He was a healthy teenager from another country, visiting friends and relatives in Minnesota, when he got sick.
Then really sick.
The teenager wound up at Hennepin County Medical Center in Minneapolis, near death with complications from H1N1 flu in early September. But his doctors there were able to get their hands on an experimental antiviral drug that saved his life. A month after he was admitted, the teenager walked out of the hospital and was able to go home to his own country.
The 17-year-old boy, who has not been identified, was among the first H1N1 patients in the United States to get the new drug, Peramivir. Now the U.S. Centers for Disease Control and Prevention (CDC) has taken the unusual step of making the unapproved drug available to hospitals across the country for emergency use in just such cases.
Peramivir is similar to other antivirals, such as Tamiflu. What makes it unique is that it can be given intravenously. Other similar drugs have to be swallowed or inhaled with an inhaler, and are widely used both in and out of hospitals.
When patients are near death or in organ failure like the 17-year-old at HCMC, an intravenous drug is the only option, said the boy's doctor, Dr. Stacine Maroushek, a pediatric infectious-disease specialist at the medical center.
"I don't think he could have been any closer to death without dying," Maroushek said. He had severe bleeding in his digestive track, almost every organ had failed, and he was on a ventilator to help him breathe. Doctors could not have gotten any other antiviral into his system, she said.
But Maroushek was familiar with an experimental drug made by a small company called BioCryst of Birmingham, Ala. She had to get permission from the U.S. Food and Drug Administration to use the drug in the boy's case. That meant she had to fill out numerous forms, get permission, then contact the company, which sent it to her.
"We were able to get it within 24 hours," she said. "After he was on the medicine for a day and a half or two days, he started turning around."
Like all antivirals, the drug works by suppressing the growth of the virus in the body, allowing the immune system to fight off the infection.
Since early September, the drug has been available on what's known as a "compassionate use" basis around the country for hospitalized patients with severe H1N1 infections. Maroushek said the teenager at HCMC was the third person and the first pediatric patient in the country to receive it.
That doesn't mean, however, that it will always work.
The same drug reportedly was given without success to Michael Milbrath, the Waseca, Minn., hospital executive who died of complications from H1N1. His family said on his CaringBridge Web site that Milbrath, 54, had received "the new experimental drug" at Immanuel St. Joseph's hospital in Mankato.
Milbrath had been hospitalized in intensive care with complications of the flu, according to the CaringBridge site. As his condition worsened, doctors received permission on Oct. 22 to use Peramivir, and the drug was flown in from the East Coast overnight, the family reported. He received the drug Friday, but died the following day..
Under the new emergency-use designation, doctors can get Peramivir directly from the CDC in Atlanta, Maroushek said. It is designated for patients who have run out of other options, either because other treatments failed or they can't use other antiviral medications.
The company, BioCryst, said that it has donated 1,200 courses of the drug to the federal government for use during the flu pandemic. It also said it is producing 130,000 more and is prepared to make additional doses, if necessary. The company is conducting a formal clinical trial in 400 patients nationwide that is expected to be completed by April 2011.
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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