Robert Webster’s presentation at the Lancet forum is IMO important enough to be reported here in detail on its own thread.
Title: Identifying the gaps in pandemic preparedness
He gave his opinion on these gaps, how to think about them, and what needs to be done. Stuff in quotation marks are quotes, as far as my notes tell me. The rest are synopsis of what he said. Stuff in italics are my comments/additional thoughts. ? is where I’m not sure if it’s exactly what he said.
Three Major Gaps:
1 Will H5N1 acquire consistent h2h?
There has been family clusters, may be some genetic link there. There are those who say, “It’s been around 10 years, won’t happen” Webster says “I’ve worked with flu all my life, this is the worst virus I’ve ever seen.”
DON’T BE COMPLACENT
In chicken, the virus goes to brain, causes disease, together with systemic collapse. “We have never seen an h5 or h7 doing what it can do in a mammal what it’s been doing in chicken.”
He estimates that the virus needs “miminum 10 mutations” to go h2h, 3 in the HA gene, 2 in ?PB2, probably 1 mutation in almost every gene segment. “All the mutations are out there, but the virus hasn’t got them yet, they are not lined up like ducks in a row yet.”
I wonder what he means exactly by “all the mutations are out there”?
2 “We don’t know anything about transmissibility”
Monotreme, that was my point at your CFR/lethality rate thread
This also echos what Fouchier said, that we know a lot about the nucleotide determinants of virulence, we know next to nothing about the determinants of transmissibility. This may be because these studies are harder to do?
They (Webster) did a Pig to pig study – first pig infected and had a lot of virus in respiratory tree, but second pig did not catch it despite high exposure.
“Give us 5 years, we will understand more”
Pathogenicity: likely to be polygenic, and include host genome interactions.
3 Lack of autopsy report – calling for more autopsies, but these are limited by many factors, cultural, religious, political, as well as insufficieny of resources, eg the need for BSL3+ facilities
The Avian Reseroir How do low path (H5, H7) viruses become high path?
Will the high path h5n1 be perpetuated in the aquatic bird reservoir?
Historically, emerged strains do not go back to reservoir, there is already evidence that it has for h5. This is worrying.
Who or what spread the H5N1 virus? (1) in Asia (2) to Europe?
Initially, poultry industry. In Europe, migratory birds played some role, human major spread
I would guess they have seen all the “required” mutations in idetified sequences, but not in a single sample. The inference being that the more mixing of various strains there are the higher the chance of developing the “killer” H2H virus.
The Avian Reservoir
Reassortment was rampant during evolution of the Asian h5n1.
What selected the dominant Z genotype?
Did gene segments from H5N1 in domestic avian species contribute to the high transmissibility of the Qinghai H5N1 virus?
Genes from domestic species getting into wildbird species is a new phenomenon and worrying.
European, thanks.
<light-bulb goes up in head>
Gaps in Pandemic Preparedness
Inadequate link between animal and human surveillance as one key issue. Example of Thailand, several hundred volunteers did surveillance of every village, to pinpoint the exact problem, fighting cocks
Lack of co-opoeration between neighboring countries
Lack of strategy for the sotrag and distribution of antiviral agents
Lact of advanced provision in immunization strategies
Agricultural Vaccines
Agri vaccines, if used correctly, do they have potential to control /eradicate? - Webster thinks so
Problem, agricultural vaccines not standardised for HA antigen, not like human ones.
Poor vaccine will drive antigenic drift
Most of selection will be in duck under natural condition of long term shedding
Human H5N1 Vaccines
Why are H5N1 (A/Vietnam/1203/04) vaccines so poorly immunogenic?
H5N1 (A/HK/213/03) is a good antigen.
Why is there no correlation of protection with current H5N1 vaccines?
Studies on recombinant H5N1 vaccines in ferrets:
r.g/ A/Hon Kong/213/03 (H5N1)
Complete protection from homologous challenge
Cross protection from challenge with A/Vietnam/1203/04 (an extremely virulent strain)
#virus shedding reduced
anon_22, thanks.
With the mutation he seems to mean single amino-acid replacements
and each single of them occurred. But I don’t know, how he can know
that that strain which he has in mind would cause a pandemic.
Didn’t they always say: no one knows which strain can go pandemic ?
Is that strain stable, reproducable, virulent ?
And when they know the strain, can’t they make a vaccine ?
The reassortment, I hadn’t heard this. Where exactly did it happen ?
Webster – if we modify the HA, might get higher titre
Basis for pre-pandemic vaccine A/HK/213/03 complete protection from homologous challenge in ferrets even for worst strain A/Vietnam/1203/04
“We should be stockpiling this vaccine in hundreds of millions of does. We should be using it if we have a pandemic. If there’s a pandemic, and you were vaccinated with this vaccine, you will probably get sick, but probably not die.”
If we use a whole virus, recomb with N3, single dose , no disease, no shedding, ducks totally protected,
Current vaccine production: Limited capacity, need antigen sparing, etc, but whole virus vaccine will be its own adjuvant
“Whole virus is superb antigen. Historically, we took it apart cos it was toxic to children.” So you take a good antigen, break it apart so its not a good antigen, then fiddle around with adjuvants to make good antigen again? Doesn’t make sense. Now we can use recomination and substitute N3 and make the vaccine safe.
Human Pandemic Vaccines:
Many needs:
Antivirals
Pandemic Preparedness Gaps
what’s N3 ?
OTC : very good ! we have been saying this here, now Webster says it too !
economic impact : what costs the vaccine ? I assume it’s not affordable for poorer countries.
ribavin: we didn’t talk about this already …
is Webster connected with the Vaccine producers ? Does he profit ?
what’s with Africa ? Africa=Qinghai.
I thought southern China were the problem ?
N3 as in H5N3 instead of H5N1
Africa = problem(s) so big that it’s almost incomprehensible, we don’t even know how to begin, (my words)
what’s N3 ?
N3 is one of the other neuraminidases (there are 9 variants altogether).
OTC : very good ! we have been saying this here, now Webster says it too !
Interesting thought.
economic impact : what costs the vaccine ? I assume it’s not affordable for poorer countries.
Huge economic impact, but the bigger issue is availablilty and rationing. Who gets it first? Who decides?
ribavin: we didn’t talk about this already …
ribavirin is an antiviral used for RSV in kids (inhaled) and Hepatitis C in adults (IV). Iffy results, very expensive, mutagenic (do not use if pregnant). Not a very satisfactory alternative.
is Webster connected with the Vaccine producers ? Does he profit ?
St. Jude does vaccine research, but otherwise not afaik.
what’s with Africa ? Africa=Qinghai. I thought southern China were the problem ?
Southern China and Africa are both problems, for different reasons. Bit I don’t understand your question.
Webster elaborated on Africa here in Nov 05.
OK, HIV+H5N1-people are shedding H5N1 longer. But Qinghai strain is stable, mutations occur in south China. And how long might they shed ? twice as long ? That’s the same as one 2-cluster then
Remember that for reassortment to happen, there has to be a dual infection (two flu viruses in the same host). Homologous recombination also requires dual infections, and the recombinations (which create NEW genes) are ACTIVELY ignored by Webster (and new sequences from China by researchers in China continue to show CLEARCUT recombination, which was also in the latest H1 swine sequences from Wisconsin).
Recombination is the name of the game when it comes to rapid eveolution of H5N1 (and other viruses).
The “10 mutations” described by Webster are those listed in the Nature paper on sequences of the 1918 PB1, PB2, and PA genes. These polymorphisms are usually species specific. One of the 10 is PB2 E627K, which prior to Qinghai Lake was only found in mammalian sequences (with the exception of one H9N2 isolate from Africa), including ALL H1, H2, and H3 isolates from humans (dating back to 1918).
There are other past bird isolates with one of these 10 changes, but the Qinghai strain of H5N1 is the strain with E627K fixed (ALL Qingha strain isolates since Qinghai Lake have had E627K).
Where does G228S come in? That was the change you predicted as “spring bride”, wasn’t it, but we have yet to see it? Is this good news? Where I am, spring is over and it’s summer today, but admittedly I’m a long way north and it could be winter again tomorrow :-)
you keep saying this, but no actual examples with H5 and you can’t prove it and Webster and others ignore it. (they must have reasons) We can’t so well estimate the threat from recombination. Webster uses recombination in the lab with ferrets, though.
There will be no flame wars over recombination vs reassortment here. Assume both are potential mechanisms, then move on.
The dual infections possibility is the reason for flu vaccine (seasonal) suggestions for poultry handlers. That, alas, doesn’t make them flu-proof.
“Webster uses recombination in the lab with ferrets, though.”
The word recombination is only a process. Whether you use it in labs or describe it in nature. It bears no relationship to Niman’s theories.
ahh, those 10 mutations. But that doesn’t mean that the thus constructed virus is indeed able to cause a pandemic or is even able to survive.
G228S was assumed to happen in Europe, but there seem to be no opportunities in Europe actually. Swine in South China are probably more of a problem. And then G228S might also happen by “random mutation”. BTW. what’s with S227G ? That’s what H2N2 has.
anonymous, give yourself a handle. It makes it tough to chat. ;-)
anonymous – at 10:33
Yes, that’s right. It’s not a prediction or a guarantee. It is a concern and a possibility.
The term “recombinant” is frequently used to indicate an artificial combination, such as growing the HA gene in bacteria, a mammalian, or insect cell. The HA produced under these conditions is callede a “recombinant protein” because it was grown in an unnatural host, but the sequence of HA in these systems is the same as HA in H5N1.
Similarly, the H5N3 recombinant is the combining of H5 with N3 so when used to vaccinate it can be distiguished from H5N1 (vaccinated people or birds could be tested for N3 to see if the antibody response was due to the vaccination (by H5N3) or a natural infection by H5N1). N3 can be easily distingusihed from N1 (and this is also the reason the vaccinies in China are H5N2 instead of H5N1 - the N is used to distiguish between antibodies due to the vaccine and antibodies due to an H5N1 infection,
G228S has not been reported in Europe. However, large numbers of H5N1 are just beginning to migrate into the area and reporting will almost certainly require human infections. The acquisaition of G228S requires two polymorphisms, which S227N only required one, so G228S may take more time.
>amantadine - A surprising no of strains 50% sensitive to amantadine, therefore use combination therapy. Should do studies now, on combination therapy.
THIS IS THE CHEAPEST, FASTEST SOLUTION. IT CAN AT THIS TIME SAVE ALL THE PEOPLE WHO ENCOUNTER A STRAIN SENSITIVE TO THIS DRUG. IT COSTS PENNIES.
IT’S INSANE, TRULY INSANE, THAT THIS IS NOT BEING MANUFACTURED IN HUGE QUANTITY.
It costs retail, in Egypt, ONE US DOLLAR for 20 capsules. So, the cost of production is about 50 cents per life.
And what do we as a society do? NOTHING!!!
Roche’s Tamiflu is only one solution. It works too. But rimantadine and amantadine work well, if the strain is still sensitive.
There is an equal risk that the sensitive strains to both Tamiflu and the mantadines will become resistant, IMO as I’m no expert; but it seems logical.
Where is the 24×7 manufacturing of amantadine?
It’s up some stupid, frightened politician’s kiester. Not one person who can pull the trigger is willing to do so. It’s disgusting. WHO’s officials, including the car mechanic, deserve to approbation at best.
The mantadines cost nearly nothing. They will save lives. Hello Out There!
RE: “Human Pandemic Vaccines: Many needs: replace eggs with cell-based vaccine”
Does anyone know anything about the plasmid technique for vaccine production: http://tinyurl.com/hrj65
Gaudia Ray – at 13:29
Stop shouting, especially at us. You assume much, but it is not at all clear that this is a wise strategery. The adamantanes can induce resistance in flu strains in as little as a few days.
I agree with you that combos of all sorts need to be considered, including the amantadine or rimantadine with tamiflu, etc.
But calm down.
Where are you reading about amantadine. That drug has been worthless for years for treating flu with resistance well past 90%. I had read months ago that this was holding true for h5n1 as well. Also its lack of use so far seems to suggest that I am correct in saying its worthless. You are correct in that its cheap and readily available, so if it worked they would be using it. Clearly you seem to be missing some important data. If you know different I would love to read anything that is peer reviewed.
Although there is Amantadine resistance in seasonal flu, resistance in H5N1 is largely limited to Vietnam and Thailand. H5N1 amantadine resistance in Vietnam nad Thailand has been a known since first human cases were described. However, no human isolates from China or Indonesia have been found that are resistant, and there has never been a hint of resistance in the Qinghai strain (resposible for human cases in Turkey, Iraq, Egypt, and presumably Azerbaijan).
The above data are well known and without controversy. The only controversy were comments about resistance in China (which in poultry is rare, but is present in about 10% of isolates - as is the case worldwide including pigs in the US).
Sequence data on M2 is publicly available, and for amantadine resistance, as well as most issues regarding H5N1, the story is in the sequence.
You comments on amantadine are not supported by any facts that I know about. China uses Amantadine for its patients, and a large number of doses were rushed to Liaoning when H5N1 was pretty much out on control in the fall of 2005.
I have a question? This is probably off the wall, but it has been on my mind, since I read the reports yesterday, that some people may be genetically more likely to catch H5, because of suseptible receptors, we all don’t have.
I have had a sister that contracted Rhumatic Fever, a child diagnosed with Post Streptoccocal Rhumatic Infection Syndrome, and another that had Strep B pneumonia, that became blood poisoning. Through all this I was told that very few adults will ever get strep, less than 3%. I was also told that only some children or adults can even get these post strep diseases. It seems that some people have receptors in their body, that will allow the strep to attach and cause more serious damage. We all don’t have these receptors. I was also told that people with OCD and some of the more serious psychological disorders, may have these receptors in their brain and are more likely to become more seriously impaired after a strep infection, because of these receptors. With my two young sons, I was warned to always have them tested for strep, whenever they had any sore throat. There is another psychological disorder, I think know as PANDA, that is caused by strep as well.
Could there be any link between these strep receptors and the receptors they are finding in some of the clusters of H5? Maybe they are the same and could test families with clusters of identified post strep disorders, to learn more about how H5 infects. This must be rare, since I’ve never met another family, that had a history of all this post strep junk.
Oh well…had to let this lose from my small brain! Back to a brainless activity…my garden!
None of these drugs should be ruled out (or in) a priori. Nor should they be declared ‘the answer’. The story is not just in the sequence, which can, of course, change over time. It’s in clinical efficacy.
It appears I stand corrected. This is what I think I was reading before. http://www.rense.com/general66/dller.htm It would all depend on what it combines with and when it gets exposed to the drug. If you caught H2H early on I think there would be a good shot of the drug working. Farther down the line I think the drugs usefulness will quickly degrade. Although considering its availability and cost I guess you have nothing to loose in trying it. Here is where the 90% figure comes from. Not avian, but it was off the top of my head afterall. http://www.medscape.com/viewarticle/521940
Annoyed Max-Not mad yet. If one assumes that we are going to have a pandemic leaning more towards 1918 then 1957 or 1968; and if we assume that there will always be a fixed budget that regulators are willing to spend given the speculative nature of a pandemic at the moment in time then…spending the limited budget on speculative treatments is not appropriate unless there are no effective prophylactic measures avaliable.
I’m not sure any of the present, primitive anti-virals will be of much effectiveness…the alternatives are masks, alcohol hand washes, powdered electrolytes, broad spectrum antibiotics etc. that do have proven prophylactic capabilities.
As far as Amantadine resistance is concerned, the story is pretty much in the sequence. For the isolates from Vietnam and Thailand (as well as Cambodia and Laos) the M2 gene has TWO amantadine resistance markers (at positions 26 and 31). Both markers are in EVERY H5N1 isolate from the area since 2004, regardless of whether the source is human, bird, or cat. The double ,arkers are not found in China or anywhere else.
In China, Indonesia, and other locations, there is a marker at position 31, but this marker is not present in human isolates or Qinghai stain isolates.
Amantadine resistance can develop, so there is no guarantee that Amantadine will work in the future, but it is effcective in current human H5N1 outside of SE Asia and is used in China.
The “rapid emergence of drug-resistant variants” is a known clinical issue, hence thereluctance to rely on it. The role of the adamantanes (rimantidine has less side effects and is the preferred agent) remains unclear, but (as noted) I agree with the sentiment that it shouldn’t be ruled out.
“effective in current human H5N1 outside of SE Asia”… there are few (if any) published cases that used amantadine alone. The largest published study was the WHO writing group and their current statement is:
I suspect more important 9and more up to date) is this statement from anon_22′s other thread from the Asia conference:
WHO will be releasing recommended doses for H5N1 treatment in the next couple of weeks.
That might help, but keep in mind 200 human cases is perhaps not enough clinical data to answer the question.
DemFromCt. Thanks for an excellent review of this point in time concerning antivirals.
The fact that the WHO will only be releasing recommended doses for an outbreak that has been ongoing for three years says a lot about the current state of the science.
Nothing would please me more than effective antivirals and vaccine but to this point they remain ‘wishful thinking’, and I see little evidence that this state of affairs will change.
Unless monies are avaliable and targeted for many other related expenditures, things do not look good.
However, if they are gambling for a pandemic after three years from now, then maybe there’s a chance.
Yup, give yourself a new handle, I guess. :-?
sorry, this was meant as a comment to DemFromCT – at 10:54.
The review is dated. It applies to H5N1 in Vietnam and Thailand, where ALL of the human cases were in 2004.
It is OBSOLETE in 2006. Vietnam says it had NO human cases in 2006. The vast majority of human H5N1 cases in 2006 were due to the Qinghai strain in the Middle East and Africa or to H5N1 in China and Indonesia. There have been NO reported human H5N1 cases that have amantadine resistance in 2006.
Post dated infomation as fact is VERY misleading, since it has no relevance to the human 2006 cases (or any case outside of Vietnam, Thailand, and Cambodia).
The data are VERY clear. ZERO amantadine resistant cases outside of Vietnam, Thailand, and Cambodia.
Dr. Niman Thanks. Given the fact that this class of antivirals has been fed directly to poultry, I would expect that resistance will follow rapidly in human clinical cases.
All antivirals have exhibited the development of resistance at an early date, unique from and not seen with antibiotics. This alone allows questions of their future usefulness.
Dr. Niman, was the report of the Liaoning outbreak at the beginning of this year ever substantiated?
The review is dated, but not obsolete, nor is Dr. Moscona’s review. The rapid emergence of viral resistance remains a clinical concern with these drugs regardless of what’s reported, and that’s based on years of experience with this drug by the medical community. Lab reports of resistance (or lack of same) are not a substitute for that experience.
The more recent data that (I hope) WHO will provide will be a help. The more recent 2006 data that niman refers to is why it shouldn’t be ruled out as effective before we’re even in a pandemic situation, and these drugs are part of (and should remain in) the toolbox both for the US strategic national stockpile and for WHO’s containment strategy. But no one should be comfortable relying on them.
The WSJ did a story on the massive shipment of amantadine into the area. The boxun report on the deaths of cullers was not independently verified, to my knowledge.
The is a good chance that the amantadine resistance seen in Vietnam/Thailand was from Amantadine use in poultry or pigs. However, there is no direct link because only the Vietnam/Thailand H5N1 has both markers.
The press made a major deal out of Amantadine use in poultry in China, but to date there are NO reports of amantadine resistance in human cases in China (and very little resistance in bird isoaltes in China).
Thus, at this time Vietnam/Thailand/Cambodia is the exception (all have the same TWO resistance markers). Indonesia, China, Turkey, Egypt, Iraq, and Azerbaijan have NO reported cases of amantadine resistance and no indication that resistance will develop anytime soon, in part because only China uses Amantadine on human cases at this time.
Here is a cautionary look at the situation from the NEJM, Feb 2006 by Frederick G. Hayden, M.D. They have been very good, I should add, at providing open access to flu articles.
A further comment…
niman, I’m sure, will be the first to support the concept that things can change rapidly. Today’s bug may not be tomorrow’s picture, so following this is the only way to be sensible. But support is provided for my comments above, including thinkng of these drugs in combo and not as unitherapy.
In the end, optimal therapy is still not known.
DemFromCt. I think you would agree that there are a lot of questions unanswered with respect to both of the WHO’s technological solutions-fixes. Despite evidence pointing to the real potential for future problems with the efficacy of both, the WHO has left all their eggs in this one basket…and have not appeared to consider stockpiles of other treatments and preventatives.
Tom DVM – at 19:36
There are more questions than answers, indeed, and a fitting return to the topic of this thread!!
Which other treatments and preventatives? The US, which hardly has cornered the market in foresight, has both rimantidine and tamiflu (and some relenza) in the strategic national stockpile (skippping the logistics questions for the moment). But the truth is that all of this is stopgap in the race to develop an effective vaccine technology and production system. If we develop such technology as non-egg vaccine production (speaking of eggs) or the Holy Grail of a universal flu vaccine (one shot fits all for 6 billion people, made and delivered in a timely manner), it won’t matter how well amantadine works.
DemFromCt. That last line is not only a long one but quite a stretch even in the wishful thinking file. There have now been three studies in the past twelve months, including one last week from Ontario, that seem to prove that flu vaccines do not work…period.
If they are totally redesigning influenza vaccines from the ground up then I am all for it, but they should have started this about twenty-years ago.
The facts are that influenza vaccines don’t work…these are not my facts but the facts of independent scientists from at least two countries.
As far as preventatives and other treatments go. What about food supplies? Either solve the infrastructure problems, talk to farmers or stockpile food…no food, the battle is lost before it starts.
I think we should stockpile N95 masks (arguments against their effectiveness appear a little rediculous to me), gloves, disenfectants including alcohol based hand washes and treatments broadspectrum antibiotics, oral electrolyte powder, anti-pyretics and other supportive therapies that can be given at home with telephone support from professionals.
I think we should stockpile N95 masks (arguments against their effectiveness appear a little rediculous to me), gloves, disenfectants including alcohol based hand washes and treatments broadspectrum antibiotics, oral electrolyte powder, anti-pyretics and other supportive therapies that can be given at home with telephone support from professionals.
That’s a good idea. Let me also remind folks of this:
Nonpharmaceutical Interventions for Pandemic Influenza, International Measures as there’s more to prep than stockpiling antivirals.
And whereas vaccine in its current form has been disappointing, I’m optimistic that something nbovel may help some day.
DemFromCt. It appears that vaccine does little in response to seasonal influenza’s.
Does it not seem that we need to fully acknowledge this fact or provide evidence to the contrary before jumping the lily pad to advertise a cure for the H5N1.
It seems to me if you don’t realize that you’re stuck in the paper bag, it’s a little hard to fight the bully.
Nope. The “little in response to seasonal influenzas” is really a hot topic of debate and not an accepted fact. The one controversial paper assenting this has been roundly challenged. No question that it’s less than 100% effective, but that’s not the same as having little efficacy.
Here’s the current CW on flu vaccine (seasonal) from CDC and NIH.
should not receive influenza vaccine. Rather, the study concludes that the vaccine may prevent fewer deaths among the elderly than previous studies would have suggested. Therefore, the authors note that there is room for improvement in influenza prevention efforts, including research into developing more effective vaccines for the elderly and the increased use of medicines to treat flu.
DemFromCt. Like I said before, I wish the news was different. It is not about one paper that has been challenged. Being from Canada, I have heard the challenges…quite feeble in my opinion.
It’s just hard to see that something that looks so good on paper just doesn’t work. This is not the first time the same has happened with other treatments ( ex hormone replacement therapy).
This is the third study in one year to come to a similar conclusion, two in the United States and now one in Canada.
I won’t go on any further about it but I will say that I question how many studies it will take before we get the message that nature is sending us.
I won’t go on any further about it but I will say that I question how many studies it will take before we get the message that nature is sending us.
If you want to argue data, fine. If you want to argue that you know better what nature is trying to say, I give up. ;-)
Dem,
Can’t argue with psychics.
DemFromCt. We can go on all night if you would like…give me some field data that indicates that any influenza vaccine works.
By the way, I believe the price tag was 50 million dollars for the vaccine experiment in the province of Ontario, Canada.
Efficacy data is summarized here.
The elderly have the toughest time, and children need their two shots. The best years are ones where the flu virus and vaccine match. but to assert, as you have done, that “that vaccine does little in response to seasonal influenza” is not supported by the data.
Actually the burden is on you to show it doesn’t work.
I believe there have been now three reports in the past twelve months that have concluded that influenza vaccines don’t work. Am I to take this summary from the CDC at face value? And if this was the case, how do you explain the other studies?
Decreased efficacy vs not working. The vaccine ain’t 100% and in some cases is closer to 50–65% effective in preventing flu symptoms. But in some poulations, it’s better (young adults) and in some worse (seniors).
What the studies really raise is the question “are we vaccinating the right population”? Instead of seniors, maybe we should shoot up all the kids in school, e.g. and not just ‘risk groups’.
Am I to take this summary from the CDC at face value?
Nope. Go look up the individual studies if you’d like.
Tom,
You could start here.
DemFromCt. I have had a bit of experience with vaccines that don’t work.
First, the trip from the lab to the field is sometimes a long one. Just because they work under lab challenges doesn’t mean they work in the real world.
Second, yes we can vaccinate persons with antigens and we will get a immune response to the antigen…but that does not ensure that the immune response is actually protective against infection…and it happens quite often that it does not protect. A lot of vaccines have been sold in history on the illusion of protection that did not exist.
Since this is a democracy, I believe that I am discussing this on flu wiki at the moment because the evidence of the past year indicates to me that I can no longer take what the WHO, CDC and the Public Health Agency of Canada state at face value.
“influenza vaccine prevents influenza illness among approx. 70–90% of healthy adults less than 65 yrs.”
“vaccine effectiveness was estimated to be 52% among healthy persons and 38% among those with one or more high-risk conditions.”
These two quotes remind me of the researcher that proved and produced a paper to indicate there were asymptomatic infections in Asia by asking a few questions.
What kind of a scientific experiment has a sensitivity of twenty percent (70 −90% of healthy adults)…and how exactly did they determine that vaccine effectiveness was ESTIMATED to be …
How many experiments have you seen where they use the term estimated.
I don’t know if this is already posted-It’s the dateline pandemic in several showings separated by very brief commercials while the next ones load up. (not able to fast forward)-they are very good.
Also, there is a great group of folks at the Texas A+M Health Science Center at College Station Texas who have and are doing pandemic preparedness sessions. I’ll see if I can send this forum any of the sessions from my DVD.
Thanks to all of you who have posted references, info and insight. It helps me in preparations in the healthcare setting, and in presenting convincing sound facts to those who need help believing in the need to plan and understanding the consequences of inaction. Whether a pandemic happens In November 06 or 1–5 or 20 years from now, long ago yesterday is the time to begin planning.
Thanks Melanie
icp,
Welcome, but please learn how to make a link properly so the mods don’t have to clean up after you. The directions are on the bottom of every page.
Tom DVM,
It’s a scary thing, but we’re all beginners here. [Shudder.]
Tom DVM, time for some sleep. I don’t think CDC/NIH data should be accepted just because it’s posted at CDC/NIH, but it shouldn’t be rejected either just because info is posted there (that’d be a mistake to think that way).
Some vaccines really don’t work. The current H5N1 vaccines fall in that category, with or without adjuvant. But i think the track record for seasonal flu is better than ‘not working’. The data’s there.
See you in the morning!
Sorry Tom, thanks
In response to what Tom DVM posted at 23:10…
PubMed article number 16213065 (Vaccine. 2006 Feb 20;24(8):1159–69. Epub 2005 Sep 19) - abstract:
We performed a quantitative review of 31 vaccine antibody response studies conducted from 1986 to 2002 and compared antibody responses to influenza vaccine in groups of elderly versus younger adults. We did a weighted analysis of the probability of vaccine response (measured as seroconversion and seroprotection) for each vaccine component (H1, H3 and B antigens). Using a multiple regression model, we adjusted for factors that might affect the vaccine response. The adjusted odds-ratio (OR) of responses in elderly versus young adults ranged from 0.24 to 0.59 in terms of seroconversion and seroprotection to all three antigens. The CDC estimates of 70–90% clinical vaccine efficacy in young adults and these estimates suggest a corresponding clinical efficacy in the elderly of 17–53% depending on circulating viruses. We conclude that the antibody response in the elderly is considerably lower than in younger adults. This highlights the need for more immunogenic vaccine formulations for the elderly.
And, at this link http://tinyurl.com/qbwv6 is a transcript of the FDA/CBER discussion that took place in March 2003, on what to include in the 2003/4 influenza vaccine, and the problems surrounding that decision. Folks, this is a very educational read. They talk about problems growing the current Fujian strain, the possibilities of using MDCK cell cultures (including a direct statement from an FDA person that it is “a tumorigenic cell line”), the problems of adventitious (contamination) agents getting into the vaccine from source material, etc. Really, there some material that gives cause for concern, in one way or another.
And there is this statement on page 63 by one of the panelists: “But the fact is that we don’t always known whether a new strain, even if it is supposedly a better antigenic match, will provide any superior coverage to the current strain. We only find that out in retrospect, after the vaccine is produced.”
It just seems that regarding flu vaccines, the public deserves to be better informed or to have fuller information from the CDC, as to true efficacy - or at least what the realistic limitations of the vaccine might be.
Finally, here is a newspaper article about the Canadian report that Tom DVM mentioned. http://tinyurl.com/o8xhp
Maybe some of this material will help give more depth to the vaccine discussion.
Excellent, beehiver, and thanks! As I said above, part of the question in the ‘it didn’t work’ studies is “what are measuring”? From the article you posted:
Another question is “are we vaccinating the right people”?
Also:
Another is ‘which is the best vaccine to use’?
I don’t suggest vaccine issues for seasonal flu are non-existent, I simply take exception to the idea that they are completely ineffective. The studies raise important questions, they don’t refute the practice of vaccination.
BTW, back on track for anon_22′s topic is this comment from the Lancet Asia Forum, which should be read in parallel to this thread:
Tom DVM, DemFromCT is right about vaccines, but you also have valid concerns. No vaccine is a 100% effective, something we should keep in mind during a pandemic. But the data that flu vaccines are helpful, if given to the right people, are pretty strong. The problem in the US, and perhaps Canada, is that the wrong people have been getting almost all of the vaccine - the elderly. Although it is certainly true that they are more likely to die from flu than other people, giving them vaccine has NOT been shown to significantly decrease mortality. There are two reasons for this. First, the older you are the less likely you are to mount a immune response to the vaccine. So, the vaccine does little to protect them from the flu. Second, children are the fire that feeds local outbreaks flu pandemics - each one is a little flu factory. They are quite good at infecting each other and their parents and grandparents. However, if vaccinated, school children do mount a good immune response which will protect them. Consequently, the parents and grandparents are less likely to get infected.
The best evidence that I am aware of the vaccinating children decreases flu associated-deaths comes from Japan. In the 1960′s, Japan vaccinated it’s school children against flu. This program stopped in 1994. Guess what happened? There was a spike in deaths of children in the winter months. They realized their folly and began to vaccinate their school children in 2000.
In the US, the director of the CDC ignores all available science and instead stupidly allocates vaccine to the elderly instead of children. She is aided in this ignorant decision by the Advisory Committee on Immunization Practices (ACIP) for control of influenza. This policy has almost certainly resulted in the deaths of children and thousands of the elderly.
The Japanese Experience with Vaccinating Schoolchildren against Influenza
Monotrene at 8:54
“Although it is certainly true that they are more likely to die from flu than other people, giving them vaccine has NOT been shown to significantly decrease mortality.”
Do you have a reference for this data? At what age does protective effects of vaccine decrease significantly? since I’m 62 this is an important question to me. I get the4 flu vacine every year and so far it hasn’t failed me.
thanks for all your efforts.
There is a table in the Emerging Infectious Diseases Journal The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention, Meltzer et al, 1999 (scroll down to conclusions) ‘Table 8. Setting vaccination priorities: Which age group or group at risk should be vaccinated first?’ showing how you would prioritize vaccination depending on different outcomes: risk of death (of person receiving vaccine), total deaths, returns due to vaccination. The last category is what you want to use to reduce overall economic impact. The interesting point is that children (0–19) gets pushed up in this category, NOT because of the direct economic consequence of them getting sick (shown in Table 3 as lowest) but because of transmission.
So the issue is reducing death or reducing ecconic impact?
jim, my comments are based on population studies, and are definitely NOT specific recommendations to individuals. I’m not a physician.
There is a general trend towards reduced immune system functioning as we get older, so vaccines are, in general, less effective the older we get. But there is alot of individual variation. The best policy would be to vaccinate everyone. However, given a limited supply of vaccine, you would be safer if all of the available vaccine for your city went to children rather than the elderly. Since that is probably not going to happen, you may benefit from a flu vaccine. You should talk to your doctor about this.
In any case, you should not count on the vaccine working. If you are concerned about getting the flu, avoid children and crowds during flu outbreaks in your city. Also, hand hygeine can help alot. Carry alcohol based wipes with you and use them religiously.
References
Antibody response to influenza vaccination in the elderly: a quantitative review
The effect of mass influenza immunization in children on the morbidity of the unvaccinated elderly
It seems to me this study should be retitled “The Economic Impact of not having enough vacine in the United States. I’m sure many of the over 64 ‘s would pay the Cost for the vaccination since its shown to reduce the likelihood of death.
Monotreme- “you would be safer if all of the available vaccine for your city went to children rather than the elderly”
I still don’t see this conclusion substantiated by the study. Which figure compares total deaths for over 64′s in the various options. the extent to which they are protected seems pretty good if they recieve the flu shot.
The vague statement “There is a general trend towards reduced immune system functioning as we get older, so vaccines are, in general, less effective the older we get.” does not justify the quatitative conclusion you make.
I don’t think this is an issue of CDC Stupidity as you called it. This is a matter of life and death not ecconomic analysis.
“ As I said above, part of the question in the ‘it did’t work’ studies is “what are measuring”? (DemFromCt 7:40)
I agree…that is the point. We have seen a number of studies mentioned above and I’m sure that there are many more.
One question is are these experiments? It is pretty clear to me as stated last night that a statement including “prevents influenza illness among APPROX 70–90% of healthy adults…” is not an experimental finding but an epidemiological finding. “vaccine effectiveness was estimated to be…” Same problem. Someone in an ivory tower is using epidemiological data to prove what appears to be a preconcieved notion.
Where I come from, there is a saying…bull shit baffles brains…and the best way to baffle brains is to provide a lot of numbers. As I said last night, I saw the very nice press release on the peer reviewed study proving with lots of numbers that there were widespread asymptomatic cases of H5N1 in Asia…why would anyone have the need to question these pristine studies.
The point is that a study was done in the US over twenty-five years, by independent researchers, that analyzed death rates in years when the vaccine was a PERFECT MATCH to circulating flu strains in comparison with years when there was a PERFECT MISMATCH. What were the statistically significant findings…the DEATH RATES didn’t change.
The studies you have quoted have a high degree of subjective observation in them. Experiments are set up to remove this singular variable that produces results of little value.
I am not interested in a particular antigen producing an immune respone. I am interested in a vaccine that in laboratory and field studies produces a result in response to direct viral challenge.
The fact is the response rates so well quoted in these studies is estimated.
DemFromCT. I was wrong to say influenza vaccines don’t work. I just think we should be honest enough to say if in fact they protect less than 30 % of those vaccinated….thirty percent protection is better than nothing in a population.
I have a problem when vaccine are sold on disguised data that says they will save us all.
Therefore I will qualify my statement and say that influenza vaccines in the past and those for H5N1 in the future will have very limited effectiveness.
I am not sure what the vax rate was for Ontario Canada population last fall - but the rate of infection for Influenza B was quite high - lots of people were sick in spite of free vax - current Ontario reports found at http://tinyurl.com/huq6r
We can agree on much of that, Tom DVM. As beehiver points out above, we shouldn’t drape “what we believe based on data” with the trappings of “we know this for a fact, so just do what we say”. That usually backfires somewhere down the road. And healthy skepticism will serve us well with H5N1 and other areas.
As my friends, the reveres (the epidemiologists) say (I’m paraphrasing), sometimes a study effect measure is so powerful that even an epidemiologic study can show it! So don’t dismiss the epidemiologic studies.
“I have a problem when vaccine are sold on disguised data that says they will save us all.”
Me, too. And I agree transparency is a good thing for public health officials.
“Therefore I will qualify my statement and say that influenza vaccines in the past and those for H5N1 in the future will have very limited effectiveness.”
I disagree based on past data, but refuse to argue about future data (except to say you should keep an open mind and be prepared to be persuaded). ;-) But they are not likely to be 100% effective; many vaccines are closer to 85% - enough to achieve herd immunity.
gharris, this year’s flu vaccine had H3N2, H1N1 and B.
DemFromCt. I agree with everything you have said. As far as the study of epidemiology goes…I think many would agree with me that it has been slightly tarnished in the last 15 years. In my opinion, it has become for want of a better word a ‘mercenary for hire’. If your company wants a set of statistics to prove a point, any point, then there is always someone who will provide the statistics, in a very formal, sophisticated manner, the 95 % subjectivity component camouflaged behind a lot of numbers and statistics that leave the reader in the end confused and saying ‘what the hell was that all about’ (I think this run-on sentence beats yours from last night).
In Ontario, I have just payed for a 50 million dollar experiment. I was not given an option whether to participate. There are a lot of places that 50 million dollars could be spent and we all agree that healthcare public health budgets are limited. And we would agree that a lot of the 50 million dollars goes to private industry.
An analysis was done that indicates the flu vaccine was largely useless over the 5 year period. The experts have come back to say that the study was improperly formulated. My question would be…where were the experts before and during this experiment. They spent 50 million dollars and didn’t have the foresight to set up an extensive analytic study to answer a controversial and essential issue, one way or another.
Now that someone else did the study, they come out of the woodwork with all sorts of criticisms less the personal attacks that may be coming in the future…
…and that’s my point. When it comes to report after report that says they don’t work (with good reason), there is always an excuse…given to the wrong target group, Oh if we had just done it differently.
When you use a vaccine that does not save lives in the target groups, the very young and the very old, it doesn’t really matter what the reason is.
If you switch and only give it to those with top notch immune systems then of course the epidemiological data will be slanted because those with excellent immune systems will not be as susceptible to the flu in the first place so the appearence of success will be there.
If it is to be proven that these vaccines work, then statistically significant numbers of persons will have to be lined up, vaccinated and then challenged with a SIGNIFICANT viral challenge…then the vaccine will have to be tested in the field backed up with serological and well as subjective information.
All else is conjecture and at this point I think the general public and healthcare workers for that point, deserve the truth, the whole truth and nothing but the truth.
“So the issue is reducing death or reducing ecconic impact?”
reducing economic impact is used as the (measurable) parameter for preventing infrastructure breakdown. So the debate might be do you 1) protect the high risk people (just for the moment assuming that the pattern is the same as seasonal flu) 2) reduce total death or 3) minimize systemic breakdown.
Economists can give us figures, we as societies need to debate this NOW, to get some consensus, as to what choices we make.
Sorry Anon, I can’t find the context for the quote you mention. Where did you get it.
jim 09:34
you can always directly transform “saving lives” into “money spent”.
You won’t save 1 life , when $xxx is required and when you could save 2 lifes with the same amount at another place within your responsibility.
Assuming that all lifes are of same importance, that is. So, there will be an amount $xy, where you can say this is the current “value” of one life. Typically this value isn’t communicated to the public for ethical reasons. But the data is available and you can make your own estimates for xy.
Thanks
Jim, some studies have shown a statistically significant effect in vaccinating some groups of older people. However, it should be pointed out that the current policy of allocating most of the available vaccine to the elderly has failed, as a whole. 30,000–50,000 people, mostly the elderly, die every year as a result of flu and pneumonia. There has been no improvement in that number despite numerous campaigns to vaccinate more elderly people. The studies I cite above show that vaccinating childrend decreases morbidity and mortality in the elderly at the population level.
Monotreme.
“30,000–50,000 people, mostly the elderly, die every year as a result of flu and pneumonia. There has been no improvement in that number despite numerous campaigns to vaccinate more elderly people.”
You don’t suppose that this could be because the vaccine doesn’t work…is not efficacious.
There are two at risk groups from influenza…the old and the young. When the death rate, in the age groups you are specifically targeting, is not affected, the only factual conclusion that can be reached is that the vaccine doesn’t work…there is no possibility of ‘herd immunity’.
If I had a measles, mumps, rabies or polio vaccine etc. and said in giving the vaccination…the target group for this vaccine will see no beneficiary effects but we are going to try and vaccinate all those in middle age groups to provide ‘herd immunity’, what would you say?
Why would you give vaccines to children if they would be of no benefit to children.
If they want to figure out the problem and completely redesign flu vaccines great…but first one must admit there is a major problem with efficacy.
Monotreme wrote yesterday at 13:41 - “30,000–50,000 people, mostly the elderly, die every year as a result of flu and pneumonia.”
And - we often see this figure of 36,000 deaths per year, especially coming from CDC and press releases. But consider this. The National Vital Statistics reports show a breakdown of how many deaths were from influenza and how many were from pneumonia (which can be caused by many pathogens, bacterial and viral). http://tinyurl.com/jrxhr
At pages 16 and 36: influenza deaths 2002 - 753 2001 - 257 2000 - 1,765 1999 - 1,665
pneumonia deaths 2002 - 66,231 2001 - 61,777 2000 - 63,548 1999 - 62,065
So, how can the CDC claim that about 36,000 die from flu each year, as they state at http://www.cdc.gov/flu/keyfacts.htm?
That number is evidently based on mathematical formulas used at the CDC. An explanation is posted here, page down about 1/4 page to “122 Cities Mortality Reporting System”: http://tinyurl.com/fy56v
Now, even allowing for the possibility that many physicians never test their serious pneumonia patients for influenza virus, and that some of them indeed may have influenza, consider this article http://tinyurl.com/l544o citing lab documentation of agents causing “influenza like illness” (ILI) in one UK community in 1992–94. In that instance, barely 1/8 of cases were due to influenza A&B (see pie chart). The author of this article writes “Such studies, rigorously validated by laboratory identification of agents, can at best provide a rough average of causality of the seasonally complex epidemiology of respiratory tract infections: over several years one third of influenza-like illnesses are of unknown cause, one third are caused by rhinoviruses, and the remainder by a mixed bag of other agents, which include influenza A and B viruses.”
There’s another article which reviews use of vaccines in children, it’s at PubMed 15733718. The abstract reads: “Live attenuated influenza vaccines had 79% efficacy and 38% effectiveness in children older than 2 years compared with placebo or no immunisation. Inactivated vaccines had lower efficacy (65%) than live attenuated vaccines, and in children aged 2 years or younger they had similar effects to placebo. Effectiveness of inactivated vaccines was about 28% in children older than 2 years…Influenza vaccines (especially two-dose live attenuated vaccines) are efficacious in children older than 2 years. Efficacy and effectiveness of the vaccines differed strikingly. Only two small studies assessed the effects of influenza vaccines on hospital admissions and no studies assessed reductions in mortality, serious complications, and community transmission of influenza. If influenza immunisation in children is to be recommended as public-health policy, large-scale studies assessing such important outcomes and undertaking direct comparisons of vaccines are urgently needed.”
We’ll want to note here that their definition of the term “efficacy” of a vaccine is reduction in laboratory-confirmed cases; and “effectiveness” is reduction in symptomatic cases of influenza-like illness. Other authors also use these definitions.
Another writer at http://tinyurl.com/edsnc, reviewed the above-mentioned article and had access to the full text, which I don’t have at the moment. But the reviewer further quoted the original author: “We recorded no convincing evidence that vaccines can reduce mortality, [hospital] admissions, serious complications, and community transmission of influenza.”
Considering these various things, the flu vaccine emperor may have less clothes on than we’ve been led to believe. To bring this discussion back to the intent of this thread, using non-vaccine preps against the potential of H5N1 would certainly seem in order. I for one am alarmed at the high hopes so many good people are pinning on the eventual availability of a truly efficacious H5N1 vaccine. Even with ordinary influenza strains, it seems the purported efficacy is very cloudy and confusing.
I apologize, the influenza and pneumonia death numbers in above post near the top, did not print out as intended. Let’s try this.
At pages 16 and 36:
influenza deaths 2002 - 753; 2001 - 257; 2000 - 1,765; 1999 - 1,665.
pneumonia deaths
2002 - 66,231; 2001 - 61,777; 2000 - 63,548; 1999 - 62,065.
beehiver. No problem. The numbers just confuse me anyway.
Thanks for the information.
Beehiver, I can’t tell you how this info. made me feel tonight. I have a six year old daughter upstairs with a 102 fever tonight. It came up very quickly. I didn’t even realize she was feeling sick. We live in the midwest where there are concerns about the spreading mumps cases. My children are not completely vaccinated. I know that makes everyone jump with opinions, however, I have a neice that reacted so adversely within an hour of receiving a series of vaccinations, that the doctors have explained to me that my children would each be the one out of a very few (I don’t want to quote an inaccurate #, and I can’t remember the exact #) that would react adversely. Every time a parent signs the consent form agreeing that they won’t place blame anywhere if their child gets sick or DIES from the shots that are so highly recommended…. I struggle every day worrying and wondering why my family is genetically predisposed to react to the vaccinations??? They do receive the polio vaccine. It’s sort of nice to hear that the numbers don’t always support getting a shot :) especially when you’re told that your children shouldn’t get the shot and then one of those scary diseases is circulating and you wonder if this time your child might contract it??? So, I won’t be sleeping much tonight:(
Hi Mother of Five at 00:34.
This is not on topic for this thread, but I also have many many concerns about vaccines, and have heard too many reports about children that reacted badly, sometimes very badly. So as not to divert from influenza, may I suggest you read as much as possible at the website for National Vaccine Information Center http://www.nvic.org, it may help answer some of your questions.
There is valid research surfacing, that some people are genetically predisposed to not easily clear toxic substances in the vaccines from their bodies.
I hope your daughter feels better soon. I have read that 50–67% of the kids that got the mumps recently, had both doses of the vaccine. Go figure.
Thanks, Beehiver
Mother of Five We did not vaccinate either of our children. It is scary because if anything happens to them, everyone blames you. If they are vacinated and something happens- it is all “ÿou did everything you could”. Anyway, being a parent is the scaryest thing I have ever experienced. I honestly think that getting sick is good for you if you are healthy.
My kids are healthy and if I was lucky enough to have another child- I would not vaccinate. You pay your money and you take your chances.
When we were kids, mothers would take the kids over to a house where there was the mumps or chickenpox. The idea was to have the kids all home and sick at the same time- being ecological. I am sure that the childhood diseases are very good for most children. There are some that it is a disaster for- and I am so sorry for their families.
Just a bit of logic to back up Monotreme (I think) - we vaccinate our dogs and cats for rabies, not people, because dogs and cats are more likely to get rabies from wild animals and then infect people. Protecting our pets therefore protects us. I rarely got sick before I had children, and then I got every bug they came home with. We went through a “flu slump” when they got older, but now every time my grandchild has a bug, we get that too. Ever since she got a flu shot in January, she has been pretty healthy, and so have we. Not very scientific, but it sure makes sense to me.
Also, what about other anti-virals in the long run of treatment, like garlic and elderberry? Do they count in the scientific testing? Since I doubt that I’ll get any tamiflu or other medicines, is it silly of me to think I can eat my garlic bread and drink my elderberry wine ;) and at least have a little protection? I’ve read lots of pros and cons, but there is little scientific testing being done on any of the “natural” anti-virals. Why?
Mother of Five: i have a lifelong chronic condition as a result of the polio vaccine. If i had my time over i would still get vaccinated. Polio is a lot worse than what i live with as a result of the vaccine. My mother did the right thing. Even if she questions it now..i dont
There is a large anti-vaccine movement in the US which I neither support nor condone. It is inevitable that it would surface in flu discussions. I’d take CDC over NVIC as a trusted source (so what, you say? Others don’t trust CDC either!). But it’s an endless discussion, and I do not criticize individual decisions.
The basics of ‘what’s out there’ are on Wikipedia.
The reference is to Anne Moscona, from Cornell. The claim is not made that the vaccine is always effective, and there are questions raised as outlined above. But on the whole, the vaccine program across the board has been highly effective, as seen in countries like the UK when the pertussis vaccine was temporarily dropped and children started dying from whooping cough again in the 70′s and 80′s.
Since trust in medical authorities is at an all time low, expect this question to come up again and again. But please be clear that there’s a difference between discussing flu vaccine in particular and discussing vaccines in general.
A general discussion of vaccination does not belong at Flu wiki, except in the context of flu vaccine.
DemFromCt. I am not questioning the efficacy of pertussis vaccine, polio vaccine, tetanus vaccine: I am questioning the efficacy of influenza vaccines which for sound physiologic and immunological reasons appear to not work at anywhere near the efficacy they being advertised. The studies that have indicated they don’t work at very high efficacies are many and sound.
Dem from Ct. I respect your opinion regarding vaccines, and don’t want this discussion to go that direction either. However there are quite legitimite concerns in relation the flu vaccine.
In 2003 Barbara Loe Fisher (head of NVIC) was on the panel right along with other experts, voting on which strain(s) to include in the next year’s vaccine. NVIC has always had a platform of “informed consent”. It’s the “informed” part that is sometimes so lacking. Concepts and numbers are stretched and watered down by some of our health agencies, for what is automatically assumed to be a non-thinking population. Yes, Wikipedia is a good start. But pathogens can and do change when under selection or drug pressure (infl A is notorious for that!), and there is still a lot of unknown about the delicate interactions of the human immune system.
The difference cited last night in influenza mortality figures is very unsettling. Over a four-year period 1999–2002, verified influenza mortality was anywhere from 200–1,800 persons, as opposed to the usual quoted 36,000 by the CDC. That’s a huge difference. Even if there are additional deaths from influenza not verified by lab tests, it’s a long way to go from 1,800 to 36,000. This does not build credibility for the CDC. In reality, the CDC does not really know how many people truly die each year from influenza.
Barbara Loe Fisher did release a comment this morning regarding flu vaccines - it couldn’t be said better, and the concept does apply to other common diseases. “The irony is that if the M.D./Ph.D. “experts” are wrong about mandated use of flu vaccine from birth to prevent all natural experience with type A and type B flu, if their zealous enforcement of mass vaccination policies create a virgin population without any immunological experience with the natural disease, then the day that pandemic flu virus does show up, it might well take out half of humanity.”
And consider the study posted last night, in which it was determined that efficacy of flu vaccine in children aged 2 or younger had the same effect as placebo. And yet we have a public health policy advising immunization beginning at 6 months of age.
This is not to imply an anti-vaccine stance for very serious diseases. However, the industry definitely has problems. Problems with contamination factors, problems with nucleic acid exchange, problems with toxic elements.
Allowing the possibility of H5N1 to blindingly and hurriedly drive our total opinions regarding vaccines and the concerns associated therewith, has the potential of producing sorry scenarios in the future. There is much to learn from in the short history of vaccines (less than 100 years), if only we would take the time to do so. More more rigorous study, thinking and testing is needed - and yes it takes time. Unfortunately, vaccine science and industry may have lost very valuable time in the last 20 years, by bowing too often to the god of corporate profit - instead of indulging in careful research.
We are facing the possibility of a serious disease, and expecting a vaccine to help out humanity, but prior stats on vaccine efficacy/effectiveness are uncertain and cloudy. It is no wonder we are asking unsettling questions (sorry!), and it is no wonder Webster is suggesting more than one egg in the H5N1 basket.
thanks again, beehiver and Tom DVH. I am not suggesting either of you are anti-vaccine, just putting a marker down because of experience on other boards.
As far as reported cases in the hundreds vs predicted cases in the thousands, see here and here for an interesting take on the topic.
I am not necessarily against vaccination myself. I think if my neice had not reacted so severely before I began having children, that I would have just had all of mine vaccinated, but perhaps something else may have made me question vaccinations, hindsight’s always 20/20. However, I brought it up in the context of getting a BF vaccination and how difficult it may be for me to have my children get a shot due to our circumstances. Of course, we won’t be the only ones worrying about this issue, I know, so it’s good to get feedback and think about it before we are in a position where we HAVE to make the decision. Sorry, DemFromCt :)
As was seen in 1918, I am sure many of the flu deaths are not listed as such because too often victims actually die from complications from the disease, not the disease itself. “Respiratory Failure” is often used for eldery patients. Well, they probably went into failure from flu complications, but it isn’t counted.
Anyway, on vaccines, I’m not couting on a miracle. The more I read about influenza the more worried I become. It can change too quickly and there are too many variables. The horse will have long left the barn. We’ve had our kids vaccinated for the usual stuff, and had them vaccinated for Chicekn Pox for 2 reasons 1) state requires it for school, 2) DH never had it. So, this year my middle one gets a mild case of CP anyway because the vax is only at best 70% effective. And sure enough, DH got it too. Boy was he sick, and that was with anti-virals to lessen the impact. That’s when I really started getting serious about prepping. Modern medicine can only do so much. After than, kiss your arse and hope for the best.
Mother of Five. I have had serious reactions to booster shots of several vaccines including rabies and pertussis (whooping cough). The only vaccine that I have not as yet reacted to is tetanus probably because I no longer get vaccinated.
I was very worried when it came time to vaccinate my daughter; I had all the same concerns as yours and I empathize with your struggle.
Even with my personal experiences, I believe in vaccinations and thankfully in the end, my daughter was fine and has never had a reaction.
However, I see no point in recieving vaccinations with little or no effectiveness. In this case you are taking all of the risk without the possibility of benefit…and until proven otherwise influenza vaccines and H5N1 vaccines specifically would fall into that category.
I know everyone has opinions on whether to give vaccines or not. My mother was one who did not want to have me receive them. I got sick with diptheria when I was in my early 20′s (some 20 years ago) and pregnant. I was sick for a month and I mean SICK. At first I thought I had strep throat and went to an instacare type facility, they thought it was a bad case of strep at first too. They gave me antibiotics which did nothing. I went back in several days and by then I was really, really sick, high fever, an incredible sore throat with a weird grayish coating, vomiting, ears infected, dehydrated because my throat was so sore I couldnt eat or drink, I couldnt swallow at all, I remember spitting to avoid swallowing saliva. I was hospitalized for 5 days and released. Within 3 weeks I lost my baby and was hospitalized for another 2 days. I was contacted by the health department because I had a communicable disease. It was an awful experience to say the least. Please consider ALL the possibilities when you choose not to have your children vaccinated. They completely depend on you to make the right decisions here. I can tell you that all my children were vaccinated and on time.
Tom DVM – at 15:09
H5N1 vaccines at the current time certainly are not “proven effective”. They’ll have to do better than they currently are, with data, and in time to matter. At 10:02, I left some links to consider regarding the actual number of deaths per year due to seasonal flu.
It’s worth reading in full, including comments by Lone Simonsen and another by William W Thompson (CDC mounts a vigorous defense of the 36K figure):
DemfromCt. I read the references. I am not debating the numbers: in fact I think the numbers distract from the bottom line.
I respectfully disagree with you. I wish you were right but the evidence in my opinion is conclusive that influenza vaccines for the mild seasonal influenza’s has a success rate of less than ten percent…and there’s nothing wrong with protecting ten percent of the population…the question is where are there expenditures for the other ninety percent.
If they want to spend the money on vaccines and all the other treatments and put us on a ‘war footing’ in the next six months then I don’t have a problem…
…and the ten percent or less is for the seasonal influenza’s. What is the success (efficacy) rate for their experimental H5N1 vaccine…less than one percent. That’s a lot of money to spend to protect one percent of the population while having nothing to treat any child with after the pandemic starts…when these treatments are proven, avaliable and cheap!!
beehiver (rather than you) and others discussed mortality, hence the references. And above are field studies, as you call them, showing efficacy especially in younger patients. So I respectully disagree with your statement about conclusive that influenza vaccines for the mild seasonal influenzas has a success rate of less than ten percent. Hardly so.
Anyway, thanks all for the discussion. The more information that’s out there, the better. One of the reasons panflu is so diistressing is that we have so much work to do to rebuild the public health system for the so-called “every day” stuff. Better communication, better studies, better data, better surveillance, better vaccines shouldn’t have to be debated only because we might have H5N1. This should be bread and butter, provided all the time.
DemFromCt. We agree to disagree on the minutia but agree on everything else…still how do you explain the use of the term ‘estimate’ in each of the first two sentences and then say this is a field study.
In my opinion, estimate and subjective are one and the same. In an experiment there is no need to ever estimate because you have solid serology to back up your conclusions.
Monotreme – at 08:54
DemFromCT – at 07:40
That, plus the CDC data that I accept and you reject (DemFromCT – at 22:43), is more than estimate and subjective data.
DemFromCt. First, despite my experiences with vaccines which were on one occasion life-threatening, there is no greater supporter of vaccines then myself…when their is data that supports there use and efficacy (serology and experiments).
I have already critiqued the data you list at 22.43 which were not based, as best as I can tell, on any kind of serology but on epidemiological and therefore subjective estimates.
The data on Japan is also subjective.
I would read the study from Tecumseh Michigan if avaliable but it is a little hard to assess it without seeing it.
However, I would think there should be a little more evidence than one town on one year thirty years ago to substantiate the expenditure of most of a panflu budget on vaccine if non-subjective data is not avaliable to confirm the future protection rate of the H5N1 vaccine.
The study released by independent American researchers last year found, objectively, that the death rates did not vary in years when the vaccine matched from years when it did not match. I didn’t make this research up but that’s the way it is.
There was a second study released also twelve months ago with similar evidence but I can’t remember the exact context.
Then there was the Ontario study just released…again with no proven return for the fifty-million dollar expenditure.
How do you explain the two studies based on your experience?
DemFromCt. The only point in asking this question is where are we going to get the supportive medicines that will save lives if H5N1 breaks as big as 1918 when the existing expenditures are being spent only on their two ‘magic pills’: Tamiflu and vaccine.
As I’ve said, I agree with you on the bigger picture. There’s more than “tamiflu and vaccine and we’re done” in terms of both where they money goes and what we should be doing.
The studies looking at the elderly (it kills me to say that, being closer to 65 than 40) suggest less than excellent efficacy IF you accept that deaths rates are what needs to be measured, and that it’s accurate to do so by the study methods. As noted in my citation of a CDC statement on the topic:
the elderly from serious illness and hospitalizations- but the degree to which it works varies from year to year and can be difficult to measure. For example, influenza seasons differ each year in length and severity, and the health status of individuals also matters.
I think that’s right, and that death rates in the elderly are not the only thing to measure, nor does that necessarily apply to younger people, where flu symptoms and serology as well as preventative efficacy seem to me pretty well established. Again, to me, the bigger issue raised by this is whether we are vaccinating the right people (maybe we should do less seniors, more kids).
DemFromCt. Thanks for the information. I guess I am dense…I just don’t see it…but as in all other things while I know my science is good, I hope my intuition is wrong.
They, Governments and Regulatory agencies, had better step up to the plate and do better in a ‘hell of a hurry’.
Tom DVM – at 18:48
You’re one of my favorite people to dasagree with. ;−0 Thanks for the respectful conversation.
Maybe Leavitt should have separated out those unwilling to tell the public from those willing to tell the public in each state as he went through… (maybe there wouldn’t have been enough to shake a stick at, but, every place needs some, now.)
(“hell in an hurry” is what echo I hear, TomDVM.) :-/
With regard to the efficacy of vaccinating the elderly, a point I didn’t see raised here is that older people are likely to have more aquired immunity by virtue of having encountered a wider range of pathogens. A lower impact on mortality rates from vaccination programs targeting older age groups is therefore exactly what one might expect.
As for school-age children, whether schools are closed or not, they’ll be running around coughing and sneezing everywhere, and wiping their boogery little fingers on everything. Instead of vaccination, we might consider mass tranquilization. Years ago, a friend of mine, sufferring terribly from a week-long bout of hiccups, got a bottle of Thorazine from a nurse friend. Which worked. But it was his weekend to have his kid, who found the bottle, and downed some of the pills. After an initial panic, it was determined that the dosage was not life-threatening. It may not have been the most memorable weekend the kid ever had with his dad, but he sure wasn’t any trouble to look after. Just sat in a chair the whole time.
I haven’t read all the comments in detail but vaccination priority is one topic that keeps coming up for debate among both scientists and government officials. The general view is that you would vaccinate high risk groups (normally elderly, but not for H5N1, but that’s a separate discussion) to reduce total deaths, vaccinate young including kids to reduce impact. I would say there is real awareness of the issues in this instance but not any consensus yet.
In the case of H5N1, the high risk group and the impact group are the same, children. Although Leavitt is urging preparation for a 1918 type pandemic, the CDC is still basing their default vaccine recommendations on the 1957 and 1968 pandemics, ie, they’re assuming that the elderly will be the hardest hit. This despite the fact that almost of the victims of H5N1 have been children and young people.
As for vaccinating children (which I’m all for), what about their parents? Is the definition of ‘young’ not those under 30? Although some people wait a little to have kids, many are parents in their 20′s(and some even earlier). If the children are vaccinated and the young parents are not, who will care for all of the orphans?
“As for vaccinating children (which I’m all for), what about their parents? “
Vaccinating in clusters sounds like the way to go. That’s how the virus will spread. I’m high risk for even seasonal flu, so I get a flu shot. But if the rest of the family doesn’t get one too, why bother?
A problem with vaccinating certain segments of society would be maintaining the “social distancing” recommendations.
People that are vaccinated are still capable of transmitting the flu. I would think that precautions such as handwashing, social distancing, etc. would suffer in that those vaccinated and their families would have a false sense of security.
It is not that I am not for vaccinating - it is just that education will be critical in making those who are vaccinated realize that they still can carry the flu to their families, loved one, work colleagues and community.
Ok, the vaccine thread is up and running, so you might want to tranfer discussions over there for visibility…
See also, a thread titled Vaccine Distribution Ethics-Initial Federal Plan.
Washington Post article today about the priorities set by the Federal plan, and the controversy about their choices. http://tinyurl.com/hxbak
I am bumping this so it will be easy to find when I get a chance to read it.
Also this summarizes major problems and considerations for a pandemic vaccine. Vaccination strategies for pandemic
bumped again-The entire subject of vaccines suddenly is interesting. PLENTY to talk about- lots of interesting discussions- and some heated debate- what more could you ask for late at night when you should be doing something else?
There is ‘something else’ to do?? :-)
Old thread - Closed to increase Forum speed.