cannot quantitate what percent probability or possibility of there being a bird flu with this particular strain of the virus, which is the H5N1 this year and next year.
But most public health officials, myself included, feel that a pandemic influenza, namely a flu to which we've never been exposed to before so we're much more vulnerable than you would be with the seasonal flu, is inevitably going to happen within a reasonable period of time.
There's more focus being put on it now because of the activity that's going in Southeast Asia that you just mentioned with birds getting infected and the inefficient jumping from the infection from the chicken to the human.
GUPTA: A lot of people are focused on it. We're going to talk about exactly why that is. But as we've said before, this flu is for now primarily in birds...
GUPTA: ...passing to humans from birds or contaminated areas.
So Dr. Fauci, a lot of question coming in along that topic. People are worried about the birds and have questions about that specifically.
Barry in Texas writes this question. "I feed wild birds in my backyard. Am I at risk for the bird flu? What precautions would you recommend?"
And doctor, you know, this spreads through migrating birds.
GUPTA: So those are harder to control. Should people be taking precautions?
FAUCI: No, absolutely not. There is no bird flu in the United States. There's quite good surveillance on the part of the -- in the chickens from the Department of Agriculture, the Department of the Interior, and others when you think about migrating birds. So it really is not something that the American public should be concerned about, vis-a-vis birds.
We get a lot of questions like that, Sanjay. What about the birds in my backyard? What about the birds in the trees? There's no bird flu in the United States right now.
GUPTA: OK, well let's keep the questions going here. In the United States, we're just weeks away from Turkey day, as you know. And a lot of people have questions about that.
Mike in Philadelphia asked this question. "Can a person get bird flu from eating infected chicken or other fowl?" Bottom line, I guess, Dr. Fauci, is it OK to eat Thanksgiving dinner this year?
FAUCI: Sanjay, it's perfectly fine to eat Thanksgiving chicken, whether or not you have a turkey, or a duck, or a chicken. It's fine.
In the United States, there's quite good controls over whether or not the flocks that are used to provide food for us are infected. And they're not. So people in this country should not be concerned about things like their Thanksgiving turkey dinner for sure.
GUPTA: OK. We're talking to Dr. Anthony Fauci. Lots of good information. More of your flu questions coming up after the break.
UNIDENTIFIED FEMALE: Fears of a pandemic. Is this year's flu shot effective against avian flu? And how helpful are drugs like Tamiflu? Some are rushing to stockpile them, but is that doing more harm than good?
First, our quiz. When was the last flu pandemic? That answer, coming up.
UNIDENTIFIED FEMALE: Checking today's quiz we asked, when was the last flu pandemic? The answer, in 1968, the Hong Kong flu caused one million deaths.
GUPTA: And the government is trying to prepare for another such outbreak, which could have wide ranging effects like the rapid spread of a virus on a global scale, millions of people infected.
What would happen? Well, this would overload health services, create a shortage of medical supplies and personnel, mostly likely disrupt society by closing schools and businesses.
These are all topics that our guest Dr. Anthony Fauci has been thinking about. He's an integral part of our government's preparedness. He's also the head of the National Institute for Allergy and Infectious Diseases.
Dr. Fauci, the way we prepare for seasonal flu is with the vaccine. You talk about that a lot, getting a flu shot. How closer are we to having a similar shot for avian flu?
FAUCI: Well, we have a vaccine, Sanjay, that has been in the process currently of being tested in individuals in this country. We isolated a virus from a Vietnamese patient who was infected from a chicken.
We made what's called a seed or a reference virus to make it for a vaccine. And we had with two separate companies enough doses to do a clinical trial. The clinical trial looks promising. The vaccine seems to be safe. And it induces an immune response that you predict would be protective.
The only sobering component of all of this is that the dosage that's required to induce that degree of immunity is substantially higher than the dose that we use for the seasonal flu vaccine, which gets us into the issue of the perennial problem of the production capacity for influenza vaccine in this country and worldwide.
That's the big problematic area. That's the stumbling block. Not getting a vaccine, we have one, we're testing it. And if the virus changes, we can isolate that virus and get a vaccine right away for that.
The question is can you get enough for the people who need it? And that's the thing that's going to take some time and why we're working with the companies now to dramatically increase the vaccine production capacity in this country.
GUPTA: Now that's an important point, though. So you just said if the virus changes, which it would have to to become easily transmissible from human to human, you could still get a vaccine pretty quickly.
FAUCI: You can get the vaccine in your hand, but what you won't have pretty quickly is enough doses to give to the people who might need it, mainly because of that production capacity stumbling block that we have.
GUPTA: OK, let's keep going here. Another question from Patricia in California. "Will the flu shot we get today be of any help in protecting us from bird flu?"
And again, sort of same topic. You've been hearing this sort of question a lot, I'm sure, Dr. Fauci.
FAUCI: That's a very important question. Unfortunately, the answer is no, it doesn't because the flu vaccine that you get today for this upcoming seasonal flu is against three strains of the influenza, H3N2, which is a common strain that comes by every year. H1N1 and then influenza B.
The virus that we're concerned about with the bird flu is an H5N1. And to our knowledge, there's very little, if any, cross reactivity or cross protection there. So we can't rely on vaccination for the seasonal flu to give us protection against the bird flu.
GUPTA: But you should still get your seasonal flu shot.
FAUCI: Oh, there's no doubt. You should treat this season of influenza exactly the way you treat any other influenza. You should get vaccinated, particularly those who fall into the high risk category for complications.
GUPTA: All right. Could the one drug that's our biggest hope no longer be effective to fight avian flu? We're going to have details with Dr. Fauci after the break.
UNIDENTIFIED FEMALE: How prepared are we?
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Right now, we have enough Tamiflu to cover maybe one percent of the population, maybe two percent.
(END VIDEO CLIP)
UNIDENTIFIED FEMALE: Drugs like Tamiflu are touted as a first line defense against a flu pandemic. Will they work? And do we have enough?
First, more of this week's medical headlines in "The Pulse."
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): A doctor in Oregon this week suggested that using a drug called probenecid, along with the antiviral drug Tamiflu may stretch the nation's supply of the drug. Probenecid would allow Tamiflu to stay in the body twice as long. And as a result, could cut the dose needed to combat a possible avian flu infection by half.
The technique was used in World War II to extend precious supplies of penicillin. But experts say more studies are needed and that governments should still be working to stockpile Tamiflu.
And pollution may raise your risk of stroke. Harvard scientists looked into 150,000 case of stroke and found a one percent higher risk for the most common type of stroke on days with high air pollution. Researchers say inhaling solid particles in the air may change blood clotting patterns and increases heart rate and blood pressure.
Christy Feig, CNN.
GUPTA: Welcome back to HOUSE CALL. Our topic, preparing for a possible flu pandemic. Now the antiviral drug Tamiflu has been in the news a lot this week as a possible way to prevent and treat avian flu, but how much can it really do? And do we have enough?
GUPTA (voice-over): Antivirals fight the flu virus and prevent it from making you sick. They're made to protect you from the regular flu.
Tamiflu is the antiviral everyone's been talking about. Public health officials think it can provide good protection if taken as soon as symptoms show, but they're basing this on a few studies done in mice and only a few dozen human cases.
IRA LONGINI, EMORY UNIVERSITY: Tamiflu appears to be the only good antiviral available.
GUPTA: Now isn't that a drug you're supposed to get after somebody gets sick?
LONGINI: No. It's recommended for treatment, but it's also extremely effective prophylactically.
GUPTA: For adults, Tamiflu comes in a pill, but you don't need to take just one pill. Every person needs to take 10 pills, two per day for five days. But public health experts believe to protect yourself from bird flu, you need to double the daily dose. That's four pills a day. And you need to take it for twice as long, 10 days.
So now you're up to 40 pills per person. And some of our leaders realize the numbers just aren't adding up.
REP. BARAK OBAMA (D), ILLINOIS: Right now, we have enough Tamiflu to cover maybe one percent of the population, maybe two percent. We need 25 to 40 percent coverage. And so, we are way short of where we need to be.
GUPTA: That's because today, the U.S. government's national stockpile only has enough Tamiflu for 2.3 million Americans. Health officials want to have enough Tamiflu for 8 million people within a year and eventually enough for 20 million Americans, but the World Health Organization thinks that each country should have enough antivirals to protect a quarter of its population to prevent a mass spread of a deadly flu virus.
So 25 percent of the U.S. population is 68 million people. Multiply that by the 40 pills each person needs, and now we're talking about needing three billion pills.
GUPTA: And the math is somewhat hard to understand for sure, but the government is trying to stockpile as much Tamiflu as possible, but so are many other countries as well. That leaves us far short of what we might need.
And now some avian flu patients have developed resistance actually to Tamiflu. So where does that leave us all?
And Dr. Anthony Fauci is here to help answer that question. Again, he's the director of the National Institute of Allergic and Infectious Diseases.
Doctor, do we even know that Tamiflu works? And what do you make about these reports of resistance?
FAUCI: Well, first of all, Tamiflu, if you look at its sensitivity and its ability to block the virus, the H5 and what it does, the problem is that when you have an antiviral like Tamiflu, you generally need to give it within the first day or two of the onset of symptoms. And in the experience that we have, it generally shaves off about a day and a half or so of your symptomatic period. We are not totally confirmed about how it's going act when you're dealing with very seriously ill patients during the period of a pandemic. So although you can make the presumption that it will be effective in helping you, and perhaps cutting down on hospitalizations and pneumonias and deaths, we really don't know that for sure.
GUPTA: And can you develop resistance to this antiviral?
FAUCI: Oh, there a no doubt. Any time you give an antimicrobial, an antibiotic for a bacteria, or an antiviral for a virus, if you give enough of it during the time when people get infected, sooner or later, there will be the evolution of resistance of the particular microbe.
Hopefully, that will not occur to the point of interfering with the utilization of that particular medication, but there's always the potential of the development of resistance when you're treat treating someone with an antibiotic or an antiviral.
GUPTA: All right, we're talking with Dr. Anthony Fauci, answering more of your avian flu questions as well. But first, an epidemic that's already here within our borders.
UNIDENTIFIED FEMALE: Obesity is an epidemic in this country and it's striking kids especially hard.
(BEGIN VIDEO CLIP
UNIDENTIFIED MALE: If it wasn't for this place, I would probably be dead right now.
(END VIDEO CLIP)
UNIDENTIFIED FEMALE: A one of a kind school for kids in trouble.
GUPTA: We're back with HOUSE CALL. We're taking a quick break from talking about the flu, to talk about an epidemic that has already taken this country by storm. Obesity. Childhood obesity is on the rise, but CNN's Gary Tuchman went to one school that's determined to try and change that.
GARY TUCHMAN, CNN CORRESPONDENT (voice-over): These are teenagers who in a sense have become weight loss pioneers in a brand new program.
RYAN CRAIG, ACADEMY OF THE SIERRAS: The Academy of the Sierras is the first year-round treatment program for obese and overweight adolescents. And we do it in a boarding school environment.
TUCHMAN: Jared Fitzpatrick is 13 from Illinois. He is the boy who used to weigh 220.
How much do you weigh right now?
JARED FITZPATRICK, TEENAGER: One hundred and thirty-eight.
TUCHMAN: They do their reading, writing and arithmetic here, but the reason their families are paying a steep $5500 a month is because nothing else has worked in their efforts to lose weight.
In a typical day when you weighed 591 pounds, how much food did you eat?
TERRY HENRY, STUDENT, ACADEMY OF THE SIERRAS: About 60,000 calories a day.
TUCHMAN: About 2,000 calories a day is what the students here average while eating three meals and two snacks. They're allowed no more than 12 daily fat grams. They keep journals of what they eat and how they feel.
UNIDENTIFIED FEMALE: I'm still hungry and it's after dinner.
TUCHMAN: They're required to exercise every day. All students wear pedometers. Five miles of walking, 10,000 steps are required. Privileges are taken away from anyone who ignores exercise and other requirements.
MOLLY CARMEL, ACADEMY OF THE SIERRAS: It would be nearly impossible for them to do anything if they didn't change the behaviors that they came in with.
TUCHMAN: Terry says he has become disciplined and motivated.
HENRY: If it definitely wasn't for this place, I would probably be dead right now. Seriously, I mean, I was one of the biggest human beings in the world. I'd like to get my weight around 200 pounds.
TUCHMAN: So you still have another 137 to go, right?
TUCHMAN: Do you think you'll make it?
HENRY: I know I'll make it.
TUCHMAN: Gary Tuchman, CNN, Reedley, California.
GUPTA: Gary, thanks.
If you and your child are struggling with weight, our bod squad is here to help with the top five mistakes that could be keeping you from getting in shape.
KELLY CALLAHAN, CNN CORRESPONDENT (voice-over): A common fitness mistake people make is not concentrating.
UNIDENTIFIED MALE: Concentrate and focus, paying attention to the muscles involved for maximum results.
CALLAHAN: Error number two, doing only cardio or only weight training during a workout routine. Mix it up by combining weekly aerobic and strength training.
Another big mistake is ignoring nutrition. And spot reducing is a myth. Doing crunches over and over again for a flat stomach and nothing else won't help you achieve the results you desire.
UNIDENTIFIED FEMALE: I want to know how this machine works.
CALLAHAN: While in the gym, don't be afraid to ask for help. Most facilities have fitness professionals who are there to assist you.
(INAUDIBLE) says by getting educated, staying motivated, and avoiding the top five fitness mistakes, you can get in shape faster.
Kelly Callahan, CNN.
GUPTA: For more information on avian flu and the government's plan, click on pandemicflu.gov or try the Centers for Disease Control Web site at cdc.guff/flu/avian. You're going to find the latest news and the latest updates as well on any outbreaks.
We've been talking with the head of NIH's Allergy and Infectious Disease Division, Dr. Anthony Fauci. He is the point man on this. He knows more about it than just about anybody else.
Doctor, we've got time for one more e-mail. This is from a viewer in Japan. Eric writes this, "I travel extensively in the fall and winter to countries across Asia. Should I be concerned?"
And I should point out, Dr. Fauci, you just traveled to Southeast Asia as well. How concerned were you?
FAUCI: Well the concern, obviously, is not strong because right now, there is not much at all of transmission other than direct contact with birds. So the travel restrictions are not on, but the advice from the State Department is that if you travel to countries that are involved in Southeast Asia, that you try to avoid as best as possible chicken farms in places where you have free-ranging chickens because that's really where the action is, where the transmissibility is from chicken to human is right in the middle of those chicken farmers or even in backyard farms.
But if you just go as a regular tourist or on business, you should have no trouble going to Southeast Asia.
GUPTA: You got any Tamiflu in your medicine cabinet, doctor?
FAUCI: Well, we brought Tamiflu with us just in case. So we still have it. Yes, I do.
GUPTA: Listen, unfortunately, we're out of time for today. I want to thank Dr. Anthony Fauci for coming back with us. Again, thank you very much, doctor. I know you're busy.
FAUCI: You're quite welcome. Happy to be here, Sanjay.
GUPTA: Thank you. And stay tuned to CNN for all the latest on both avian flu and this year's seasonal flu as well. Make sure to tune in next weekend. We're going to find out the latest and best treatments for diabetes. E-mail us your questions at firstname.lastname@example.org.
Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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