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Forum: CDC Orders Human H 5 N 1 Vaccine

03 November 2006

Bird Guano – at 10:05

http://www.taipeitimes.com/News/tai…1/03/2003334581

Posted under Fair Use because this WILL definitely result in a discussion for academic purposes.

CDC places order for H5N1 vaccine STAFF WRITER, WITH CNA Friday, Nov 03, 2006

The Center for Disease Control (CDC) has ordered 190,000 doses of avian influenza vaccine

 to enhance the nation’s flu-fighting capability amid renewed pandemic 

warnings, a senior official said yesterday.

According to CDC Deputy Director Chou Chih-hao, the government decided

 to procure the vaccine from two foreign suppliers after a new resistant
 strain of the highly pathogenic H5N1 virus deadly to humans and poultry 

was found to have spread through Asia.

Chou quoted a report by scientists in Hong Kong and the US as saying that the new virus — dubbed the “Fujian-like” strain — may have mutated in response to vaccination programs designed to h alt the disease in farm flocks.

Noting that the strain emerged last year and has already spread throughout China as well as to Hong Kong, Thailand, Laos and Malaysia, the report said that the spread of this virus over such a large geographical region within a short period of time directly challenges current disease control measures.

Against this backdrop, Chou said the CDC has spent nearly

 NT$60 million (US$1.81 million) purchasing 190,000 doses

of the vaccine against the H5N1 virus from two foreign companies.

The vaccine is 70 percent to 80 percent effective and has a shelf life of between six months and two years, Chou said.

Nevertheless, Chou added that although the vaccine has been proven safe and effective in preventing avian influenza in humans in initial clinical tests, it has not yet been approved for commercial sale.

Therefore, Chou said, the vaccine will be stockpiled for emergency epidemic control use or domestic clinical testing.

“Basically, only frontline medical and epidemic control personnel will get vaccinated,” Chou said, adding that the vaccine will not be available to members of the public.

According to the procurement contracts, Chou said, the vaccine will be delivered by the end of this year.

“The vaccine will be ready for use if an avian flu outbreak occurs this winter,” he said.

If each medical professional gets two doses of the vaccine, Chou said, the stockpile will be enough to cover 90,000 individuals, or one-third of the country’s health care personnel.

Moreover, Chou said, the CDC has also kept in stock enough doses of Tamiflu — an oral anti-viral drug for treatment of influenza

 — for 2.3 million people, or 10 percent of the nation’s population 

in accordance with the recommendation of the WHO

Bird Guano – at 10:07

So it’s unclear to me if this is the Taiwanese CDC, or the US CDC.

I’m trying to find additional articles to clarify.

Either way, my take-away from this article is:

a very real possibility of TSHTF, and Soon.

uk bird – at 10:13

All the articles referring to Chou Chih-hao are from Taiwan.

janetn – at 12:03

Im confused. Didnt WHO just come out and say that prebuying vaccine wasnt a good idea??? Could someone please clarify what strain this vaccine is being made from. It isnt the 2004 one is it? Sorry if Im being dense here.

Bird Guano – at 12:10

Janetn, you’re not being dense.

It’s a poorly written article.

I’m trying to find additional articles in other press that may clarify.

So far no luck, but it does look like the Taiwanese CDC.

anon_22 – at 12:20

It has to be Taiwan, look at the currency NT$60 million (US$1.81 million)

Bird Guano – at 12:40

Still significant that they are taking the initiative.

May want to change the thread title to reflect the Taiwan part, so people don’t freak out.

anon_22 – at 12:46

Do you want me to make a comment on the top post? Or you need to ask pogge to change the thread title.

Jane – at 12:46

They must be using the Fujian strain, since that’s the latest version and the one mentioned as the one that’s spreading.

Pixie – at 12:48

It looks like they are hoping this vaccine will offer some degree of protection to medical staff on the front lines:

“Basically, only frontline medical and epidemic control personnel will get vaccinated,” Chou said, adding that the vaccine will not be available to members of the public.

If so, I say go for it. It is worth a shot. We will have to offer the medical professionals who serve us the best protection we can possibly get. Even so, they note that this vaccine only cover 1/3 of Taiwan’s medical professionals.

It does look like they’ve gone right around the usual approval requirements for this one - I wonder if they could get away with doing that here? Maybe with an executive emergency order exempting the vaccine’s producers/dispensers from litigation?

Bronco Bill – at 12:59

I just hope that if the virus mutates again from the current version to something entirely different, and then a vaccine becomes available for the new virus, they don’t just say that they don’t have any more money to spend on the new vaccine.

Pixie – at 13:05

Bronco Bill - at 12:59

I think that was what Bird Guano was alluding to. If they’re poneying up for this vaccine now using cold hard cash, rather than waiting, there may be, in their minds, some compelling reason to do so.

It would definitely be preferable to wait till the last moment to get the best match to “the” pandemic virus strain (if, indeed, “it” is “one” strain). But then leaders risk the accusations that they waited too long, and it is too late.

We’ll be printing money for to cover a lot of problems caused by this pandemic. Vaccine manufacture seems as good a reason as any, and now seems as good a time to start as any (maybe a very good time). And, anyway, Dude keeps saying that we can just send him the bill. ;-)

TreasureIslandGalat 13:13

Taiwan is opting to spend a lot of money to secure this vaccine which really only has a shelf life to get it through this next season. After this season, even if the shelf life still has a little time left, the odds are that the virus will have migrated away from the vaccine having optimal effect to prevent the new form of the bird flu.

The fact they see this as so important to do THIS year that it is worth the investment makes me take notice.

I add to this action the information that came out some weeks ago that the Chinese were also wanting to vaccinate their population against a possible bird flu pandemic that they feel has a 20% likelihood of erupting THIS SEASON.

I think that a few countries are now looking at the serious possibility that it could happen this year, if not in the very near future. Money is starting to move beyond mere planning and into direct actions to mitigate the effects.

Add to this the fact the WHO now says it may remain just as deadly as we see now when it does go pandemic. That could put this pandemic into the realms of the great plagues of human history… the black death, the plague, etc.

In retrospect, we may WISH that it had been a mild pandemic like the flu of 1918.

Klatu – at 13:24

WHO issues startling bird flu report

11/3/2006

 KARE 11 News

“The World Health Organization has just completed a report that raises startling concerns about the so-called Bird Flu.

And in the new report, the WHO says if the virus becomes easily transmissible between people as a result of mutation,”.. then the present high lethality could be maintained during a pandemic.”

The report also raises concern about vaccine. It says, “Efforts to develop a vaccine that confers adequate protection have been greatly complicated by the emergence of … diverse viruses…”

The report adds “.. Decisions about which vaccines to stockpile may be premature.”

Infectious Disease expert Dr. Michael Osterholm says, “We have no evidence that these vaccines will protect, and on top of it, we just don’t have the production capability.” So even if an effective vaccine is created, it most likely can’t be manufactured fast enough to be distributed to all those who would need it.

http://www.kare11.com/news/health/health_article.aspx?storyid=138212

Bird Guano – at 13:41

TreasureIslandGal – at 13:13

Taiwan is opting to spend a lot of money to secure this vaccine which really only has a shelf life to get it through this next season. After this season, even if the shelf life still has a little time left, the odds are that the virus will have migrated away from the vaccine having optimal effect to prevent the new form of the bird flu.

The fact they see this as so important to do THIS year that it is worth the investment makes me take notice.


This is EXACTLY why I took notice.

It disturbed me enough to post it.

Also see the article I posted about California allowing (on a temporary emergency basis) the use of seasonal vaccines containing mercury in young children.

They see a compelling reason to do so NOW. This season.

I find that curious.

Perhaps so that if H5N1 does go pandemic, they can rule out seasonal flu more easily ?

TreasureIslandGalat 13:49

BG,

I think that California is doing that in the hopes that limited immunity may be gained. I believe that Asian countries are most concerned that H5N1 will coinfect with someone with H3N2, the flu that is running rampant in Japan, China, and Taiwan right now. It has been an early flu season over there, just like in some areas of the US this year. The current flu vaccine contains the H3N2. So in theory, if there is swap of genes between the two, the current vaccine may offer a little protection agaisnt the resultant mutant strain. Maybe not much, but it might be enough to save a life.

So, balancing that fact out with the low risk of the development of autism, they see this as more of a critical risk to protect against. Again, this fact shoudl raise eye brows too as to what the USA really is thinking right now too.

Pixie – at 13:54

Bird Guano -

A few weeks ago they announced that there might be some protection against H5N1 afforded by the seasonal flu vaccine. They announced this the same week that the pediatric vaccines were mysteriously and very sudenly delayed.

90% of the pediatric vaccines still have not turned up at pediatricians’ offices.

A child who is vaccinated on Dec. 1st will be afforded protection all the way out to June 15th, 2007.

The kids may not be well protected against the seasonal flu during the early winter, but they will be afforded whatever degree of protection the seasonal flu vax offers against H5N1 out to early summer. I don’t think that choice was made by accident.

(There is sufficient regular pediatric flu vax in every doctor’s office to vaccinate high risk pediatric patients - asthma, etc. - now, however).

Bird Guano – at 14:01

I don’t believe it was by accident either.

It immediately caught my attention.

I had my shot yesterday, and it was the first time the particular HMO was pushing pediatric flu shots in clinic, and I mean pushing them HARD.

The medical director was practically grabbing people passing by in the hallways to get them to go get a shot.

It was a night and day difference from last year when it was like pulling teeth to have my kid vaccinated for flu.

I believe the watch phrase is:

Watch what they DO, not what they SAY.

cottontop – at 14:33

Taiwan, U.S., doesn’t matter. Frankly I have more trust in the CDC than in WHO and that’s not saying much. I’m tired of watching WHO bounce back and forth on this, as if there is “powers that be” that they are trying to keep happy. In one day, I have read WHO say not to stockpile, that’s being extreme, and the other report issuing a startling bird flu report. Which way is it guys? Is there a pandemic on the horizon, or is this just hype, because from the chair I’m in, I see something coming at us, and there is no room for playing bouncey ball. Who, exactly, controls WHO?

anon_22 – at 14:49

I am not specifically addressing the Taiwan CDC’s decision but in general, there may be a case for keeping a small stockpile of pre-pandemic vaccine against the most current strain, despite short shelf-life and despite rapid mutations. Such stockpiles will need to be replenished whenever newer strains appear. But this will give each country the ability to rapidly vaccinate first responders at the very beginning of a pandemic, which will add significantly to their ability to maintain a stable infrastructure.

anon_22 – at 14:52

cottontop,

I believe the WHO’s warning against stockpiling is more in the context of countries who are announcing their intention to stockpile vaccines for the whole population. I absolutely agree with the WHO report (actually it wasn’t a WHO recommendation, technically, but recommendation from a meeting of a group of scientists organized by the WHO) that countries should not rush to do that, for the reason stated, but also because often this will be used by politicians as justification to not do anything else.

JR – at 17:05

Taiwan is also starting to fine doctors and hospitals for not reporting dengue illnesses to health authorities.

http://tinyurl.com/v9br2

04 November 2006

anonymous – at 01:15

sure, there is a good reason to keep a stockpile of any prepandemic vaccine which you can get. The question is how much and what does it cost.(~$20 per dose) The 190000 doses is not so much. Switzerland ordered 7.5 million doses, Singapore 4.4 million, France is close to ordering -well, 60 million ? All of the Vietnam/1203 strain, I think. I think, H5N1 vaccine for at least 4 strains should be commonly available for private stockpiling too.

anonymous – at 09:11

bump

Bird Guano – at 13:08

anonymous – at 01:15

sure, there is a good reason to keep a stockpile of any prepandemic vaccine which you can get. The question is how much and what does it cost.(~$20 per dose) The 190000 doses is not so much. Switzerland ordered 7.5 million doses, Singapore 4.4 million, France is close to ordering -well, 60 million ? All of the Vietnam/1203 strain, I think. I think, H5N1 vaccine for at least 4 strains should be commonly available for private stockpiling too.


I would think the cost would be trivial compared to outlays for other things in their budgets.

Especially if they are stockpiling only for first responders and HCW’s.

It should be an annual budget expense to replentish with whatever the newest vax is with the newest variants.

05 November 2006

Pixie – at 09:17

Bird Guano – at 14:01 I don’t believe it was by accident either.

Then the most practical, least cost, safest, and best single pandemic prevention & preparation policy they could do right now would be to begin a very loud and public push to get our kids vaccinated with the seasonal flu vaccine.

Whether that vax will help fight off pandemic H5N1 or an H5N1/seasonal reassortment or whether it may simply help to prevent a reassortment, they can do this now, if they choose.

But I’d like to see it done now, rather than to wait and see Gerberding ride in on her white horse in some dramatic attempt to save the day later. These are kids we are talking about here.

Pixie – at 09:20

anonymous - at 1:15:

What’s the status of vaccinating your country’s kids for the seasonal flu? And what’s the level of childhood vax for kids around the rest of Europe?

I’m all for the creation and purchase of possibly protective pandemic vaxes as CDC in Taiwan is doing for their healthcare workers. But if we have the option of offering protection to our kids using seasonal flu vax, is anyone out there taking this seriously and already doing it? Is Taiwan?

anonymous – at 09:44

Pixie, seasonal vaccine won’t help with H5N1. That little bit from N1 is very tiny. The possible reassortment unlikely happens in USA. They should add a H5-strain to the seasonal vax, IMO. But this was not yet available when the seasonal vax was made. Hopefully next year…

With a quick search about vaccination in Europe I found this:

1: Vaccine. 2006 Jan 30;24(5):622–8. Epub 2005 Aug 24. Links Influenza vaccination coverage and reasons to refrain among high-risk persons in four European countries.Kroneman M, van Essen GA, John Paget W. NIVEL, Netherlands Institute of Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands. m.kroneman@nivel.nl

This paper examines influenza vaccine coverage using a population base of an average of 2300 persons in each of four European countries (Germany, Spain, Poland and Sweden). The reasons for non-vaccination of those in the high-risk groups were explored by questionnaire. The vaccine coverage rate (VCR) for elderly ranged from 18% in Poland to 67% in Spain. The VCR for high-risk population under 65 was 10% in Poland, 13% in Sweden, 27% in Germany and 30% in Spain. The most important reasons mentioned for not being vaccinated were: perceived sufficient resistance to flu (33–42%) in all countries; financial barriers in Poland (25%), and not to qualify for the vaccination (30%) and forgetfulness (20%) in Germany. Receiving a personal invitation for the vaccination, results in higher coverage rates in all four countries. We think that future interventions could be directed towards: an information campaign with special attention to the high-risk groups due to disease; promotion of personal invitations; and, for Poland, solving financial barriers to vaccination.

PMID: 16169638 [PubMed - indexed for MEDLINE]

Pixie – at 10:22

Thanks anonymous. But any details on the coverage of the kids? What does it take for “qualification” for the vaccine in Germany? (They note 30% do not get it there as they are not qualified). I take it that during a usual flu year, the kids are not considered to be in the “high-risk” group?

anonymous – at 10:55

here are the German recommendations for seasonal vaccination
http://www.influenza.rki.de/agi
maybe they also have a statistics for children, I haven’t yet found it.


(auto-translation:)
Recommendations of the constant inoculation commission at the RKI standard inoculation: Persons over 60 years indication inoculation: Children, young people and adults with increased health endangerment due to a basic suffering - e.g. chronic lungs -, heart cycle -, liver and kidney diseases, diabetes and other metabolic diseases, Immundefizienz, HIV infection - as well as inhabitant of age or nursing homes vocational/indication inoculation: Persons with increased endangerment, e.g. medical personnel, persons in mechanisms with extensive public traffic as well as persons, those as possible source of infection for of them ungeimpfte risk persons to function can indication inoculation cared for: If epidemic diseases arise or due to epidemiological observations to be feared (according to the recommendations of the health authorities)

anonymous – at 11:23

I found it for Bavaria, season 2002/2003
15% of the population vaccinated
39% of those over 65 years were vaccinated
6% of those younger than 15 years were vaccinated


there was some recent discussion that more children should be vaccinated, since they are the main spreaders.

Pixie – at 11:36

Thanks anonymous.

Ok, so if only 6% of kids in a wealthy, educated, part of Europe such as Bavaria are customarily vaccinated with the seasonal flu vaccine, then I think it is logical to assume that there is probably not enough seasonal vaccine in the current Bavarian supply with which to vaccinate them with anyway should that ever be seen as a good idea in order to ameliorate the effects of pandemic flu (at least for this upcoming year).

Not enough seasonal vax for kids in Europe = WHO won’t move to recommend it then as a pandemic measure(most likely).

And that’s not even moving on to the “social justice” inequalities brought to light by WHO possibly recommending seasonal vax as protection to a broader audience made up of many countries that just can’t afford it now or ever, never mind their current actual supply of seasonal flu vax.

So, if seasonal flu vax is thought to have some measure of protection against pandemic flu for kids, and if seasonal flu vaccine should be urged to be used in kids for this reason, then the individual countries that have this vaccine in hand, and have enough of it to be able to offer a large number of kids this protection, have to make the decision to move ahead on their own and recommend that this be done because the WHO will never put that recommendation in place for them.

anonymous – at 12:11

no, they do have enough vax. Just that there is not much interest by the children and parents to get vaccinated. It’s not generally recommended to vaccinate kids, they are not a risk-group, they usually survive the flu and don’t get severe illness. Old people are more at risk. If some parents or kids do want to get vaccinated in Bavaria, they will probably have no problem to get it.

Bird Guano – at 12:15

However kids ARE a flu reservoir/mixing vessel during the season, so there also exists an argument to vaccinate them.

Grade schools are a petri dish with a playground.

Snowhound1 – at 12:24

A Question

If Taiwan is ordering 190,000 doses of avian influenza vaccine, which will be enough to cover 90,000 individuals, or one-third of the country’s health care personnel, which will include only front-line medical and epidemic control personnel…

It seems to be that they have done some math and considered that they would be able to offer a reasonable defense for continuing medical care in the event of a pandemic with these numbers or why would they bother? Since they are stating that the vaccine is only 70–80% effective, that means that they will be working with “front-line medical and epidemic control personnel” that would equal about 67,500 people out of the entire force of 270,000 people.

Does anyone know, in a best guess scenario, what the population numbers would be for front-line medical and epidemic control personnel say in the US or Europe? I am just trying to think of a best case scenario for front-liners, if they would have a vaccine that would offer some protection for 70–80% of this population…. In the U.S. for instance, what would be the number of courses of vaccine would be needed to inoculate 1/3 of this force? (What would be a guess to the total number of this group?) Is this number significant enough to even be enough to make a difference? How much vaccine would be needed to inoculate 1/3 of the U.S. number? Or Europe?

Bird Guano – at 12:50

Depends on how you define “front line”

Nurses, Physicians, Paramedics, Respiratory Technicians, Hospital Lab Workers, Janitors in the Vaccine plants, Ambulance personnel, first responders ????

anonymous – at 12:54

military(-doctors),police(-healthcare)

Snowhound1 – at 13:14

It sounds to me that they are talking about medical personnel and epidemic control personnel only…(excluding the military, police and support personnel), what kind of numbers would we be talking about? How many hospitals are there exactly in the U.S. and in Europe? What are the numbers for actual hands-on care-giving staff? (Doctors, nurses, anesthesiologists, etc?) Is there a number anywhere?

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