Melissa James Policy Paper (Antiviral Resistance)

Policy Paper Microbiology Melissa James

BACKGROUND:
Antiviral resistance can occur when antivirals are given to too many people with the same symptoms. When the resistant forms are transferred then antiviral resistance occurs in those newly sick hosts. When antivirals are prescribed for the susceptible influenza strains, the resistant strains are then able to dominate the population of viruses, and therefore, infect people with a strain that can not be treated. Transfer of these mutant viruses could cause an outbreak of resistant strains of influenza. Oseltamivir is the only antiviral used for influenza or influenza-like symptoms. In some countries antiviral resistance to Oseltamivir is going up by 67% for the H1N11 influenza virus because more and more antivirals are being used to treat the susceptible forms. Studies are being conducted to find the different forms of the influenza viruses which have been associated with increased resistance. It has been found that influenza in general is spread by direct contact much easier than it is by aerosol because only susceptible forms can spread through the air.2 Viruses need a host to grow, and therefore, can die rapidly in the air if a host is not present immediately. It has also been found that treating for influenza or influenza-like symptoms after a day was more effective than treating for the symptoms immediately. In a study conducted by researchers, they injected one group of ferrets with Oseltamivir four hours after they were injected with the influenza virus and the other group of ferrets twenty-four hours after they were infected with the influenza virus. The ferrets that were treated later with antivirals were able to block the spread of the virus to internal organs and to reduce inflammation as well as the usual lethargy3. When working with a mouse model, mice were infected with different strains of influenza. Some of the strains were more virulent than others. When they then used antivirals to treat the infected mice, they found that with the less virulent forms of the influenza virus, the mice were more likely to develop complete protection from that strain. The more virulent the virus, the less protection the antivirals offered to the mouse.4 When testing for resistance, researchers found more resistance in strains of influenza that had already mutated than in strains that had not mutated. There is only one drug (Osletamivir) on the market that can be used to treat the influenza virus right now. Therefore, resistance to this drug (Osletamivir) would cause major problems and safety issues concerning the spread of the virus. By limiting the contact of individuals with the virus, the spread will be contained to a population of the college community. Since research shows that susceptible strains are spread both through air and direct contact, but resistant strains are spread only through direct contact, we have made a policy to prevent direct contact between healthy individuals and individuals infected with a virus. With the research supporting the policy we could move on to enforcing the policy.

POLICY:
Morningside College must quarantine all students, faculty and staff with influenza or influenza-like symptoms to reduce the antiviral resistance to Oseltamivir (tamiflu).
As the President of Morningside College, we as a college are enforcing a new regulation that all Morningside College students, faculty and staff with influenza or influenza-like symptoms must be quarantined to prevent antiviral resistance. If the same strain is not spread to everyone, not enough of the virus can become resistant and pass on the genes that cause resistance. If this policy is not followed voluntarily, we will enforce it. If a student chooses not to follow the rule, they will be sent back to their room by any staff that sees them and be forced to take independent study class to avoid or limit contact with people. They also will be checked on by their RAs to make sure that they are in their room using a knock and response system as not to expose the RA. The professors will be forced to have an attendance policy and syllabus that will allow for this quarantine to occur. If the professor refuses to do so, they will be documented and receive either a pay cut or they won’t be able to be promoted. If a professor comes to school with influenza or influenza-like symptoms, the other staff members around them should send them home, where they should stay until their symptoms are gone for at least twenty-four hours. The same will happen to the professors if they refuse to have a policy that quarantined students can have their records safe from harm. In quarantining people, we find the costs to be minimal. Food will be provided by the meal plans of the students or the families of the sick faculty and staff. The housing is already provided as well. The unexpected expenses that may occur will come from the college. We will supply the money because of the minimal cost that is foreseen. Most likely the health center of the college will supply the money because the health center’s goal is to keep a safe and healthy campus for faculty and staff as well as its student population. From our standpoint, quarantine is the only possible way to try to prevent resistance at this time because the viruses cannot spread without direct contact between hosts, and therefore, cannot spread mutant forms of itself to others. More resistant forms exist in the environment when antivirals are used to treat the susceptible forms or when the body of the infected person fights off the susceptible forms. Resistant forms die off in the air if a host is not found quickly.

CONCLUSION:
The policy proposed will prevent antiviral resistance because with less people contracting influenza, less people will need antivirals, and therefore, the influenza viruses (all strains) will not easily become resistant. This policy will help keep the college community healthier, and therefore, safer because the students and faculty are not at as much risk for contracting influenza. This policy is also important because some people can have an allergic reaction to influenza that can cause death. In addition, the more the quarantine policy is followed, the safer the community surrounding the college will be. However, when looking at this policy, we perceive that some people will disagree. One disagreement or argument they may make against quarantining people with influenza or influenza-like symptoms is that the students, faculty or staff quarantined will not be able to hold class or go to class, or perform their job; therefore, their grades or their class requirements or job duties will suffer. When looking at this argument, we can say that the students will be given all their work and grades will not suffer due to absence because we are enforcing the implementation of a syllabus and attendance policy to accommodate for the sick students’ needs. The staff will be able to work from home as much as possible and will be allowed phone contact with the office if they need something done immediately. The faculty will be able to hold class using Blackboard or Moodle. The students will still attend class with the professor teaching from home. The college requires the professor to have a system that will allow them to be involved but not infecting others around them. Therefore, this argument can be countered with solutions. A second argument that may be made towards my policy is that the influenza is spread through the air, and, therefore, it will not matter if the infected people are locked away because the viruses are so small they could get out through the doors or windows and infect the community the policy is trying to protect. However, in one article it states that influenza is spread through direct contact much easier than aerosol contact because only certain forms can go through and survive long enough in the air, and they are the forms that have not become resistant to antivirals yet.2 So if people contract a susceptible strain of influenza, we could give them Oseltamivir to treat the virus. Therefore, quarantine would prevent the direct contact, and since influenza cannot be spread as easily by air, the viruses die off before they find another host to infect. The problem of spreading through air is countered and not true with influenza or influenza-like symptoms. By limiting antiviral resistance and spreading of resistant strains of the influenza virus, Morningside College will be a safer place, not only for the college community but also for the surrounding community who come to events that the college hosts. Antiviral resistance is a large problem because only one drug is effective in treating influenza viruses. An outbreak of a resistant strain of influenza would be very detrimental to the college and the surrounding community because an outbreak would not only close down the college for a while to stop the spread of the disease, but the college would also have to go through a sterilization process to prevent any further spread of influenza viruses. Those not infected would have to be sent home to prevent them from contracting the influenza viruses. Those with influenza would have to stay on campus to keep from further spreading influenza elsewhere in the country. Which is better: a short period of quarantine or a long period of missed classes causing the semester to run longer? In our opinion, quarantining is the best option to prevent the unthinkable from occurring. The costs of multiple infections are greater than the costs of quarantining. Colleges should prefer lower costs and would have to choose quarantine to obtain the best outcome.

BIBLIOGRAPHY:
1) Tamura, D., et al. (2009) Oseltamivir-Resistant Influenza A Viruses Circulating in Japan. Journal of Clinical Microbiology, 47(5): 1424 – 1427.
2) Bouvier, N.M., Lowen, A.C., Palese, P. (2008) Oseltamivir-Resistant Influenza A Viruses Are Transmitted Efficiently among Guinea Pigs by Direct Contact but Not by Aerosol. Journal of Virology, 82(20): 10052 – 10058.
3) Govorkova, E. A., et al. (2007) Efficacy of Oseltamivir Therapy in Ferrets Inoculated with Different Clades of H5N1 Influenza Virus. Antimicrobial Agents and Chemotherapy, 51(4): 1414 – 1424.
4) Govorkova, E. A., et al. (2009) Susceptibility of Highly Pathogenic H5N1 Influenza Viruses to the Neuraminidase Inhibitor Oseltamivir Differs In Vitro and in a Mouse Model. Antimicrobial Agents and Chemotherapy, 53(7): 3088 – 3096.
5) Sheu, T. G., et al. (2008) Surveillance for Neuraminidase Inhibitor Resistance among Human Influenza A and B Viruses Circulating Worldwide from 2004 to 2008. Antimicrobial Agents and Chemotherapy, 52(9): 3284 – 3292.
©Copyright 2009 Melissa James

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