Abstract
Response to: Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev. Anti Infect. Ther. 10(1), 95–104 (2012).
We compliment Kouadio and colleagues for a meticulous review of the risk factors and potential infectious diseases that followed the prolonged secondary effects of major natural disasters that occurred from 2000 to 2011 Citation[1].
The future response by clinicians and public health personnel responsible for management of several clinical syndromes following any natural disaster would depend on constant supplies of potent therapeutic and prophylactic agents. The basics of the storage requirements of different therapeutic, prophylactic and diagnostic agents used after such disasters in the field should be appreciated; they have not received much attention so far.
The potency and bioavailability of different medicines would be maintained only by their storage either in cold temparatures at 2–8°C or at temperatures ranging up to 25 or 30°C at all times. Inadvertent exposures to temperatures above or below this could easily happen after disasters. Furthermore, vaccines and diagnostic agents also have to be stored under similar temperatures, while the biological standards have to be stored at all times at temperatures lower than -70°C Citation[2]. Any exposure to extremes of temperature, humidity, radiations and air flow in the postdisaster phase could reduce their potency and bioavailability, blunting the postdisaster therapeutic and prophylactic response against infectious diseases.
Extremes of environments are associated with different disasters globally, for example, the August 2003 power shutdown in vast areas of the northern parts of the USA and Canada had lasted several days. An inadvertent casualty during the shutdown might have been the biological standards stored in these areas Citation[3]. Later, during August 2005, the after-effects of hurricane Katrina were associated with prolonged power shutdowns. The auxiliary generators in hospitals and laboratories ran out of fuel Citation[4].
Formulations with enhanced stability would be necessary to ensure the maximal utility of therapeutics, prophylactics and diagnostics in the field after disasters Citation[1]. There are formulation and processing technologies that could improve the stability of vaccines, therapeutics or diagnostics at extremes of temperature. Further research would be required for individual vaccines, medicines or diagnostics. Experimental lots of the least stable of the common childhood vaccine, live poliovirus vaccine, have indeed been stabilized by pirodavir and deuterium oxide. Stabilized lots resisted an exposure to 42°C for 10 h Citation[5].
Public and private international and national agencies could fund projects by vaccine developers and pharmaceutical and diagnostic industries to expedite progress of various stabilization processes. Moreover, policies that would increase demand for thermostable vaccines Citation[6] and therapeutics during natural disasters would be welcome and, indeed, need encouragement.
In conclusion, an integrated multidisciplinary approach would be needed for the development of stabilized formulations to address the postdisaster state of affairs Citation[1] more efficiently. The developmental cost, or the manufacturing cost, including better field usage of the final product, would be of great importance.
Acknowledgements
The authors wish to thank D Wadhwa for her secretarial assistance.
Disclaimer
This work is the opinion of the authors and does not represent the views of Expert Reviews Ltd or its employees.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
References
- Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev. Anti. Infect. Ther. 10(1), 95–104 (2012).
- Jerne NK, Perry WL. The stability of biological standards. Bull. World Health Organ. 14(1), 167–182 (1956).
- Arya SC, Agarwal N. Power shutdown and biological standards. Lancet 362(9390), 1159–1160 (2003).
- Dalton R. Health centres and labs left reeling by Katrina. Nature 437(7056), 177 (2005).
- Verheyden B, Andries K, Rombaut B. Capsid and RNA stabilisation of the oral polio vaccine. Vaccine 19(15–16), 1899–1905 (2001).
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