Saturday, February 17, 2007

February 16 Flu Update

The biggest flu news remains on the vaccine front. The UN says a bunch of things, most notably that vaccine could be available within three months of a pandemic beginning. How much...different question. Note that this quote seems to hint that we're talking multiple strains, too.

“For the first time, results presented at the meeting have convincingly demonstrated that vaccination with newly developed avian influenza vaccines can bring about a potentially protective immune response against strains of H5N1 virus found in a variety of geographical locations,” WHO said in a news release.

“Some of the vaccines work with low doses of antigen, which means that significantly more vaccine doses can be available in case of a pandemic,” it added.

CIDRAP on the vaccine story. Emphasizes current production capacity of 400 million in world of 6 billion. Note also that CIDRAP cites a difference between the tone of WHO's November vaccine release and this release.

Here's the official WHO report.

Effect Measure decries WHO for seeking good news headlines which are supported by carefully measured words that don't promise very much....and with strong emphasis on the lack of production capacity. (My note is this: isn't it true that we could make real progress without vaccinating everyone in the world? Couldn't we at least head off the apocalyptic predictions we have seen in the last few years? Couldn't it be 1968 instead of 1918?).

For those who are really into vaccines, here is a table of all ongoing flu vaccine trials.

A five-year old in Egypt is now confirmed H5N1 positive.

CIDRAP on Egypt, and other countries. Note the death is confirmed H5N1 from a couple of days ago. Note outbreaks in Laos (new) and Turkey.

There is an outbreak in Moscow among birds. This is the first time the bird flu has been found in the capital region.

Indonesia will resume sending samples to WHO....once it has guarantees it will have access to the vaccine produced from the samples.

CIDRAP has this story, as well.

ProMed has a Japanese report on rodents spreading bird flu there. Note skeptical mod comment.

With bird flu breaking out in new countries each week, Revere looks back one year and sees what he was writing then...the most things change (you know the rest).

Britain hastily changes its regulations in response to the Suffolk update.

Mexico is looking to prevent bird flu with some new animal health rules.

The Ivory Coast is also stepping up its surveillance program.

Here's a story from the local press on flu prep in Louisiana.

Roche has filed to sell lower dose Tamiflu in Europe, partly for children in an influenza pandemic.

The Society of Human Resource Managers looks at the recent hurricane-style pandemic rating from the US.

The Archdiocese of Edmonton says it is planning for a pandemic. They are prepared to cancel Church in a worst case scenario.

Professor tells Whitewater, Wisconsin audience about the uncertainty of a pandemic.


At 1:36 PM, Blogger Wulfgang said...


I am clearly vote on the side of caution when it comes to the current optimistic news on influenza vaccines – pretty much like Revere. Not only does there exist a tremendous manufacturing gap in the ability to produce said miracle pandemic type vaccines, there are additional obvious gigantic hurdles and issues remaining that will have to be overcome, that must be taken into consideration: namely, multiplicity of strains (countless H9, H5 types), continued mutations, pre-priming the populations, differences between children and adult dosages, multiple dosages required for effectiveness and full immunization, and adjuvant strategies. These are all complex issues. It would be nice if pandemic planning all culminated in a Y2k type happy ending, but we are years away from that scenario occurring. So keep replacing that Peter Pan peanut butter.

The longest pole in the vaccine development tent, now, is time and money… can the manufacturing and technical hurdles actually be resolved before the virus crosses the threshold and becomes highly transmissible between humans. That’s the answer to your question whether this will turn out like 1918, 1957, or 1968. Do the simple math to understand the dilemma Orange: global vaccine production capacity at present for normal seasonal type influenza, is limited to 350-400 million doses per year. That’s it, that’s all we get. If a pandemic happens this year or next, everyone better be able to hunker down for a few months, especially if it exceeds a Cat 3. If it would reach Cat 5 level or higher (which it could easily do in my mind), better get ready to have your life altered in a serious way.

With the world population of 6.525 B (2006), it would take at least the next five years at the present rate of production to inoculate only 30% of the population (assuming we shifted away completely from normal flu vaccine production – which isn’t going to happen). The matter does become resolvable though, if world production capacity of influenza could be just doubled to about 1 billion doses per year, then easily about one third to one half of the total worlds population could be inoculated against avian influenza in three years.

If influenza production capacity were to be re-targeted to the worlds only 10 largest countries, which comprise 60% of the worlds population, then the solution gets even more intriguing, because Indonesia, China, Nigeria, and Russia, which could all be considered “bird flu incubators”, are on the top ten list (as is of course, the US). Since nearly two-thirds of all documented human pathogens are zoonotic and concentrated in most of these densest and poorest per capita countries (where they are endemic), a strategy and investment for increasing vaccine manufacturing capacity in these areas would seem very prudent to any sane political leader.

Finally, a few miscellaneous comments – it’s heartening to see the various church congregations getting the message, like in the Canadian Catholic News article. I truly believe, like in 1918, and as in many other catastrophes, like Katrina, the churches will come through with flying colors – even out classing other over hyped organizations like the bureaucratic Red Cross. Churches were the unsung hero’s.

As for the Human Resources folks, well, they always act like they just landed from another planet – who knows if they will ever get engaged when it comes to pandemic continuity planning. They seem to be the ultimate bureaucrats, who salivate on new regulations, but I will admit, they all make good colorful Powerpoint presentations.

Probably when it’s all over, they will be the first ones to claim credit for their regulatory compliance contributions. I know, cheap comment, but appropriate.


At 2:13 PM, Blogger Orange said...

I often wonder if people in the flu community would do if a solution did emerge. We should be careful, because we could end up as in denial as Marc Siegal if we don't keep our minds open.

No doubt, the containment strategy with antivirals is not workable. That wasn't what anyone was talking about. All I suggested was that we might be closer to averting the total meltdown many fear if we can employ a vaccine at some point early in the process, even on a limited basis. That's even more likely if there is some existing immunity, as there may be. Because yes, we will have another pandemic again. But not all pandemics are "cataclysmic"--it does not have to be a 1918 pandemic.

Finally, I don't believe anyone really ever prepares for the absolute worst that could happen. It isn't in our nature--and we would literally be paralyzed.

At 8:31 PM, Blogger Wulfgang said...


I hear you, but every thing depends upon timing in the near future, and the resultant decision tree.

If the world trundles on for the next two to three years, with seasonal waves of H5N1 outbreaks throughout the world, which are mostly fended off via Tamiflu blankets (assuming the H5N1 doesn’t become too resistant), and with what is deemed an acceptable number of fatalities – we should be okay in North America.

The government will stockpile a reasonably large amount of pre-pandemic vaccine during this window, to be held in reserve – this also helps us build up our capacity to produce when/if the real one hits.

I doubt very highly if there would be any advance “priming” of the population before hand – it takes too long for clinical trials, it is somewhat risky, not cost effective and generally would not be acceptable to the public, in my opinion.

If a pandemic were to surface during the next 36 months, we’ll find ourselves thrust into a major league ball game, and it depends what inning we find ourselves in.

First, the US would try to “measure” or estimate the severity of the pandemic in the famous CDC hurricane index terms. If the pandemic turns out to be “epidemic-like”, then the most likely chosen weapon will be best antivirals we have. Then it would turn around and start producing an updated perfect-match version for the general population, during the famed 6 month timeframe.

I do believe, with absolute certainty, that if we have human to human transmission and the progression even appears to approach the 2.5% 1918 scale or beyond, the government will move out with whatever pre-pandemic virus it has in its arsenal and start mass inoculation of the public. Absolutely no question about this in my mind.

Regarding preparation for the absolute worst case and paralysis, I am going to be very blunt to you and your readers, but also respectful, because we all have different perspectives – and tolerances and expectations.

First I ignore both Marc Siegel and Michael Fumento’s opinions, because they are incorrect and ill-informed, and quite frankly, pretty dumbed-down on the subject.

A pandemic, when it comes down to it, is not a misplaced, mistaken medical or questionable societal fear and health alarmist issue, it is a fundamental national security issue.

Michael Leavitt continues to reiterate, “Any state or community that fails to prepare for a pandemic flu, which will happen, will suffer serious consequences”. Listen to his advice.

I don’t hang around on these boards to kill idle time, or even strike up friendships – I could care less. I have better things to do with my time. But because of what I do, I hear and see things that most other people don’t. I am certainly not saying that a pandemic will occur, or predicting when, only that the very high likelihood exists, and if it does, people better have their preparedness factor in a correspondingly high state of readiness. I suspect things could get ugly beyond anybody’s present ability of most people to comprehend – maybe even mine, and I have a vivid imagination.

Why does anyone suppose Mssr’s Leavitt, Nabarro, Webster, Osterholm and Ms. Gerberding say what they do ? Think closely what they say. Why does anyone think the US State Dept is cautioning its Embassies to keep three months of provisions on hand – to keep money in circulation ?

Not for their own health or professional advancement - it's not their nature.


At 9:10 PM, Blogger Orange said...

Well, it is in their nature to cover their butt...

Anyway, as always you make good points. We agree on this. There will be no vaccinations until the presence of the virus is freaking obvious. After Swine Flu, Bill O'Reilly will not allow it.


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