Medical and Health Research Network

Date: February 26, 2008 (Tuesday)
Time: 12:30 – 14:00 (sandwich lunch from 12:30 –12:45; seminar begins at 12:45)
Venue: Seminar Room 6, LG-1/F, Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong

Much of the world's attention is being directed to avian influenza caused by the highly pathogenic A (H5N1) virus. There is a real threat that this virus will mutate or reassort and cause the next pandemic. While it is imperative that the world, each country and every region be prepared, we should not forget about the yearly impact of interpandemic influenza. Compared to pandemics, the occurrence of ''seasonal" influenza appears almost predictable. The interrelationship is strong; if we are to have enough pandemic vaccine for the world, we need to have more vaccine used for seasonal influenza. We need to evaluate pharmaceutical and non-pharmaceutical interventions that would be used in a pandemic against seasonal influenza, given the low frequency of A(H5N1) infections.Vaccines and antivirals have been the pillars of control of seasonal influenza. We are learning more about the seasonal vaccines in terms of their effectiveness in years with and without drifted viruses. Now, vaccines specifically designed for A(H5N1) are producing good antibody response at low antigenic doses. They may be useful in preventing seasonal influenza in populations such as the frail elderly. Antivirals have proven useful in post-exposure prophylaxis against seasonal influenza. They may be useful similarly in pandemics, as long as antiviral resistance does not develop. The recent recognition of resistance of A(H1N1) viruses to oseltamivir indicates that we must be prepared for the unexpected. Non-pharmaceutical interventions have not been a prominent part of seasonal influenza control in the past. However, because of their important role in pandemics, they are becoming the third pillar of control, joining vaccines and antivirals. In the US, their use in pandemic planning has become prominent, and components are being evaluated. They are now being considered by WHO for use globally.

Arnold S. Monto is Professor of Epidemiology at the University of Michigan School of Public Health in Ann Arbor and is Founding Director of the Bioterrorism Preparedness Initiative. The major focus of his work has been the epidemiology, prevention and treatment of acute infections in the individual and the community. These activities have included work on the occurrence and characteristics of the infections as well as potential for vaccine prevention and antiviral treatment. Respiratory infections, in particular influenza, have been a major interest, with special reference to the evaluation of vaccines in various populations and the assessment of the value of antivirals such as amantadine, rimantadine and the neuraminidase inhibitors. Dr. Monto was closely involved in the US HCFA-sponsored studies, which made influenza vaccine a covered benefit for older individuals. He has also studied other approaches to influenza vaccine use, particularly to control transmission of the virus in the community and in nursing homes. He is currently involved in assessing the efficacy of live and inactivated influenza vaccine in prophylaxis and the neuraminidase inhibitors in therapy of influenza. He is also working extensively with national and international organizations on issues related to pandemic preparedness and is a member of the WHO Influenza Pandemic Task Force.

During his tenure at the University of Michigan, Dr. Monto has also served for periods of time in the Acute Respiratory Infection program at the World Health Organization, Geneva, and as Scholar in Residence at the United States Institute of Medicine/National Research Council. He has been a member of the Pulmonary Diseases Advisory Committee of the National Heart, Lung and Blood Institute and of the National Advisory Allergy and Infectious Diseases Advisory Council. He has also served on various United States and international advisory bodies addressing the overall response to the problem of emerging and reemerging infections, control of influenza in the seasonal and pandemic situation, and bioterrorism preparedness. He is the past president of the American Epidemiological Society.