Editor’s Note: William Haseltine, PhD, is chair and president of the global health think tank, ACCESS Health International. He is author of numerous books, including the recently released, “A Family Guide to COVID-19: Questions and Answers for Parents, Grandparents and Children.” The views expressed in this commentary are his own. View more opinion on CNN.
A study published in the July 23 issue of the New England Journal of Medicine found that the anti-influenza drug baloxavir marboxil significantly reduced transmission of influenza among people living in the same house.
The news comes just in time for the 2020-2021 flu season, which threatens to coincide with a new upswing of Covid-19 infections in countries this fall and winter. The confluence of these two viruses could overwhelm already strained medical resources and complicate testing procedures, particularly given that the illnesses they lead to have remarkably similar symptoms.
A previous study, published in the Lancet in June, proved that a single dose of baloxavir was just as effective as Tamiflu (oseltamivir) at shortening the duration of the flu when administered twice daily for five days. But the newer July study is perhaps even more significant, as it shows the role that baloxavir plays in reducing the spread of illness among household members.
We have all become acutely aware of how easily respiratory infections can spread within households and in schools, dormitories, or other places where people gather together closely for long periods of time. A prophylactic drug with the potential to significantly reduce the incidence of pandemic influenza is very welcome news indeed.
In 2018, baloxavir was initially approved for treating uncomplicated influenza A and B in Japan and treating people 12 years and older in the US. The July study was conducted during the 2018-2019 influenza season in Japan and assessed the ability of baloxavir to reduce transmission within a household. In the majority of cases, the first member of the household to contract influenza was a child 11 years old or younger. Notably, household members were unvaccinated for influenza. Upon the detection of a flu infection in at least one family member – judged both by fever, at least one moderate or worse respiratory symptom, and a positive flu test – the uninfected members of the households were either given a placebo or baloxavir.
In households that received the placebo, 13.6% of the residents contracted influenza. Only 1.9% of those that received baloxavir came down with the flu, and there were no serious side effects noted in the treatment group.
But there are several caveats. Two strains of influenza typically circulate in the fall and winter months, influenza A and B. Although baloxavir is approved for use against both influenza A and B, influenza B was not active in Japan during the 2018-2019 flu season. The hope, though unproven in this study, is that the drug also protects against infection by influenza B.
Household transmission beginning with a child is one of the most frequent routes for influenza transmission, although it is by no means the only one. The virus can be transmitted in many different settings including colleges, workplaces, sporting events, theaters and other social gatherings. The authors argue that the prevention of household transmission supports the concept that prophylactic use of baloxavir will also reduce transmission in other settings.
Baloxavir works by a novel mechanism. The influenza virus uses a process called cap snatching to reproduce itself, snatching parts of a host cell’s RNA and using it to continue on with the process of reproduction. Baloxavir binds to and inhibits the protein the virus needs to reproduce itself. Human cells lack any similar enzyme or function.
The success of baloxavir against the transmission of influenza is significant, and provides hope that drugs directed against other viral enzymes could be developed to treat and prevent Covid-19.
In the critical condition many health care systems find themselves in today – with hospitals and providers already overwhelmed after months of treating Covid-19 infections – an approved drug that could help reduce the number of people falling ill from the flu this winter will be a welcome relief. It is unlikely that effective antiviral Covid-19 drugs will be available for prophylactic treatment for the majority of those at risk for Covid-19 by this fall and winter. Similarly, a vaccine that is both safe and effective may also not be widely available.
A combination of a seasonal flu vaccine and an effective prophylactic drug such a baloxavir – in addition to personal protective behaviors already being practiced across the US – could significantly reduce the severity of the coming influenza epidemic and spare our hospitals the worst of the combined effects of simultaneous epidemics.