Thursday, March 10, 2011

Let's vaccinate against a nonexistent flu virus: the "preemptive strike" rears its head again/ BBC

UPDATE:  I just learned that in 2008 GSK obtained European regulatory approval to market a so-called "Prepandemic" Vaccine for H5N1 avian flu.  This virus is not circulating in humans.  The theory behind the vaccine is that if a bird flu virus emerged to cause a pandemic, the GSK vaccine is likely to be somewhat similar to it, and might provide partial immunity.  Such immunity could then be theoretically boosted by a more specific vaccine, made to order for the specific disease-causing virus. 

However, it remains more likely than not that a vaccine for a new pandemic would not be available until 4-6 months or more after the pandemic was identified, likely too late to have much effect.  This happened for the 2009 swine flu pandemic.  The swine flu vaccine was probably only needed for small numbers of people who were at particularly high risk of  severe sequelae from the virus.  The European Parliament now suggests that the death rate in Europe from swine flu was only 1/10th as high as from an average seasonal flu.  This is because those over 50 were, in large part, already immune.
From the BBC:
Governments should launch a vaccination programme now to guard against a possible H2N2 flu pandemic, according to an article in the journal Nature.

The US authors say immunity to the H2N2 flu strain is very low in people under the age of 50. But a safe vaccine already exists after an H2N2 outbreak in the 1950s and '60s.  They say that vaccinating now could save billions of dollars if a pandemic does develop.

Dr Gary Nabel and colleagues from the Vaccine Research Centre in the US say H2N2 has the ability to cause a pandemic in the same way that H1N1 did in 2009.

Between 1957 and 1968, the strain is thought to have caused up to 4 million deaths in a global outbreak, during which time a vaccine was developed.

When the pandemic was over the H2N2 vaccination programme was stopped in the late 1960s, although the virus is still present today among birds and swine...

"Another major influenza pandemic is likely to cost far more and create a much greater health burden than a well-planned pre-emptive programme.

"The US Centres for Disease Control and Prevention estimates that a pandemic outbreak costs the United States between $71 billion and $167 billion."  Dr Wendy Barclay, Chair in Influenza Virology at Imperial College, says the H2 flu virus does pose a credible pandemic threat, as do other strains of bird flu.  But she believes there are some big questions about whether a pre-emptive vaccination programme would be welcomed by the public.

"Now we are in the calm after the storm of that swine flu pandemic, it is timely to open up the debate about pre-pandemic vaccines. As Dr Nabel himself points out in his article, we have to ask whether the public will want or accept a vaccine against a disease that does not at the moment exist.

"Work towards making such vaccines available is ongoing in many laboratories around the world.  "Scientifically we are in a position to be able to offer a good solution, the issues to be decided are of cost and of public attitude."


Vronsky said...

"Between 1957 and 1968, the strain is thought to have caused up to 4 million deaths"

To me, and probably to most people, it is difficult to know how to react to this number. I know that very large numbers of people die from various forms of flu every year and therefore an apparently high a number of deaths does not necessarily signify some new and elevated risk. Why isn't there some normalisation factor for flu deaths, so that we can say deaths from all forms of flu in such-and-such a year were 1.01 or 0.95 with 1 being the norm? Could you suggest such a measure (the Nass unit)? Is the 4 million figure quoted in fact just normal?

Anonymous said...

It is not unlike selling any product to the public they really do not need. Except the government will pay for it, and they need something to seem like they are not blindly transferring monies to drug companies. So the ad firms jimmy up the "science" and stoke fear.

Meryl Nass, M.D. said...

There are no reliable influenza deaths stats even today, for several reasons. One is that most flu-like illnesses are not due to influenza, but the majority of people with these illnesses are not tested to assure an exact diagnosis. Another is that most people die of something else: a complication of influenza (like bacterial pneumonia), or another condition they had which worsened during acute influenza (like congestive heart failure). So who do you count? Flu only accounts for the cause of death on about 2,000 death certificates in the US yearly.

CDC has claimed that about 36,000 Americans die yearly from influenza. This is a gross estimate with no solid statistical underpinning. Extrapolating this number to the entire world population (our population accounts for 5% of the total) would suggest that from the 1957 through 1968 flu pandemics, 4 million flu deaths is no more than would be expected.

BUT neither the 4 million nor the 36,000 figures have validity. So I cannot answer your question.

Anonymous said...

Flu deaths are often related to dehydration. So how about more consumer education ? I've noticed medical doctors/nurses have set a higher threshold for what is considered a "dangerous fever" which in itself is dangerous as children and infants are at risk of medical negligence with this new threshhold.

Since body temperature is an "average", and normal body temperature can vary from individual to individual, I believe any fever in infants, children, or the elderly should be a cause for extra monitoring.

Further, I have noticed that not only the average citizen, but medical personnel lack common sense methods of reducing fevers to save life, such as using cool compresses on the forehead, face, back of neck, chest, and also using these around the wrists and ankles.

I really think first age and CPR training and recognition of shock should be required of all citizens just like Drivers Licenses. The training would save many lives, and reduce medical costs and the burden on medical facilities.

There needs to be some government incentive to encourage people to take these courses, such as employer sponsored courses, mandated for welfare recipients, and for all who work with children or the elderly. I really would like to see infant CPR and first aid required of all new parents also. It is not a violating of freedoms to improve on one's knowledge and ability to protect those in one's care.