I’ve just read through this report Influenza research at the human and animal interface. I’m going to list the points made in the report that has already been reported/discussed here. After that, I will list the new/surprise findings.
You will find that this forum has a lot to be proud of.
Verified by WHO report
Surprise or new findings
anon_22 – at 17:54 Surprise or new findings 2. recommend poultry vaccination in countries that cannot cull due to economic or other reasons – high quality vaccine combined with continuous surveillance
I am somewhat surprised with this recommendation because of all of the problems caused by the Chinese bird vaccination program. If the research that came out yesterday states that the new H5N1 strain was directly caused by poor vaccination procedures/processes, why would WHO want to promote more bird vaccinations? Wouldn’t there be a greater risk of a pandemic if more countries began vaccinating birds with potentially substandard vaccine?
Clear summation, anon 22 !
And meanwhile, at the local, non-pharmaceutical, communities must care for their own during illness or quarantine without outside assistance of any kind, does the public know what we’re talking about when we say “influenza pandemic” interface…?
“We’re pretty much screwed right now if it happens tonight,” ~Dr.Osterholm
Thank goodness for the Flu Wiki people, and good luck to Dr.Osterholm, Dr. Nabarro, Helen Branswell, et alia.
Sniffles,
Unfortunately, I do think they are right. It is an inferior solution in the absence of better solutions.
The case for vaccination is that poultry vaccine will reduce the net mass of infected birds, therefore reduce the risk of bird to human transmission.
I’m not sure that it increases the chance of a pandemic, because we simply know too little about exactly what the natural evolution would be like. But it does cause the problem of asymptomatic poultry carriers, which was previously thought to be important cos if you can’;t see chickens dying, you don;t know where the virus is.
However, if the recent data shows that it is actually the ducks and geese that are the vectors, and they are mostly asymptomatic anyway, it might not make a lot of difference.
I’m getting to a point where I need to re-think my own opinion about poultry vaccines. It is an evolving science and therefore our own thinking may be hampered by moving targets.
What is undoubtedly important is good quality vaccine combined with ongoing surveillance.
I think vaccines do direct the selection of viruses and therefore may aid the appearance of a dominant strain. But whether that dominant strain was naturally dominant to start with or only got so because of the vaccines, I haven’t seen data one way or the other.
For example, hypothetically, if you have 2 areas with exactly the same demographic and ecological environment to start with, and one country uses a bad vaccine, the other one uses a good one, and you find that the second country consistently fare better in terms of keeping outbreaks away, while the first country has a dominant strain appearing, that kinda proves the case.
I’m thinking of China and Vietnam,
But the purists will say we don;t have statistically significant data.
Those are my musings, Not sure that they are answers.
anon_22,
Per the poultry vaccine issue, I suspect there has been a reassessment which has taken place concerning the “doability” on the ground of mass culling, and the impact of culling operations on poor subsistence farmers. At what point do you cross over from worrying about H5N1 to worrying about famine/hunger. Vaccination is a stop-gap measure. They’re danged if they cull and danged if they don’t cull. So they vacilate between the rock and the hard place,…and vaccinate.
H5N1 Vaccination in Poultry = Epidemiological Realpolitik
pre-pandemic vaccines – problematic, governments should not rush to order
does that mean, there will be no pandemic in the next months ?
Swiutzerland,Singapore,France do rush to order it.
UK is on the jump.
Somehow surprising, that WHO , who advocated stockpiling antivirals
and increasing vaccine production capacities, now is against
prepandemic vaccines. Why is it ?
It is not that they are against vaccines. What they are stating is that preordering vaccines now that are from old strains is not effective. They are stating that there is no eviedence that these unmatched vaccines are going to work, H5N1 has mutated and continues to mutate. A poorly matched vaccine is not a effacious use of funds in their opinion.
anonymous – at 21:04
Could it be that the WHO is beginning to realize what a swift moving viral target Bird Flu is? What happens when you load your cannon with “grape shot” when what you really need is “armor piercing” rounds.
WHO did publish an analysis of cross-protection of prepandemic vaccines some weeks/months ago. We recently heard about a new study showing good cross-protection with the Vietnam/1203 strain. That was after Switzerland had ordered the prepandemic vaccine. The yearly vaccine for normal flu is only 20–30% effective, yet it is recommended. What does WHO think is more effective than prepandemic vaccine ? Better spending the money for more Tamiflu ? WHO did recommend stockpiling of Tamiflu. For one package of Tamiflu you get 3 packages of prepandemic vaccine. And you need 4 packages or 2+Probenecid according to anon_22. And there is a chance (50%?) that the virus will be resistent. And you still get sick, but not so severe. When you take Tamiflu prophylactically, you also need many packages per wave. Vaccine, even if only effective with 10% probability is cheaper. Or does WHO expect that we will get something better in the near future ? Or does WHO think, the threat is not so big yet ?
“prepandemic vaccine ?” Gently saying, Geriatric Serums no Gold Standard
“WHO did recommend stockpiling of Tamiflu” Going to sell antivirals as good stuff not giving satisfaction?
“does WHO think, the threat is not so big yet ?”
Au contraire; Getting seriously grand scale.
bump for attention and comments
ain’t finished reading it yet - interesting page 7: some participants expressed surprise that seroprevalence studies were detecting so few cases - questioning test sensitivity with mild cases. I wonder if we’ll ever know.
so bump
in addition to their (4 million?) doses of other H5N1-strains CDC just ordered 190000 additional doses of the Fujian strain for $20 per dose to be delivered by the end of 2006. Expires in 2 years, not safe for commercial sales, $20 per dose, 2 doses required per person. So they consider it cheap enough for frontline workers but not for the whole population. But they could add some doses for those who are willing to pay their $40, couldn’t they ?
Here is a CIDRAP discussion article about the report.
anonymous – at 10:21
If you are referring to this report CDC orders human H5N1 vaccine, I think that is the Taiwan CDC, not US CDC.
nonymous – at 05:00
I think the short answer to your series of questions/musings is that they don’t think we have very good vaccines yet. They just want to warn governments not to be complacent and to be careful when they make these decisions. That’s how I would read the piece.
I hate to mention this, but I believe countries had to promise to buy these pre vaccines in order for the research and development to continue as the virus progressed. In other words without the signing agreements of intent to purchase many companies wouldn’t have been researching for a vaccine for H5N1. That said, depending on time or should I say timing, countries at least have something to offer critical front line workers whoever they determine them to be.
Okieman “Could it be that the WHO is beginning to realize what a swift moving viral target Bird Flu is? What happens when you load your cannon with “grape shot” when what you really need is “armor piercing” rounds.”
It is so easy to sit in your armchair and make rash statements about the WHO. I’ve been visiting this site for over a year now and listened to the many cries of WHO = murderers, WHO should move to level 4 NOW!
Fortunately, it takes a considered approach from data in the field and its many scientific contributors, not armchair specialists. Some obviously think that it consists of a bunch of corporate do-gooders who sit around drinking coffee, but imagine the effects of the wrong call. It would serve all of us badly, financially crippling poor nations, and would be seen by the majority of people as crying wolf. This would lead to less awareness and preparation, not more.
The WHO and everyone else is clearly looking into a dark tunnel without a torch. No one knows how (and if) this thing will develop but I for one am glad to have it on my side.
I just finished the article and I’m musing on it.
I had to laugh when the Who group questioned letting rival Pharma companies be in control of vaccine development. I liked their Idea of wondering if WHO could set the “benchmarks” for experimnetal vaccines to hit, before being passed to the next level. I bet there was some late night meetings for Pharma management over that speculation.
Can we discuss the issue of the over 50 age group having an advantage with the virus?
Would I be correct in assumming that the people in the areas of current outbreaks don’t normally receiving annual flu shots? And these are the people with the advantage, correct?
Isn’t there a difference in resistance when a body encounters and fights off various virus over many years versus the fake version of resistance achieved by influenza vaccines? Isn’t this the pink elephant in an all white room?
anon_22, when the current prepandemic vaccine is bad, then the consequence would be to add more strains to it. And not disqualifying it as premature. Unless , of course, WHO thinks there is no imminent panflu-threat and we have enough time to wait for better products. Or unless WHO has a recommendation how to better spend the money on pandemic preparedness. Some time ago they recommended Tamiflu stockpiling. (do they still recommend this ?) Why do they consider Tamiflu better than vaccine actually ? I’d like to see their calculation. And why some countries like Switzerland,Singapore seem to disagree.
anonymous, I don’t think they are saying that tamiflu is better than vaccine. I think they are saying the pre-pandemic vaccine is not good enough yet to spend so much money on and to assume that stockpiling it for the whole population is a viable solution.
Its not just a matter of adding strains. It has been difficult to make an effective vaccine because of the poor immunogenicity of the H5N1 virus, and its extremely poor yield on egg-based production. That applies to any and all strains.
I personally do think tamiflu is better than vaccine, at least at the moment. It is very likely to be at least life-saving if given in time. It has minimal side effects, compared to problems with the H5n1 vaccine and the potential need to use adjuvants, it is much easier to distribute, etc. Only problem is there is not enough, its expensive, and we are worried about development of resistance.
We need to use combination antiviral protocols, and we need to develop IV NA inhibitors, among other things, IMO.
Leo7,
I’m not sure I understand your inference. Do you mean to say that those over 50 may have some advantage because they didn’t take the seasonal flu shot?
As far as I know, most people in those areas, including kids, never take the seasonal flu shot. So it wouldn’t make any difference.
Tamiflu therapeutic dosed as recommended by anon_22 costs about $200 for
one treatment.
Prophylactic use for 6 weeks (one wave) would be about $300.
Expiration is 3–4 years. Probability of resistance is maybe 50%,
many think more.
Prepandemic vaccine is $20 per dose, maybe 2 doses required (?) and per strain.
Expiration is 2 years (?). Currently 4 strains required to cover the WHO’s
spectrum of H5N1 , but some cross-protection is expected.
So, I guess there is a 10% chance that the vaccine will be effective.
Sounds quite competitive as compared with Tamiflu to me.
And the vaccine makes you immune to later reoccurrance of the same strain,
while I’m not sure whether Tamiflu does the same.
A good vaccine is always better than antivirals, in principle. It’s just that they are not very good at the moment.
the vaccine makes you immune to later reoccurrance of the same strain, while I’m not sure whether Tamiflu does the same.
Tamiflu does not make anyone immune. It is administered to help those who already have or might already have an infection.
Vaccines help the body to learn and when they are destroyed, the body still remembers. With Tamiflu there’s no memory. It works only while it’s inside the person’s body.
Two very different things.
yes, but when you are infected and then treat it with Tamiflu,
your immune system should still have time enough to make a “blueprint”
of the virus and remember it for later reoccurrance.
But when you use Tamiflu for prophylaxis or PEP then
the virus is faught early and the immune system might not
have enough time to make that blueprint.
(?)
22, “not very good” because of side effects or because of poor match ? If it’s the latter then adding more strains should overcome. If it’s the former, then we won’t care, if the CFR is high. Or is it because not enough antibodies are built from the vaccine ? But when they(Glaxo) sell one “dose”, that should be the amount needed to build the antibodies
Anon 000 – at 13:26
My comment was actually a compliment to the WHO’s decision to recommend not purchasing pre-pandemic human vaccines. They recognize that the virus is swiftly changeing. A pre-pandemic vaccine would likely be woefully inadequate to the task. (Kinda like the use of “grapeshot” from the civil war era against tanks of the 21 century. The target H5N1, is changing, and the weapon needs to be tailored to the target.
As far as sitting in my armchair is concerned, I do what I can to help sift through the information we gather from the web. I respectfully suggest you be a contributing member too. We need as much help as we can get.
so, what do people here think is the probability that the A/Vietnam/1203 vaccine will be effective, given that there is a pandemic this season ?
It may help to recall that in the elderly, the beneficial effect from an influenza vaccination can wear off beginning as soon as 2–3 months or more, depending on the person’s age and immune status. We can’t assume the effect is permanent.
anonymous – at 07:55
22, “not very good” because of side effects or because of poor match ? If it’s the latter then adding more strains should overcome. If it’s the former, then we won’t care, if the CFR is high. Or is it because not enough antibodies are built from the vaccine ? But when they(Glaxo) sell one “dose”, that should be the amount needed to build the antibodies
It’s a bit of both, plus poor immunogenicity. If those are acceptable to an individual, it may make sense as a personal choice, but what the WHO group is saying that it doesn’t make such good sense as a policy for the whole population.
There is therefore some difficulty, in that individuals at the moment cannot get access to such vaccines unless their governments decide to get them. Governments however, has a duty of care, so their risk assessment and cost-benefit assessment will be different from that of an individual. There was some talk a while back of allowing some companies to stockpile for their employees, but I don’t know what has happened recently, whether that is going ahead.
I’m confused to be honest about the common knowledge of vaccines.
If the body REMEMBERS last years seasonal flu shot, which had both A and a B strain why do we have to get a yearly injection? I know you say it’s because the virus changes or a different strain pops up. So, then how can this years seasonal flu shot with an A an a B virus type in it help with H5N1? Doesn’t make sense. The docs qualify it with maybe or might help, but in fact they don’t say with absolute conviction it will, because they know it won’t. (They are losing my trust on this one).
What the report Anon 22 posted up top said, “people over 50 have an advantage.” Safe to say these people in the hot zones haven’t had seasonal flu vacs annually, yet they have protection from H5N1 probably from fighting off viruses for years, is the theory. So, I don’t see where the seasonal annual vaccs are going to give any help, because aren’t the antibodies built up differently from having a disease versus vaccination antibody build up? This is an area I’m not experienced in but once I’ve had chicken pox naturally (a good case where the kid remembers he had it and what the sores looked like, not a mild case). I don’t expect to get it again, unlike people who take the chicken pox vaccine who may have to take boosters, or actually get a mild case.
I’m all for a safe H5N1 vaccine, but saying the seasonal vacc may, might, could, help is basically not what the medical profession has been claiming for over forty years for influenza vaccines. I’ve noticed they repeat flu strains all the time when choosing what to offer in the annual vacc(are they letting it mutate in the lab or isn’t it kept frozen for future seasonal vacc use)? So people who for years didn’t take flu shots may already have the natural antibodies against many different A an B strains which in fact might help against H5N1 if they’re older and in good health. I can’t say I’ve ever seen that discussed before either, and it bothers me. I’ve said it before, If you’re gonna hang a sign out there, then hang all of it. There are two sides to this story and we’re only hearing about one side.
Leo7, I think you are mixing several issues here. Let me see if this helps.
Anon 22:
Thanks for the clarity of number 1.
The major factor of seasonal vacc being protective is due to the herd immunity theory which relates to #2 & #3 and the reassortment issue.
5 & 6. You’re saying that the younger person has an untrained but more advanced immune system making them vulnerable to cytokine storm. I agree with this. However in number 5 you infer immunity to those over age fifty is due to a slower immune system response, while I believe it’s an experienced immune system having met and adapted to influenza previously since this is an outbreak where seasonal vaccines are very rare. We both could be right on number 5, not much difference. If you’re correct that’s why you’re in favor of the statin idea—I get this. But what we don’t have solid evidence for is a seventy year old on a statin say taking 40mg a day (average dose)encountering H5N1--is his immune system so lowkey or laid back by age and statins it can’t respond at all to H5N1?
You didn’t address the immune system having a memory for infections as many Americans have been told for years. Well in a way you did, in number two, when you suggested recovery from a flu might be protective. I understand you’re walking a fine line here.
Question: Does the immune system have MEMORY for wild influenza strains when people have not been vaccinated? I’m thinking it does, while seasonal vacc provides herd immunity for the weaker among us. OK I get that. But, has the healthy given up a fine tuned influenza immune memory for the common good? I tend to think yes taking annual flu shots makes people dependent on seasonal vacc for protection especially as you begin to age and have a harder time coping with the flu. And this is a life long dependency as long as we have vaccines available to us. It’s like once you’re on statins for cholesterol—you’re on them for life unless you go through a major dietary and lifestyle change. Stop taking statins and cholesterol shoots right back up, it’s not really like getting your pipes cleaned as some people think. What happens to the older person who has taken vaccines all his life, and finds himself in a situation where there is severe flu, statins are out due to liver disease, and no vaccine? I understand this is another one of those fine lines, and there is no best answer. But the older people discussed in the Who report are survivors of many illnessess and are immune resiliant, who didn’t have annual vaccines and probably don’t have statins, seem to do just fine and the fact this is mentioned by the scientists in the report is noteworthy.
Anon_22 17:54
Surprise or New Findings: 3) problem with avian vaccine – ducks react differently, but vaccines tend to be standardised for chickens only.
This sounds especially curious - how exactly are ducks (wild?) reacting differently? Is the ‘different reaction in ducks’ causing this virus to change into a feared pandemic virus that the world doesn’t need? Your thoughts please.
anonymous et al – at 21:52
Surprise or New Findings: 3) problem with avian vaccine – ducks react differently, but vaccines tend to be standardised for chickens only.
This sounds especially curious - how exactly are ducks (wild?) reacting differently? Is the ‘different reaction in ducks’ causing this virus to change into a feared pandemic virus that the world doesn’t need? Your thoughts please.
Your name is interesting, slightly frightening. Makes me think there’s a huge group of you. LOL.
All kidding aside, you ask an important question. I suspect the answer is in seroconversion, ie how many ducks are actually protected so that will not be infected, and/or how many will still shed virus.
Whether it is driving the evolution of a pandemic virus, is the key question. Which I don’t know the answer to, my guess is it may be a contributory factor, but how does one prove that? Until there is a pandemic strain. no one can do better than guess, and we know guesses can be way off the mark, And how much is the contribution? It won’t be the sole reason for emergence of a pandemic, that’s for sure.
I have to look up the answers. These are just my guesses. I am posting here anyway cos I have a suspicion that the answers are not in any published papers so it might be a while before I can figure it out.
Leo7 – at 18:00
I don’t think the relative absence of cytokine storm has to do with specific immunity aka memory against influenza. It is more likely an intrinsic characteristic of a younger more active immune system triggered in a certain manner (how specifically we don’t know) which, once triggered, will amplify the effects independent of the original trigger. Notice how de Jong said that if you give tamiflu, but not early enough, you still get a rapid fall in virus titre, but the cytokine storm progresses nevertheless.
I’m not sure specifically how statins workk in this whole cascade. I don’t think anybody has worked out whether they do actually work, and if so how. It is at present a hypothesis from inference from other conditions.
You didn’t address the immune system having a memory for infections as many Americans have been told for years. Well in a way you did, in number two, when you suggested recovery from a flu might be protective. I understand you’re walking a fine line here.
No, there is no line, we are talking about the same thing.
Question: Does the immune system have MEMORY for wild influenza strains when people have not been vaccinated?
If they have been infected, and their immune system is healthy.
I’m thinking it does,
Yes
while seasonal vacc provides herd immunity for the weaker among us. OK I get that. But, has the healthy given up a fine tuned influenza immune memory for the common good?
No, you would have a fine tuned influenza immune memory whether your exposure is due to natural infection or vaccination.
I tend to think yes taking annual flu shots makes people dependent on seasonal vacc for protection especially as you begin to age and have a harder time coping with the flu.
No, dependence implies an altered immune system because of frequent use of vaccine so that you are no longer able to react as other people of your age would. That is incorrect. Your immune reaction would be the same as people of your age, whether you have been taking seasonal vaccine or not, and your specific ‘memory’ of influenza is the same, just that those who did not take vaccines will have developed that ‘memory’ from having caught the infection (and becoming sick) while you got it from vaccination (and not getting sick, or getting sick more mildly).
And this is a life long dependency as long as we have vaccines available to us.
No
It’s like once you’re on statins for cholesterol—you’re on them for life unless you go through a major dietary and lifestyle change.
No, once you are on statins, their benefit will continue as long as you take them, and probably some further time after you stopped. The dietary and life-style changes are good, but that’s neither here nor there.
I think you may be confusing ‘dependence’ with ‘drug effect will stop when you stop the drug’. Dependence means an altered reaction as a result of taking any drug, so that you are worse off when you stop, aka get a rebound. Some drugs do that eg sleeping pills. That’s why they are ‘habit forming’ on top of causing dependence. Most other drugs including statins, and vaccines, do not.
Stop taking statins and cholesterol shoots right back up, it’s not really like getting your pipes cleaned as some people think.
The cholesterol might go back up, but the beneficial effects on the cardiovascular system continues for a while after you stop, until the problems come back.
What happens to the older person who has taken vaccines all his life, and finds himself in a situation where there is severe flu, statins are out due to liver disease, and no vaccine? I understand this is another one of those fine lines, and there is no best answer. But the older people discussed in the Who report are survivors of many illnessess and are immune resiliant, who didn’t have annual vaccines and probably don’t have statins, seem to do just fine and the fact this is mentioned by the scientists in the report is noteworthy.
I think a combination of all my answers probably explains this already. There is no fine line, in this instance, cos the original assumptions are not correct, IMO. The older person in that situation is in exactly the same position as the older person who acquired their immunity by natural infection.
Ask again if that’s not very clear or you have different ideas.
To clarify, in my last post The dietary and life-style changes are good, but that’s neither here nor there. should be “The dietary and life-style changes are good, but that’s neither here nor there to our discussion”.
I wonder, how much memory our immune system has and whether one day we might
be able to upload the sequences from our computer directly into our
immune-memory, thus avoiding the detour with vaccine :-)
Also, when someone dies then all the gathered information is lost.
There should be a possibility to give it to the descendants.
lol
That’s when you know you need to quit and get off your PC!
Anon 22,if a lifetime of viral exposure were responsible for older people haveing a lower CFR would you not see this effect happening in a linear fashon?The CFR drop is rather abrupt after 40 years of age,however,not linear as you would expect from steady cumulative immune system experience.I gather from your posts that you do not subscribe to the “lifetime experience” idea anyway so my questions are meant to invite further comment.
Children and teens are still growing. Pregnant women are trying to grow another person.
And past 40 myself, I know my metabolism, resiliance, energy level, ect, are not what they were at 20 or even 30; many things are different, (and didn’t really start becoming so until past 40).
anon_22 - at1:24:
…you would have a fine tuned influenza immune memory whether your exposure is due to natural infection or vaccination.
There is going to be a lot of assumption on the part of both physcians and the public that once one contracts “the” pandemic influenza virus, that they will then be immune to it during future waves.
However, there are many stories of people contracting influenza during more than one viral wave. Barry’s book has the story of one sorry man who contracted it during the first wave in France, and then contracted it two more times (he lived). We now know this is because the virus constantly changes.
Who, however, will tell the medical community and the public that they may not have carry-on immunity to co-circulating yet differing influenza viruses or to a subseuent wave brought on by another viral variant?
Are there any studies of just how immune our herd can expect to be, moving forward? Is somebody working on those powerpoint slides now?
Reconscout – at 07:46 Anon 22,if a lifetime of viral exposure were responsible for older people haveing a lower CFR would you not see this effect happening in a linear fashon?The CFR drop is rather abrupt after 40 years of age,however,not linear as you would expect from steady cumulative immune system experience.I gather from your posts that you do not subscribe to the “lifetime experience” idea anyway so my questions are meant to invite further comment.
If lifetime exposure were responsible, you would expect a lower fatality in all flu infections in the elderly, when in actual fact they have a higher mortality normally. It is just that H5N1 and the 1918 virus cause a different type of disease than seasonal flu, so the considerations are completely different. I very much think it has to do with different immune responses of different age groups, rather than lifetime exposure.
can’t they test this with mice , or do humans have a larger sequence-memory ? Is the memory better on lived-through-infections than on vaccinations or Tamiflu-treated (or prophylactic, or post-exposure-prophylactic) infections ? With all our vaccinations, is it possible at all that there is another H1 or H3 pandemic ? How many H5-vaccinations are needed to prevent a H5-pandemic, even if the strains don’t match the vaccines ?
Any H5 vaccination of human subjects at the moment are still at clinical trial stage. Cos the vaccines are not good enough to pass regulatory standards yet.
we have not so much time…
ducks and geese, not poultry, are true vectors of transmission
Not sure I understand what is meant by this. Is it saying that people get H5N1 from ducks and geese, not poulty? Or that geese and poultry spead it to poultry in the first place? And what about the famous unknown mammalian reservoir?
i think poultry are victims, while ducks and geese are carriers (from place to place) :-?
hmmmm … okay. I can follow that. Ducks and geese are the main distribution system (the long haul truckers of the disease, currently). Poultry, humans and other mammals are the recipients, and they/we can also transmit locally and from place to place as well. For some reason that was confusing to me early this morning. Thank you, lugon :-)