Avian Influenza: A guide for the interested layperson

American Family Physician is a review journal for FPs. Unusually, all of the journal is freely available on the web. The quality is usually good; the best articles are written by family physicians. The very best are so clearly written that anyone with a basic interest in science can follow them.

Gregory Juckett's review of avian influenza (H5N1) is top notch, and is only a bit more technical than the Scientific American. Highly recommended for the curious. A few tidbits that I took away:

• Like the 1919 (H1N1) pandemic death is most often from acute respiratory distress syndrome and is probably due to a hyperactive immune response. That's why mortality is high among young adults -- they have the most aggressive and twitchy immune responses. The most promising therapy involves 'statins' (drugs like Lipitor) that [surprise!] suppress the cytokine component of the immune response. [jf: Cytokine suppression is not always a 'feature'; one must wonder how many times statin-induced immune suppression is harmful or lethal. I'm sure we'll here more about this over the next year.]
• The early returns suggest the lethality of the current H5N1 strain of Avian influenza is more comparable to the 1957 H2N2 or 1968 H3N2 lethalities, so not in the same league as the 'Spanish' flu.
• The Swine flu of 1976 was an H1N1 strain. We still don't know why it didn't wipe the floor with us. President Ford ought to have earned accolades, not scorn, for the emergency vaccinaton proram later associated with an inflammatory polyneuropathy.
• Ventilator availability is a major problem for Avian flu response. We can't make Tamiflu faster (Star Anise supplies have some production limit.), but we could make a lot more portable vents. If we don't need them, we could donate them to other nations.

The AAFP has launched a practice-oriented support web site. (Sadly, the URL was botched in the 9/1/06 editorial. You think that by now they'd have setup a redirect! I'll send them a note.)