On March 1, 2006, award-winning journalist Laurie Garrett spoke at the
University of Wisconsin-Madison as part of the Distinguished Lecture Series.
Garrett is the Senior Fellow for Global Health at the Council on Foreign
Relations and the author of "The Coming Plague: Newly Emerging Diseases in a
World Out of Balance" and "Betrayal of Trust: The Collapse of Global Public
Health."  (I recommend these very readable books to those interested in
global health issues.)

Her topic at the Mach 1 talk was the H5N1 influenza.  I found her talk
chilling, and ever since I have been wondering about the implications for us
in the breastfeeding community.  Among the points she made, as I understood
them, are these:

Since this H5N1 flu combination has never arisen before, no one has immunity
to it.

While this virus is not easily transmitted from person to person as yet, it
may mutate to one that does.  Humans who have caught it from birds have an
overall mortality rate of 55%.  Dr. Robert Webster, the world's greatest
influenza expert, called it the worst influenza virus he had ever seen
(September 23, 2005).  Tigers, cats, dogs and rodents who eat infected birds
all die.  We all know the devastating effect on bird populations so far.
The virus is spreading along migratory bird routes and infecting domestic
fowl wherever wild and domestic birds intermingle.

Like the pandemic flu of 1918, most deaths in humans occur in those under
age 35.  (In 1918, the majority of deaths were in those age 15 - 30).
Normal influenza deaths occur from secondary bacterial infections in the
elderly with older immune systems.  The hallmark of the H5N1 flu is its
effect in the young with healthy immune systems.  The immune system mounts a
robust response to the infection.  Acute respiratory distress syndrome
results and the lungs become collateral damage.  (Same as in SARS a few
years ago).  Those with weakened immune systems, such as HIV infected
people, will not get sick but can incubate and shed the virus.

What makes H5N1 especially dangerous is its long incubation period of about
16 days.  Normal influenza has an incubation period of 1-2 days.  People get
sick and stay home.  With H5N1 they don't have symptoms for 2 weeks but are
meanwhile shedding the virus.  We don't currently have a rapid diagnostic
test to tell who is infected.  There are many other types of flu outbreaks
going on at the same time, so it's difficult to tell which is which.  And a
recent Lancet article pointed out that treatment with Tamiflu lets the virus
spread to others.  There were also 2 documented cases in Vietnam of patients
whose H5N1 virus was immune to Tamiflu.  Both died.

H5N1 can survive for up to 30 days on surfaces such as handrails, subway and
bus poles, elevator buttons, door knobs, towels, etc.  It is not spread
through air droplets (masks won't help), but by touching contaminated
surfaces and then hand to mouth or nose or eye contact.   It is vulnerable
to soap and water and good hand-washing, which is good news.

In the US, hospitals have been consolidating in recent years in order to
operate at full capacity and be more profitable.  There are not adequate
beds, staff or equipment to deal with a massive epidemic of very ill people.

My own questions for all of you:

How are we preparing?  What if many mothers of breastfeeding infants become
very ill and/or die?  How will those babies be fed and cared for?  What if
family and health care and community support systems collapse or are
overwhelmed?

We know that breastfed babies have an enhanced immune response to
immunizations, one of the benefits of breastfeeding.  But with this H5N1
virus that provokes an over-reaction by the healthy immune system, what will
we see in breastfed children?  I would guess that most of the 100 or so
people who have already died of H5N1 influenza in Asia, Turkey, Azerbejan,
Iraq, etc. were breastfed.  Are any Lactnetters knowledgeable enough about
immunology to contribute to a discussion here?

What protocols should we be developing for our individual clients, our work
settings, our communities, our own families to deal with this?  I am
thinking of the helpful protocols for breastfeeding in emergencies we saw
publicized after the recent tsunami, earthquakes and Hurricane Katrina
emergencies.  Do we know enough to begin working on this now?  Garrett said
there could be a huge impact on world commerce, transportation, etc.  We
would have trouble getting food, medicines, and other goods that come from
other areas.

What are communities around the world doing right now to prepare?  Laurie
Garrett noted much more attention being paid to the danger in Europe than in
the US, with billboards and other publicity to make the public aware.

Laurie Garrett has a web site with a discussion forum, but I don't have the
time or computer expertise to get on and ask these questions there. I can't
seem to find it again.   Maybe someone else could?  You can read an article
by Garrett on bird flu at
http://www.cfr.org/publication/9964/unless_we_act_now_bird_flu_may_win.html

Anne Altshuler, RN, MS, IBCLC and LLL Leader
Madison, WI, USA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html