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Update in Preventive Medicine
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
To select the published articles that could most influence daily clinical practice, I reviewed all the major general medical journals and searched the MEDLINE database. I used an informal system for scoring the articles, focusing on their clinical relevance, scientific validity, and generalizability. Particular care was taken to choose research that was based on rigorous methods and incorporated appropriate blinding when necessary. Articles in two categories—influenza and modifications in diet and behavior—are in the realm of primary prevention, whereas work in osteoporosis and cardiovascular disease largely entails secondary preventive measures.
Preventing Influenza Virus Infection
Influenza remains a major source of illness and death in the United States, causing an estimated average of 30 000 deaths annually over the past several years. For each death, 10 to 15 infected persons are hospitalized. Despite numerous public education efforts, fewer than one third of adults who meet criteria for vaccination actually receive influenza virus vaccine. The influenza virus is very mutable, and antigenic drift may result in sizable outbreaks that cannot be prevented by whatever vaccine is in current use. It is rare for the same viral strain to cause severe epidemics in consecutive years. Amantadine and rimantadine are still used to prevent infection in this setting and in unvaccinated persons, but their usefulness is limited by significant side effects (including central nervous system toxicity in elderly persons) and rapidly developing resistance. Furthermore, neither of these agents is effective against influenza B.
The two new drugs under discussion here, oseltamivir and zanamivir, inhibit neuraminidase, an enzyme needed for both type A and type B viruses to replicate. Fortunately, the site of their antiviral action is highly conserved in the nucleic acid of virions and …
