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Page #17

This vaccine will be in addition to the regular seasonal influenza vaccine.

Again, people over 65 years of age, young children, pregnant women, and people with diseases of the heart or lungs should all receive these vaccines assuming they are not allergic to some component of the vaccine.

Q: If that is true, then why are you so worried about this new virus?

MA: Just as it is often not the seminal event that results in huge problems but the ensuing poor decisions (think Watergate)- thus it might be with this outbreak.

What we can safely assume is that (baring some very profound discovery) when fall arrives in the Northern Hemisphere and school resumes there will be a second wave of novel H1N1 cases flooding the world.

We can also reasonably infer that by then there will be a huge storehouse of neuraminidase inhibitors stockpiled and ready for distribution to millions of patients.

Individuals are buying these products online and with prescriptions just to have them ready for the first small symptom of the flu.

So what you will most certainly see in the next few months is a massive introduction into the human species of a mixture of novel H1N1 virus, a rapidly developed flu vaccine and million and millions of doses of neuraminidase inhibitors - many self-administered and many given long after the brief window where they might have helped.

We as scientists owe everyone a calm and reasoned examination of the effects of such a cocktail.

Have we evaluated the repercussions of these actions?

Are there any potential contraindications of which we should be aware?

I would like to discuss these issues with you.

Q. Please go ahead.

MA. Influenza viruses multiply by gaining entry into a host cell and upon entering these cells they commandeer the host machinery to produce new viral progeny. And they do this very well. So, if we may, let us spend a bit of time visualizing exactly how this event occurs.

The virion is generally a circular entity enveloped in a lipid membrane with two different types of spikes emerging from this surface. These spikes are proteins – actually glycoproteins - because they consist of protein linked to sugars – and are known as HA (hemagglutinin) and NA (neuraminidase).

One of the spikes, a triangular rod-shaped molecule, has haemagglutinin activity, while the other spike, a mushroom-shaped molecule, with a square box-like head sitting on top of long thin stalk, is the enzyme, neuraminidase.

Hemagglutinin is the method by which the flu virus takes hold on the infected cell whereas the neuraminidase is the enzyme that clips off the newly formed virus, so that the ‘free’ virus will infect another cell. But we can discuss that later. For it is neuraminidase and it's association with virulence that will be the focus of our discussion after we review the basics.

Q: (I did not know, at the time, that the review would take all winter)