Immunoglobulin as a treatment for pandemic H1N1 influenza

In the paper I discussed yesterday, (Gordon et al. 2010), there is a brief discussion of the effects of treating pregnant women with severe H1N1 with intravenous pooled immunoglobulin:

Although IgG2 deficiency appears to be associated with H1N1 infection severity, it remains uncertain whether administration of immunoglobulin to patients who are IgG deficient is likely to be therapeutically beneficial. We administered pooled immunoglobulin to some of our patients with severe H1N1 infection who had IgG2 deficiency, but our observations were uncontrolled.

The first author of this paper, Dr. Claire Gordon, was less constrained in her opinion of this therapy in her discussions with the media. From Metro, February 5, 2010:

Well, a 28-year-old trainee may have made the breakthrough medical researchers – and H1N1 sufferers – have been searching for.

Dr Claire Gordon found a particular antibody which helps fight the virus.

The ‘eureka moment’ came when the budding infectious disease specialist treated a 22-year-old pregnant woman who was desperately ill.

‘We were doing our best to try and pull her through,’ said Dr Gordon.

‘We were asking ourselves if there was something we were missing.’

She got the go-ahead to perform an expensive and rarely used immune system blood test – and noticed her patient had very low levels of one particular antibody, named IgG2.

She confirmed the pattern in other swine flu patients – the sicker they were, the lower their IgG2 levels.

When injected with the protein, they began to get better immediately – including the young mother-to-be. Dr Gordon, who works at the Austin hospital in Melbourne, Australia, said: ‘It was very exciting. It gives us something else to work on and think about.’

These results are preliminary. However, given the many people who died in the US and other Northern Hemisphere countries, it is surprising that this therapy was apparently not tried in severe cases, especially in pregnant women. Could the authors have withheld this information from public health authorities pending publication of their paper?

No, they told someone.

They told the WHO.

From stuff.co.nz, February 4, 2010:

The discovery also suggests a potential new treatment for a swine flu infection, as people low in protein could have their levels topped up from donated blood.

The World Health Organisation was alerted to the finding last year, and a paper detailing the research is published this month in the journal Clinical Infectious Diseases.

So, the WHO knew last year. Did they tell the CDC? On the CDC webpage providing H1N1 information for physicians, the only treatment mentioned is antivirals. Why weren’t American doctors told about this option? How many people’s lives would have been saved if they had been told?

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