Hunting ultimate weapon against flu

The ever-changing flu virus is slippery, mutating so rapidly that vaccines designed to protect against it shield for a single season, if that long.

But what if a flu shot could be a one-time proposition, maybe a rite of childhood like so many other vaccines? In a year like this with pandemic influenza racing across the globe, officials have been left scrambling to develop a vaccine to guard against this new H1N1 virus, all the while preparing for the complicated annual ritual of giving seasonal flu shots to millions. Fearing such a pandemic, researchers for years have been working to create what is known as a universal flu vaccine, a single inoculation that would defend against severe infection from any type of flu - seasonal or otherwise.

So far, while there has been some progress, no one has succeeded. At least not in humans.

"We cannot protect against pandemics. We cannot make vaccine fast enough" when a new strain appears, said Dr. Hildegund C.J. Ertl, who heads the vaccine center at the Wistar Institute in Philadelphia. "If you have a universal vaccine, you stop worrying about pandemics. A lot of people are trying."

For several reasons, it could be a decade before a vaccine like this hits the market. Researchers still haven't determined whether the approach will work. Meanwhile, any vaccine would need to be championed by a manufacturer, and it could be difficult to find a company willing to take a risk when the vaccines currently on the market do a decent job most of the time.

"We're still pretty far away from any sort of [universal] vaccine," said Dr. Wilbur Chen, a vaccinologist at the University of Maryland's Center for Vaccine Development, where an experimental swine flu shot is being tested now. "We still haven't been able to find the right candidate."

Still, Chen said, developing one would answer many of the limitations of seasonal shots, which must be given again and again: "It would be great if it was like other vaccines where you could give one vaccine or a booster shot every so often and not have to do it every year. ... It's the panacea for what we're doing right now."

While researchers are attacking the universal flu vaccine problem from many directions, the goal is the same: to find a part of this ever-changing virus that doesn't change and take aim at that.

Some researchers are focused on something called the M2 ion channel, which makes up less than 1 percent of the surface of the virus, said Dr. Robert Belshe, who is studying universal flu vaccines as director of St. Louis University's vaccine center. There are just a few copies of this on the surface of the virus, but Belshe said it plays an important regulatory role for the whole virus.

"The virus doesn't function without this ion channel," he said. "If you make antibodies to the ion channel, do the antibodies alter that ion channel and basically plug it up? Does it prevent the disease? Does it slow down the disease?"

In his studies with mice and ferrets, such a vaccine prevents death in the animals, even when they are exposed to lethal doses of flu virus.

"The mice are getting influenza, but they're not getting as sick as they would if they hadn't gotten the vaccine," he said.

A small clinical trial Belshe worked on, designed to determine safety but not effectiveness, proved successful. But what is needed is a large clinical trial, he said, to truly test the promising, though unproven, concept. So far, no such trial is in the works, he said.

Even then, he said, he believes this approach likely will not keep people from getting sick. It would just prevent many of the deaths associated with a severe flu season.

Several leading researchers said that at this point they envision a universal flu vaccine as a supplement to current vaccination, not a replacement for the yearly immunizations. Such a vaccine would be most useful in years like this, when a new pandemic strain appears and begins circulating widely. Such vaccines would also be of use in years when the strains of the flu that end up circulating don't match the strains included in that year's vaccine.

Mismatches are not uncommon. Two years ago, two of the three strains included in the seasonal vaccine had mutated by the time the vaccine was administered, leaving people far less protected from that year's flu bugs. The seasonal flu kills 36,000 Americans a year and sends hundreds of thousands to the hospital.

A universal flu vaccine, on its own, would be cheaper and easier to administer since it wouldn't have to be given every year.

Developing countries can't afford annual vaccination programs. In India, Ertl said, there are no flu vaccines given. They are too costly. Many people in the United States go unvaccinated because it can be a hassle to keep up with the shots each year. About 100 million Americans a year get seasonal flu shots - less than 40 percent of those for whom the shots are recommended.

Meanwhile, long lead times in producing a new vaccine and limited vaccine production capacity in the world mean responding to a new virus can be much slower than the spread of infection.

And a universal flu vaccine, advocates say, would be of great help when an unforeseen new virus emerges, like this year's swine flu. Prior to the outbreak in April, most flu vaccine research was focused at the H5N1 avian flu which many believed would be the next pandemic.

"As a pandemic develops, there can be difficulty producing vaccines," said Dr. Suzanne Epstein, associate director of research at the Food and Drug Administration and a vaccine researcher for nearly two decades. Universal vaccines "would be on the shelf, prepared - not prepared in a rush or a frenzy at the time of an event.

"The protection is broad. You don't have to worry that the mutation of the virus is continuing and it won't be a match."

Epstein said she sees a universal flu vaccine as "a complementary form of vaccination and preparedness."

"This is not based on a prediction," she said. "You don't have to be able to predict what will happen."

Belshe said that, alternatively, people could be vaccinated ahead of time and receive boosters, ideally, every decade or so.

"If we had a universal flu vaccine, we could vaccinate everyone in advance," he said.

Epstein said that, right now, a lot depends on nonscientific aspects of vaccine production - money for clinical trials, market forces. She wonders if those companies who make flu vaccine now will be willing to take a risk on a universal vaccine.

"Short-term, people want to make something they already know works," she said.

But, she added, "I feel there's a public health issue that is not yet satisfactorily met."

Copyright © 2009, The Baltimore Sun

SAN FRANCISCO -- More than 100 nurses gathered on the steps of the University of California at San Francisco Medical Center today to protest

Bay City News Service

Posted: 08/05/2009 09:03:58 PM PDT

Updated: 08/05/2009 11:54:53 PM PDT

SAN FRANCISCO -- More than 100 nurses gathered on the steps of the University of California at San Francisco Medical Center today to protest what they say are unsafe practices in the handling of swine flu patients.

The nurses said they are concerned about being improperly exposed to the H1N1 virus, which jeopardizes their own safety and the safety of the public.

"It's our job to stand up for health care in this country and community," said James Darby, the chief nurses' representative at UCSF. "It's our responsibility to stand up for our patients' rights. At the end of the day, the nurses are the ones taking care of patients."

The California Nurses Association organized today's protest, and members want the language in their contracts to be changed to codify stricter safety standards. Protesters wore surgical masks and carried signs that read, "Nurses and patients demand swine flu protection."

A nurse in Sacramento died July 17 after she was exposed to swine flu, according to the CNA. They also said that two weeks ago, another nurse at UCSF was allegedly fired for speaking out against the hospital's handling of swine flu exposure.

Darby said the UCSF nurse was terminated two days before her six-month probation period ended, even though management did not express any dissatisfaction with her performance at her three-month meeting.

The nurse treated a patient with H1N1 and began to experience symptoms,

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so she had a sample taken, Darby said. The sample was then thrown out, and the nurse was unable to file for workers' compensation. When she

complained about the procedure, she was fired, Darby said.

"They told her she wasn't a 'good fit,'" he said. "Usually when there are questions about somebody, they come to me and discuss extending the probation period, but that didn't happen here."

Officials at UCSF Medical Center said in a statement, "Allegations by CNA that a UCSF nurse was terminated because of comments made about unsafe patient care practices related to H1N1 are unfounded. The individual ... was released due to performance factors that occurred during this period."

The statement also said officials are investigating the grievance CNA filed on behalf of the nurse.

Nurses, however, said they are also concerned about standardized practices, including a lack of training and equipment.

Darby said he has seen nurses wearing re-used masks, and nurses are often understaffed. A nurse might have one patient in isolation and three who are not, which means the nurse is constantly moving between the two environments and changing outerwear. This makes contamination more likely, he said.

Scott Stanley, a registered nurse in the radiology department, said he used to work in the emergency room and didn't see enough emphasis on prevention there.

He said there weren't seminars or training exercises for identifying flu symptoms and using personnel protective equipment, which means emergency room nurses who were exposed to the flu could then expose other patients and health care workers.

UCSF's official statement denies any systemic problems, saying there has been extensive assessment and planning related to H1N1. It says there is adequate safety gear in place for all patient-care employees, as well as "stringent infection control procedures that are practiced at all times."

Will not be enough vaccine early in the flu season.

U.S. Homeland Security Secretary Janet Napolitano told a newspaper this week that the flu will flare up after schools open in the fall and there will not be enough vaccine early in the flu season.

"That reminded people that we have a potential problem coming," said Ron Plain, University of Missouri agricultural economist. "In the hog industry, there is a fair amount of concern that it (flu) will be back in the news a lot."

Talk that producers have been slow to reduce their herds despite nearly two years of losses also prompted selling at the Chicago Mercantile Exchange hog markets.

At the CME, the August hog futures 2LHQ9 were down 1.250 cents at 52.725 cents per lb and October 2LHV9 off 1.125 cents at 49.000. Some 2010 contracts briefly dropped the 3-cent daily limit.

"The expectations are that we will have a glut of pork and that demand is not going to improve in the next couple of months because of the flu situation," said Dennis Smith, livestock broker at Archer Financial.

Cases of H1N1 flu have continued to increase around the world, but the flu has largely been out of the headlines since last winter. However, it could reemerge as a major news event if cases and deaths increase this fall.

"Hopefully the press will continue to call it H1N1 and not call it swine flu. Obviously that's something that is going to weigh on these markets," said James Burns, a hog trader at the CME.

What makes swine flu different from regular flu?

What makes swine flu different from regular flu?

From a lab point of view, this virus is something altogether new. It has the DNA of pig flu viruses as well as bird and human flu viruses.

From a clinical point of view, it is not a whole lot different - in most patients. In the vast majority of cases, it causes similar symptoms: fever, cough aches, fatigue. Some who suspect they've had swine flu say the symptoms lasted longer than a regular flu and left them more exhausted, but for most, this new virus is not causing severe illness. While there were worries in the virus' early days, that it was killing lots of young and healthy people, we now know that deaths are relatively rare. And remember: seasonal flu is often fatal in the elderly and even, on occasion, kills young, healthy victims.

What makes swine flu so remarkable is the fact that it emerged outside of the traditional "flu season," and has continued to sicken people throughout the summer. It has also managed to spread around the globe more rapidly than any previous influenza outbreak, spreading as fast in its first six weeks than past pandemics spread in six months. With virtually every nation in the world infected, this virus will be with us for while.

Schools prep for spread of swine flu

By Larry Copeland, USA TODAY

As the first day of classes approaches for some districts, school and health officials in several states are preparing for the possibility of wider outbreaks of the H1N1 virus.

Swine flu, which disproportionately targets teenagers and young adults, is expected to begin spreading more rapidly when students return to the close quarters of classrooms and dormitories, county and state health officials say. They expect greater-than-usual numbers of students to seek inoculations because of widespread publicity about H1N1.

2 more swine flu-related deaths reported in Nevada

The Associated Press

Posted: 07/31/2009 10:04:09 AM PDT

LAS VEGAS—Health officials are reporting two more deaths in Nevada related to swine flu.

Southern Nevada Health District spokeswoman Jennifer Sizemore says a 73-year-old man with underlying health conditions died Monday.

A 35-year-old woman who was in the hospital for two months died on July 24. Thomas Wilson, Sabrina Gibson's father, says his daughter was diagnosed with swine flu and was cured of it, but she suffered massive internal bleeding and lung failure.

The deaths bring the number of swine flu-related deaths in Nevada to six.

Earlier in July health officials reported the deaths of a 47-year-old man with underlying medical conditions and a 51-year-old man. In June, health officials reported the death of a 33-year-old man and a 70-year-old woman who was a New York state resident.

Pregnant women are likely to be among the first groups recommended to receive the vaccine

Pregnant women are likely to be among the first groups recommended to receive the vaccine for the new H1N1 influenza, commonly known as swine flu, because of their unusually high risk of dying from an infection. Of the 266 U.S. swine-flu-related deaths for which the Centers for Disease Control and Prevention has detailed information, 15 were pregnant women, the Associated Press reported this morning. That amounts to 6% of the deaths, although pregnant women account for only 1% of the population. Most of the women were healthy before they contracted the virus.

The CDC's advisory committee on vaccination will meet in Atlanta on Wednesday to set priorities for who should receive the new vaccine, which may begin to be available by October. The group is expected to follow a recommendation from the World Health Organization that healthcare workers, who are on the front lines of caring for infected patients, be the first to receive the vaccine. It now seems likely that pregnant women will be next.

Pregnant women have long been known to be at increased risk for adverse effects from seasonal influenza, and health authorities recommend every year that all pregnant women be vaccinated. Even so, only about an estimated 15% receive the shots. The women are thought to be at risk of developing pneumonia -- and dying -- because of changes to their lungs and immune system that are a normal part of pregnancy, and many physicians fear that the risk is even higher with H1N1. In fact, British and Swiss health authorities have notoriously argued that women should pospone getting pregnant until after the pandemic has passed.

The vaccine protects not only the mother but also her baby. A study conducted in Bangladesh and reported in the New England Journal of Medicine last year found that vaccination for seasonal flu reduced flu in infants by 63%.