Dr. Kevin Most: The flu and blood test for concussions

Bennett get a flu shot.

A one dose drug for the flu? A Universal Virus, just a little too late for this year.

This is the first year in a long time that the Flu season just won’t go away. It has been on the nightly news every day. We know the emergency rooms and hospitals are full of patients suffering from the flu. We hear medical experts talking about when to go to the emergency rooms and unfortunately we have seen many deaths due to this nasty virus. Each year we discuss the importance of the flu vaccine, we know that this year the vaccine was not a great match and was only 30-40% effective. Many patients who got the flu acknowledged they did not get the vaccine, yet close to an equal amount did get the vaccine and still suffered from influenza. We know that those who were vaccinated had shorter and less intense infections than the individuals who did not have any protection. Just last week visits to doctors office for individuals with flu like symptoms was still climbing. The experts at the CDC feel we still may have weeks of this outbreak before we see relief.

Influenza makes a major impact on the health of the United States. On a normal flu year we see around 200,000 individuals hospitalized for Influenza, this year we will see multiples of that. The number of hospitalizations are the highest we have seen in a decade. The number of deaths from influenza will also be high with the sad fact that the infants and children have been impacted the greatest.

So why this year? Well a few things the vaccine produced for this year’s flu season was not a good match to the virus that is circulating. Remember we make the vaccine in advance of the flu season based on the activity in the previous year as well as in the Southern hemisphere. The influenza virus can mutate at any time and a new strain can pop up and cause major out breaks. That is what happened this year and unfortunately it came out during peak travel time and during the winter break allowing for the spread to accelerate.

The headlines are out every day on this flu season and almost all of it is bad news. Last week however we got a glimmer of hope. We have always asked why don’t we have an “antibiotic” for the flu. Why can’t we take a medicine that will kill this nasty virus. The best we have is Tamiflu, which is a drug that slows the virus from replicating but does not kill it. Well big news coming out of Japan where scientists have developed an experimental pill that appears is able to kill the influenza virus in 24 hours. This drug is currently undergoing clinical trials in the US and japan with very promising results. The amazing thing is the drug appears to only require a single dose. Compare that to Tamiflu which is taken twice a day for five days. Both drugs are able to contain the symptoms completely, in the same amount of time. However the new drug appears to give some patients instant relief.

The great thing about this drug, beyond that it makes the individual patient feel better so quickly, is that it will slow or stop the spread of the virus to others. Think about this year and how the flu has continued to spread, what if we had a medication that could kill the virus and thus stop the spread. The impact that this drug could make would be huge. Consider the number of individuals that are not hospitalized, consider the individuals who do not miss a week of work, consider the lives it would save. The pain and suffering from the flu, the impact it makes on families could be eliminated. This is a drug that would have a financial impact of 100’s of billions of dollars.

If this drug works as well as it is touted to could change world health. Consider if the virus could be eliminated with this medication, it would slow the spread and minimize the next flu season. The big question is will this eliminate the need for the flu vaccine? Will we go from prevention to just reacting to an infection. This is a big question, patients may think, “the vaccine has not worked well in the past, why don’t I roll the dice and take the medication if I get sick.” The timing of the release of the drug may be as soon as next year if the clinical trials continue to show success. So this could be a blockbuster.

This medication must have a company in the UK concerned. For years we have been asking, “why do we need a new flu shot each year?” the reason has been because of the mutations and variations of the virus. Well a vaccine company in the UK is currently designing and testing a universal flu vaccine, one that would cover all strains of the flu viruses. This may be a vaccine that you take once and it protects you for a longer period of time and works against all influenza viruses. This vaccine is being tested in clinical trials now and is expected to be available in about 5 years. The reason for the five year timing is waiting for influenza cycles to hit. This is not like a drug study where patients can be added each day, this study needs to wait for the flu season cycle in order to add to the study.

It may come down to, do you want a vaccine once or do you want to wait and see if you get the flu knowing that we have a medication now that works in 1 day. Medical experts will tell you the vaccine will still be recommended as we know the virus can mutate and if it mutates to a point where the medication no longer works we will have misused a powerful tool.

Think about the overuse of antibiotics, this has lead to resistance in the bacteria/ antibiotic world. Bacteria that used to be treated with simple Penicillin no longer are phased by it, they have mutated to a point where it does not work.

Concussion blood test

We have talked a lot about concussions and the impact they have made on the lives of many. Sure, we hear about the NFL players but who we don’t hear about are the players who never made it to the NFL and the impact it has had on their lives. One of the big issues has always been the diagnosis of a concussion. Currently it is made based on symptoms and then often followed up with a CT scan. The CT scan in many cases is not needed but is completed because we are not sure if trauma has occurred in the brain.

News out late last week tells us that the FDA has approved the first blood test for concussions in adults. This test was worked on by the Defense Department for the use in armed services personnel that may have suffered a concussion. In many areas they do not have access to a CT scan so soldiers were being moved to get a CT scan, often when it was not needed. This additional radiation exposure is not good for any patient.

What they were looking for and found were specific proteins that would be found in the blood only after a traumatic brain injury strong enough to cause a concussion. Now that these are identified they designed a blood test to measure these. The test has been completed on close to 2,000 individuals and was 97% accurate. This blood test would help doctors eliminate unnecessary CT scans. The estimates are that over 1/3 rd of the CT scans could be eliminated. This will eliminate a lot of unnecessary radiation exposure as well as expense.

From the Defense side, it will allow soldiers to be treated more appropriately as we would now have an objective blood test to aid us in the diagnosis. It would also give the sports side a much more objective tool and protect those individuals from getting a concussion on top of another concussion which we know can be devastating to an individual.