HEALTH 2/19-2/26/10 Bird, Other Flu Weekly Thread:WHO H1N1 Vaccine Target Selection Failure

Link to last weeks thread:

2/11-2/18/10 Bird, Other Flu Weekly Thread:13 Recent H1N1 Deaths In Michigan

http://www.timebomb2000.com/vb/showthread.php?t=354707

Please See:

Confirmed cases of Swine Flu and maps
http://www.timebomb2000.com/vb/showthread.php?t=330689

Comprehensive Flu Thread, Latest reports, States, Countries, Closings.

http://www.timebomb2000.com/vb/showthread.php?t=330395

Useful Links:

Avian Influenza (Bird Flu)
http://www.cdc.gov/flu/avian/gen-info/facts.htm

Johns Hopkins on influenza:
http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

National Avian Influenza Surveillance Information:
http://wildlifedisease.nbii.gov/ai/

CDC
http://www.cdc.gov/flu/avian/index.htm

WHO
http://www.who.int/csr/disease/avian_influenza/en/index.html

CIDRAP
http://www.cidrap.umn.edu/

Official U.S. Government Web site
http://www.pandemicflu.gov/

FAO
http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/avian_qa_e.html

European Union
http://ec.europa.eu/dgs/health_consumer/dyna/influenza/country_en.htm

The World Bank
http://web.worldbank.org/WBSITE/EXT...68427~piPK:64168435~theSitePK:1793593,00.html

WHO H1N1 Vaccine Target Selection Failure​

http://www.recombinomics.com/News/02191002/H1N1_WHO_Vac_Failure.html

The WHO recommends the following for next season's vaccine:

For the H1N1 component, a strain similar to A/California/7/2009, replacing A/Brisbane/59/2007

For the H3N2 component, a strain similar to A/Perth/16/2009, replacing A/Brisbane/10/2007

For the B component, a strain similar to B/Brisbane/60/2008-like virus

The above comments list the WHO vaccine target recommendations for the 2010/2011 flu season in the northern hemisphere. Although the recommendation leaves discretionary room for the precise A/California/7-like target, comments at the associated virtual press conference as well as media reports clearly indicate that the recommendations allowed for used of the X-181A version of California/7, which has been used for the killed vaccine worldwide, and the current stockpile has been cited as 74 million doses. This large inventory of X-181A in bulk form virtually ensures its use in the vaccination program for the southern hemisphere, which will begin in the next few months, followed by the 2010/2011 northern hemisphere campaign, which will begin in the fall. This seamless transition from the target selected in April of 2009 through vaccinations in 2011 is cause for concern.

As is well know, influenza A continually evolves away from host immunity, especially when immunity is widespread in the host population. When pandemic was first identified in April of 2009, the human population had little immunity. The elderly who had been exposed to the 1918 H1N1 strain or the seasonal H1N1 strain that followed still had protective immunity that cross reacted with the 2009 swine H1N1 pandemic strain, but most of the population under 65 had no protective immunity. Consequently, there was little selective pressure for the virus to change.

However, as more developed immunity from infections, more changes began to emerge. Position 225 in the receptor binding domain was of concern because the D225G change had been seen in 1918 H1N1 pandemic isolates from 1918 and 1919, and lab studies had demonstrated a change in receptor binding specificity to increased binding to gal 2,3 receptors which are found in the lower respiratory tract in humans.

Moreover, in the summer of 2009, which is the flu season in the southern hemisphere, D225G and D225N were found in autopsy lung samples from deceased patients in Sao Paulo, Brazil. In addition, the changes were found on additional backgrounds in China and Mexico, signaling movement of position 225 changes via recombination.

Position 225 was also of interest because the first evolutionarily fit isolate with H274Y was from a patient with D225E and an early swine isolate from Alberta had D225V, which indicated position 225 was the most hyper-variable position in swine H1N1.

Thus, where media reports described high numbers of fatalities with hemorrhagic presentations and rapid lung destruction, the presence of D225G and D225N was predicted. Sequences from Australia had just been released with D225G and D225N on additional genetic backgrounds, demonstration that these D225 changes were “in play”.

The release of Ukraine H1N1 sequences by Mill Hill confirmed the prediction for D225G, which was found in 4 of the 10 sequences. The six sequences without D225G were from an earlier isolate from Kiev, or nasal washes from 5 milder cases in western Ukraine. The four cases with D225G were from the same clade as the milder cases from western Ukraine, but isolates with D225G were from lung or throat samples from fatal cases. The Mill Hill sequences were followed by sequences by the CDC from two additional patients, which had D225N. The association of D225G and D225N with fatal cases was supported by additional autopsy lung sequences in Ukraine, Russia, and Moldova, raising concerns that increasing frequencies of D225G/N infections would lead to a higher frequency of serve and fatal cases.

This concern was increased by data from Mill Hill, which tested one of the Ukraine samples with D225G. It was designated a low reactor, indicating movement from the immune response generated by the vaccine or infection with wild type D225. Although the CDC failed to find this decreased activity in a sample with the same HA sequence, lab variation linked to difference in reference sera was not uncommon, and WHO recently proposed using reference sera from pooled serum samples from patients instead sera generated in ferrets.

However, the reduced titer reported by Mill Hill was consistent with the high frequency of D225G and D225N in fatal cases in Ukraine and Russia, as well as findings of D225G/N jumping from one genetic background in Ukraine and worldwide, including the Duke death cluster.

Thus, the failure of WHO to address these concerns and to ignore that compelling sequence data generated in January, raises serious concerns about the committee’s abilities to analyze data and anticipate changes in H1N1 antigenicity and associate effects on vaccine efficacy.

These failures continue to jeopardize the world’s health.

Bird flu recurs in northern, southern Vietnam​

http://www.thanhniennews.com/healthy/?catid=8&newsid=55222

The deadly virus was detected in a flock of 630 ducks belonging to a farmer in southern province of Soc Trang’s Thanh Thoi Thuan Commune after 500 of them died during the Tet (Lunar New Year) holiday, the Nhan Dan (People) said, citing the Animal Health Department.

The remaining ducklings in the flock were killed, the newspaper said.

None of the 45-day-old ducks had been vaccinated.

In the northern province of Nam Dinh’s Nghi An Commune, bird flu hit a seven-month-old flock that belonged to Mai Dang Viet’s family.

Provincial animal heath officials killed all 270 ducks in the flock in a bid contain the disease.

States on Bangladesh border at bird flu risk: Pawar​

http://www.thelatestnews.in/states-on-bangladesh-border-at-bird-flu-risk-pawar/32502.html

Bangladesh were particularly at risk of avian influenza or bird flu, Food and Agriculture Minister Sharad Pawar has said.

As long as Bangladesh remains in the grip of avian influenza, India will also be affected, Pawar told the Parliamentary Consultative Committee attached to his Ministry.

“Most of India’s neighbours are frequently affected by avian influenza and states sharing a common border with Bangladesh remain particularly at risk,” he informed the committee meeting here Wednesday.

The minister said India has offered assistance to neighbouring countries in testing samples and providing training to their technical manpower in diagnostic techniques.

“A beginning in this regard has been made and three scientists from Bangladesh received training at the high security Animal Disease Laboratory at Bhopal a few months ago,” Pawar said.

He added: “Avian influenza is a regional problem and requires a regional approach.”

Reiterating the central government’s determination to prevent avian influenza, the minister said a comprehensive programme of surveillance against the disease has been undertaken.

“Significant steps have been taken to upgrade the laboratory infrastructure,” he said.

H1N1 Low Reactors Raise Vaccine Selection Concerns​

http://www.recombinomics.com/News/02191003/H1N1_WHO_Vac_LR.html

Vaccines containing influenza A/California/7/2009 (H1N1)-like antigen stimulated anti-HA antibodies of similar geometric mean HI titres to the vaccine virus and a representative pandemic A(H1N1) 2009 isolate. For a small number of pandemic A(H1N1) 2009 virus showing reduced HI reactivity with postinfection ferret sera to A/California/7/2009. The geometric mean HI titres were lower than to the vaccine virus (average reductions: children, 65%; adolescents, 64%, young adults, 51%; the elderly, 56%).

Vaccines containing influenza A/Brisbane/10/2007 (H3N2)-like antigen stimulated anti-HA antibodies of similar geometric mean HI titres, that were lower to recent isolates than to the vaccine virus (average reductions: children, 67%; adolescents, 53%, young adults, 57%; the elderly, 66%).

The above comments from the WHO report on the selection of the 2010/2011 vaccine target describe data generated by low reactors, which are identied by ferret antisera directed against the pandemic H1N1 or the prior seasonal H3N2 target. Reductions in activity using sera from patients were similar in both cases. However, for H3N2 the target was changed, while for pandemic H1N1 it was not.

This difference was due in part to the frequency of detection of low reactors. For H3N2 the number of positives was small, but most were classified as low reactors. In contrast, for pandemic H1N1 number of low reactors was low, but this frequency was dependent on the reference anti-sera.

In the US, the latest CDC report cites two low reactors. It is likely that the two low reactors were A/South Carolina/18/2009 and A/Utah/20/2009, which have been characterized as low reactors. These isolates have four or five non-synonymous changes, including N159D, which is present in both sequences (as well as WSN/33) raising concerns that this change may present problems, like a recent report of severe H1N1 in a vaccinated patient in Wyoming. However, the number of sequences with N159D is low, so the effect on public health remains to be determined.

Of much greater concern are changes at position 225, most notabley D225G and D225N, which have been found on multiple genetic backgrounds and are associated with fatal cases. Moreover, D225E has been found at high frequencies in western Europe, which has raised concerns that similar increases in frequencies of D225G and D225N would produce a dramatic increase in frequencies of severe and fatal cases.

These concerns have been increased by antigenic characterization data by Mill Hill on one of the Ukraine isolates with D225G. It was classified as a low reactor, raising concerns that the low activity with the anti-sera directed against the California/7 target would signal selection for D225G. However the CDC failed to find four-fold reductions in titer when they tested an isolate with the same HA sequence, raising concerns that some assays would fail to detect the reductions seen by Mill Hill. WHO has acknowledged inter-lab differences, which are likely linked to use of different anti-sera, so a reference sera from pooled human collections has been created.

However, the data from Mill Hill coupled with increasing numbers of sequences with D225G and D225N, raised concerns because the vast majority of isolates were from fatal cases. Moreover these increases were from collections in 2009 and more recent sequences may have D225G/N with additional changes, leading to further reductions in titers.

The WHO report failed to directly address these low reactor examples, and concerns that the vaccine targets selected for 2010/2011 will produce limited activity against emerging sequences with D225G and D225N.

More information on the testing of samples with D225G and D225N would be useful.

Brebes, Central Java ::: Large outbreak in layer chicken farms​

http://birdflucorner.wordpress.com/...l-java-large-outbreak-in-layer-chicken-farms/

Brebes – About 11 thousands layer chickens in Dukuh Karang Bawang Desa Pakujati, Kabupaten Brebes found to have suddenly died. Investigation of local Livestock Service revealed the chickens had died of avian influenza (AI) or bird flu H5N1 infection.

Head of Livestock Service Kabupaten Brebes, through Head of Animal Health and Veterinary Public Health Division, Jhoni Murahman, said chicken deaths were found in six farms.

“We collected samples of three chickens from each farms and rapid test showed positive AI,” said Jhoni. “Based on our investigation the bird flu spreads through wild bird,” he said.

Desa Pakujati is one of bird flu endemic area. First bird flu case in Desa Pakujati was found in 2004 with total chicken death reached 36,000. “Chicken death has occurred since 15 Februari. It’s still continuing and rising,” said Jhoni.

In mean time investigation and control are still ongoing.

Source: Indonesia local newspaper, Suara Merdeka. http://suaramerdeka.com/v1/index.php/read/news/2010/02/19/47441/Flu-Burung-Sikat-11-Ribu-Ayam

Bird flu hits southernmost province​

http://english.vovnews.vn/Home/Bird-flu-hits-southernmost-province/20102/112798.vov

Since the beginning of the year, dozens of bird flu outbreaks have been detected in southernmost Ca Mau province despite constant efforts to eradicate the disease.

Provincial authorities have introduced a number of measures to stop the spread of the disease from seven communes in three districts.

Bird flu-infected communes include Khanh Hung, Tran Hoi, Song Doc, Tran Van Thoi, Tan Phu, Tan Loc Bac and An Xuyen. So far, more than 5,000 head of poultry have been culled.

H1N1 G158E Low Reactors In Germany Raise Vaccine Concerns
​

http://www.recombinomics.com/News/02211001/H1N1_Germany_G158E.html

Sequence analysis of pandemic A(H1N1)2009 viruses indicated that they were genetically homogeneous. A small number of viruses showed reductions in their reactivity with some ferret antisera (raised against a panel of representative viruses including the vaccine virus) in HI assays.

The above comments from the WHO report on the selection of 2010/2011 targets acknowledge the detection of low reactors. Low reactors have been a concern because the vaccine target, A/California/7/2009, has a number of amino acid differences with the vaccine target. The original isolate was a mixture and most or all killed vaccine targets use X-181A, which has 5 differences with the H1N1 consensus sequence.

Recently the CDC and Mill Hill released sequences at GISAID from Germany that were designated as low reactors, indicating that the titers against these isolates were at least four fold lower than the vaccine target. One isolate, A/Bayern/69/2009 was sequenced by the CDC. The HA sequence only had one change, G158E. Similarly, Mill Hill released another sequence from Bayern, A/Bayern/62/2009, which was also designated a low reactor and also had the same one change. The finding of isolates with a single HA change which created a low reactor designation is cause for concern. This change is adjacent to N159D, which has been reported in low reactors in the United States.

Currently, the number of publicly reported sequences is limited because in the early wave(s) most humans do not have antibodies, and the pressure for H1N1 genetic change is limited. However, as more develop immunity to the wild type sequences, there will be more pressure for variants to escape the immune response. Such isolates are designated as low reactors.

Mill Hill also identified one of the isolates from a fatal Ukraine case as a low reactor, and it only had a single amnio acid change, which was D225G. This change is strongly linked to fatal cases and there is concern that its designation as a low reactor will drive the frequency higher.

This concern was increased by additional recent isolates which had G158E and D225G. Such sequences have been found in Russia, A/Salekhard/01/2009 and Italy, A/Roma/ISS1941/2009 . The Russian isolate was from a fatal case.

These combinations of changes linked to low reactor status are generated by recombination, and the linkage of two low reactor polymorphisms in the same virus increases concerns that the H1N1 evolution will outpace vaccine targets. These concerns were increased markedly by the WHO vaccine target for 2010/2011, which allows for usage of existing targets which do not have D225G or G158E.

H1N1 G158E and D225G Low Reactors Recombine in Russia
​

http://www.recombinomics.com/News/02221001/H1N1_Russia_G158E_D225G.html

Sequence analysis of pandemic A(H1N1)2009 viruses indicated that they were genetically homogeneous. A small number of viruses showed reductions in their reactivity with some ferret antisera (raised against a panel of representative viruses including the vaccine virus) in HI assays.

The above comments from the WHO report on the selection of 2010/2011 vaccine targets acknowledge the detection of low reactors but provide little detail. Recently released sequences at GISAID by the CDC and Mill Hill provide some specifics. Both detail isolates from Germany that have N158E as the only non-synonymous HA change, and both isolates are designated as low reactors. The linkage of low reactor status to a single nucleotide change raises concerns that such low reactors will become increasingly common, as the human target population develops more immunity to H1N1. Mill Hill has also reported that another single nucleotide change, which produces D225G, also generates a low reactor designation.

The linkage of immunological escape to these small changes also allows for combining these designators by recombination, which has happened in Russia. The recently released sequence, A/Salekhard/01/2009, from lung tissue has both low reactor polymorphisms, N158E and D225G. Since each of these changes lowers the titer by at least four fold, the combination may produce an additive effect which reduces the titer by at least 16 fold, which would require titers of 640 against the wild type sequence to produce borderline protection offered by a titer of 40 to sequences with both polymorphisms. Thus, the additive effect would lead to widespread vaccine failure.

The presence of sequences (also seen in Italy) with both changes, would raise serious questions about the WHO decision to leave the vaccine target unchanged through 2011, when low reactors with both changes were identified in 2009, well in advance of the selection committee meeting.

California/7 was a controversial original selection because it was a mixture and not well represented in subsequent sequences. The current vaccine target, X-181A, has five amino acid differences with the consensus sequence, setting the stage for rapid progression to a low reactor status.

The combination of two low reactor polymorphism, N158E and D225G in the same HA sequence is cause for concern.

H1N1 G158E and D225G Low Reactors Recombine in Italy
​

http://www.recombinomics.com/News/02221002/H1N1_Italy_G158E_D225G.html

Sequence analysis of pandemic A(H1N1)2009 viruses indicated that they were genetically homogeneous. A small number of viruses showed reductions in their reactivity with some ferret antisera (raised against a panel of representative viruses including the vaccine virus) in HI assays.

The above comments from the WHO report on the selection of 2010/2011 targets acknowledge the detection of low reactors but provide little detail. Recently released sequences at GISAID by the CDC and Mill Hill identify a series of low reactors which include changes at three consecutive positions (157-159). In each case the wild type amino acid is replaced with an acidic amino acid (K157E, G158E, N159D) raising concerns that a single nucleotide change at any one of three positions in this region creates a low reactor. Those concerns are increased by reports that a single nucleotide change in the receptor binding domain creates D225G, which has also been designated a low reactor.

Moreover, recombination allows for these two changes to combine and produce a sequence with two low reactor changes. This has been described for a sequence from Russia, which is in the same clade as the sequences from Ukraine with D225G/N. Thus, A/Salekhard/01/2009, has both G158E and D225G.

A similar scenario has evolved in Italy. One sequence, A/Roma/ISS1941/2009, had C940T as well as T717A, which are frequently found together in D225E sequences. However, the sequence then acquired G715A, converting the D225E to D225G. Now that converted sequence has acquired G158E, creating a new sequence with two polymorphisms linked to low reactors, and in both cases low reactors have been reported with only G158E or D225G. However, this combination is on a genetic background that is distinct from the Russian subclade. Thus, G158E has paired up with D225G on a background frequently found in eastern Europe, as well as D225G on a background frequently found in western Europe.

This jumping of critical polymorphisms from background to background via recombination creates opportunities for dramatic increases in genetic drift away from the vaccine target.

The recent WHO decision to leave the H1N1 vaccine target unchanged, even though low reactors with G158E and D225G have been reported raises serious doubts about WHO’s expert’s ability to understand how H1N1 evolves, and how that evolution can rapidly destroy the efficacy of the vaccine recommended for the 2010/2011 season.

This falure to understand influenza evolution at the most basic level, continues to be hazardous to the world's health.

...................

thank you very much for keeping up on this. Too tired right now to understand it all, and after the coming 14 hours of work I'll be tired tonight too, lol,


but it may not be over yet.


ds

...................

dupe

Khanh Hoa girl is first bird flu patient of the year​

http://www.thanhniennews.com/healthy/?catid=8&newsid=55254

A three-year-old girl in the central province of Khanh Hoa has tested positive for H5N1, becoming the country’s first bird flu patient this year, the Ministry of Health reported in Hanoi on Monday.

The girl, who lives in Ninh Hoa District’s Ninh Than Commune, fell sick with fever, sore throat, cough and a runny nose on January 27.

She was admitted to Ninh Hoa Hospital the next day and was confirmed to be infected with the virus on February 12, according to the ministry.

The girl was recovering, it said.

An inspection conducted in Ninh Than showed no sign of the avian flu in the commune, and the poultry raised by the girl’s family showed no signs of sickness.

However, the ministry’s inspectors found that about a month earlier, ostriches had died of unclear reason sat a farm a kilometer away from the patient’s home.

According to the ministry, 112 people had been infected by H5N1 since 2003, and 57 have died.

Also on Monday, the ministry reported that the total number of emergency cases related to daily life accidents admitted to hospitals nationwide had doubled from the previous year during the six-day Tet holiday starting February 13.

The death toll in traffic accidents during the holiday increased 29 percent year-on-year, while fatalities from fights were 3.4 times higher than the year before, the ministry said.

Food poisoning cases also increased by 70 percent over more than 1,100 recorded during last year’s holiday, the ministry said.

H1N1 Low Reactor Recombinants Raise Pandemic Concerns
​

http://www.recombinomics.com/News/02231001/H1N1_LR_Recom.html

Of interest, all the escape mutant viruses generated with either 1918- or 2009 HA-specific mAbs carried mutations in the antigenic site Sa (Table 5; Fig. 5). The escape mutants that arose in the presence of the 1918 specific mAb 6B9 and 39E4 contained mutations G172E (G158E by H3 numbering) and K171E (K157E by H3 numbering), respectively. The escape mutants generated by selection with the 2009 H1N1 specific mAb (29E3) carried either a K171E or K171Q or K180N mutation (residues K171 and K180 correspond to K157 and K166 in H3 numbering). These results indicate that all the mAbs bind to the conserved antigenic site Sa

The above comments are from the PLOS paper, Protection of Mice against Lethal Challenge with 2009 H1N1 Influenza A Virus by 1918-Like and Classical Swine H1N1 Based Vaccines, and describe changes found in escape mutants when exposed to monoclonal antibodies directed against the 1918 pandemic H1N1 or 2009 pandemic H1N1. All three changes map to the same antigenic site, and two, K157E and G158E, match changes found in low reactors. Moreover, in lethal challenge experiments, involving A/Netherlands/602/2009, anti-sera against pandemic H1N1 or seasonal H1N1 circulating in the 1930’s and 1940’s was more protective than anti-sera directed against A/California/7/2009, highlighting concerns that the 5 amino acid differences between California/7 and the H1N1 consensus sequences reduces the effectiveness of the vaccine against most circulating H1N1, and a minimal number of additional changes can produce low reactors, which generate titers that are at least 4 fold lower than the target sequence.

G158E is found in two German isolates with a low reactor status as detemined by the CDC and Mill Hill. Although the isolates are easily distinguished at the nucleotide level, both have only one change at the protein level, G158E. Thus, one nucleotide change can push the target into the low reactor category. This change has been of particular concern, because of sequences in Russia and Italy which had G158E and D225G. D225G represents another single nucleotide change that creates a low reactor. These two polymorphisms can merge into the same sequence via recombination, and the identification of two isolates with G158E and D225G on two distinct genetic backgrounds indicates both polymorphisms are jumping from background to background via recombination.

The recent recommendation of a California/7-like target for the 2010/2011 season, and additional comments that the existing anti-sera against X-181A will be used in vaccinations throughout 2010, raises concerns that frequent drift away from the current vaccine target will quickly compromise the efficacy of the vaccine.

Thus, the selection of California/7, and plans to use stockpiles of X-181A, continues to raise serious questions about the vaccine selection process.

Bhutan

Bird Flu Outbreak in Rinchending, Phuentsholing​

http://www.moa.gov.bt/moa/news/news_detail.php?id=1024

The Ministry of Agriculture and Forest would like to inform the public an HSN1 Birdflu (Avian Flu) outbreak has been declared in Rinchending (Kharbandi), Phuentsholing under Chukha Dzongkhag by the National Incident Common Centre on 23rd February 2010. The source of the infection is believed to be from the Pasakha area.

However, the Ministry has asked the public not be alarmed because the incidence is fully under control and the required control measures are already in place. The Ministry will be providing regular updates to the general public on the new outbreak of HPA1 through various media including this website www.moa.gov.bt. As such, the general public has been asked to kindly extend full support and cooperation the implementation of HPA1 control activities.

hard to understand the medical terms

without being an expert, but what I am gathering from the debate regarding the vaccine for 2010/2011 is that they are choosing to use the original California/7 which was a mixture of H1N1 (that has 5 amino acid differences than the the H1N1 consensus sequences) and stockpiles of X-181A, instead of what? I don't understand what the author is suggesting they do instead? Does "H1N1 consensus sequences" mean the actual experience, the actual sequences, they have seen in the virus that circulated? What is "low reactor" in reference to? Is it in reference to the effectiveness of the vaccine to target the evolving virus?

So, am I right in understanding his concern is that the virus has evolved and that it is debatable the original mixture used to target the virus in the last season, wasn't effective because of the differences in amino acids, and certainly did not target the recombinations that were occuring in the more fatal cases. His concern is that the target vaccine for the next season should consider the ineffectiveness of California/7 to the actual sequences that were found and that the virus is showing it can recombine easily, producing now known changes that aren't being considered in the target vaccine either?

Man that was awkward to get out. Basically, the vaccine didn't work well last year and keeping it pretty much the same while knowing that the virus has evolved further, (or our understanding of the virus has evolved further, seeing how some of these markers were present in the past epidemics), makes the target vaccine for this next season pretty much useless? Right?

Can't have all those millions of vaccines

not being paid for...

Panel recommends annual flu vaccinations for all
MIKE STOBBE
From Associated Press
February 24, 2010 11:52 PM EST

ATLANTA (AP) — A government panel is now recommending that virtually all Americans get a flu shot each year, starting this fall.

The Advisory Committee on Immunization Practices had gradually been expanding its recommendation for flu shots — 85 percent of Americans were already included.

On Wednesday, the panel voted to recommend a seasonal flu vaccination for everyone except babies younger than 6 months and those with egg allergies or other unusual conditions.

The panel's recommendation now goes to the Centers for Disease Control and Prevention. The CDC usually follows the panel's advice and spreads the message to doctors and hospitals across the country.

"Now no one should say 'Should I or shouldn't I?'" said Dr. Anthony Fiore, a CDC flu specialist.

CDC vaccination recommendations tend to be influential with the doctors who give the shots and the health insurers who pay for them.

Flu shots are already recommended for 85 percent of the U.S. public, including pregnant women, children older than 6 months, adults 50 and older, people with certain chronic health conditions, health care workers and those who take care of people in a recommended group. The only people who weren't specifically included were healthy people ages 19 to 49 who don't have close contact with anyone at risk of flu and its complications.

But only about 33 percent of Americans actually get a flu shot, and unusually millions and millions of doses get thrown away annually.

The swine flu pandemic that hit last year caused a new momentum for flu vaccinations. Virtually all the 114 million doses of seasonal flu vaccine doses made were distributed, and more young adults and children got the swine flu vaccine than usually come out for seasonal flu.

The panel voted 11 to 0 — with one abstention — for the recommendation, prompting a short round of applause in the CDC auditorium where the meeting was held. Some public health experts and physicians had been pushing for a universal flu vaccination recommendation for more than 10 years.

Also on Wednesday, the panel gave its nod to a proposed formulation of next year's seasonal flu vaccine. The vaccine will be built to protect against three strains of flu scientists think will be circulating next fall and winter. Swine flu is to be one of the strains incorporated into the vaccine.

At past meetings, the panel stopped short of recommending flu shots for everyone. Panel members were mindful of a history of temporary flu vaccine shortages in the United States. They worried a universal recommendation might cause demand to far surpass supply and endanger those at the highest risk of life-threatening flu complications.

"Yet every year we wasted millions and millions of doses," said Dr. Gregory Poland, a Mayo Clinic infectious diseases expert who for years has passionately pushed the panel to recommend flu shots for all.

The swine flu vaccine campaign appears to be ending the same way. Doses were scarce when the swine flu vaccine first became available in early October, but now roughly 90 million people have been vaccinated, demand is dying and millions of doses are unused.

Swine flu provided another argument for universal vaccination. The new virus proved to be unusually dangerous to young adults, and also took a surprising toll on Native Americans and obese people. Many of those hospitalized and killed by swine flu were not in groups previously recommended for annual flu shots, and that fact was another reason to expand the vaccination recommendation, experts said.

There are a few exceptions to the universal recommendation. Children under 6 months of age, who have undeveloped immune systems, will continue to be exempt. So too will people who have egg allergies (the vaccine is made using eggs) and those who have had certain severe reactions to flu shots in the past.

The panel also decided that elderly people can consider a new, revved-up version of the seasonal flu shot. It's a Sanofi Pasteur vaccine for adults 65 and older.

In years when the flu shot is well matched to circulating flu viruses, vaccine is 70 to 90 percent effective in people younger than 65, the CDC estimates. But it tends to be only 30 to 70 percent effective in those who are older because they generally have weakened immune systems.

The Sanofi vaccine — called Fluzone High-Dose — has four times as much immunity-building antibodies as a standard dose. The U.S. Food and Drug Administration approved the vaccine in December, and it should be available for the 2010-2011 flu season. It would cost about $25 a shot, or about twice the standard version.

The panel did not state a preference for the vaccine, however. The U.S. Food and Drug Administration approved the vaccine through an accelerated process, and Sanofi is to do further studies to show the shot reduces flu illnesses.

___

On the Net:

ACIP: http://www.cdc.gov/vaccines/recs/acip/default.htm

Click to expand...

More Signals On H1N1 Wave 3 Start in United States​

http://www.recombinomics.com/News/02251001/H1N1_Wave3_Signals.html

Some of the nation's emergency departments are noting increases in flu-like illness cases that appear to be pandemic H1N1, and colleges are reporting the first increase in flu-like illness since the end of November, but it's not clear if these are early signs of a third pandemic flu wave.

The American College of Emergency Physicians (ACEP) said today in a Twitter post that some of its members were anecdotally reporting a new wave of pandemic H1N1 patients coming to emergency departments and asked if other physicians were seeing similar patterns.

Carl Schultz, MD, professor of emergency medicine at the University of California at Irvine, told CIDRAP News that the increase in the number of influenza-like illnesses appears to be real, but he cautioned that many of the cases have not been confirmed as the pandemic H1N1 strain, because many departments stopped specifically testing for it because of low flu activity. Schultz chairs ACEP's disaster preparedness and response committee.

The above comments provide additional data that a third wave in the United States has begun. Reports on flu at universities has increased 52% over last week, which is supported by anecdotal reports from emergency room physicians. The largest number of new student cases was again in North Carolina.

These developments parallel the start of the fall wave. The initial cases were in region 4 and this area has had the highest percent of samples being H1N1 positive. Similarly, state reports showed recent increases in North Carolina and Alabama, while earlier reports describe more severe cases in hospitals in Tennessee and North Carolina.

The initial reports from region 4 may signal the emergence of a more evolved H1N1 since the time between the current outbreak and cases reported in the fall would be greatest. A recent report on Allegheny County, location of metropolitan Pittsburgh found H1N1 antibody in 45% of patients age 10-17. If this population is again being targeted, it is likely that there are re-infections and the new virus has escaped the immune response generated against the fall wave.

Recently released sequences from low reactors indicated that a single nucleotide change could move a sequence into the low reactor category, and recombination was creating new sequences with multiple low reactor polymorphisms, which if additive would lead to widespread vaccine failure and frequent infections of patients infected last year.

Sequence data on new cases, including severe and fatal cases would be useful, as would H1N1 history of these new patients.

Bird flu kills hundreds of Lampung chickens​

http://balita.ph/2010/02/25/bird-flu-kills-hundreds-of-lampung-chickens/

KOTA METRO, Lampung, Feb. 25 — Hundreds of chickens in Kota Metro, Lampung Province, suddenly died this week, causing local chicken breeders to suffer material losses.

Suyadi, 31-year-old local chicken breeder, said here Wednesday that he did not know the exact causes of his chickens' sudden death but he suspected the bird flu viruses of being the killers.

"I firstly found that a few chickens suddenly died but the number got increased dramatically from day to day. I have lost a few hundreds," said the East Metro subdistrict`s resident.

Suyadi said the local agricultural office`s workers had given disinfectant to his chicken cages but he failed to keep them clean during the rainy season.

As a result, his chickens remained vulnerable to the attacks of dangerous diseases, he said.

Jaelani said hundreds of his chickens also suffered sudden death during this rainy season.

The 40-year-old chicken breeder of North Metro subdistrict said the bird flu viruses might have caused the death of his 200 – 300 chickens.

Therefore, he urged local veterinarians and other related authorities to take immediate actions to halt the spread of bird flu viruses and conduct the awareness campaigns.

"The awareness campaign is needed because not all people here have well understood about the dangers of bird flu viruses and how to handle them," he said.

Jaelani said not all people had known what to do when the viruses attacked their chickens.

During the rainy season, the avian influenza has not only infected chickens in Lampung but also those in other provinces, including South Kalimantan and West Java.

The infected regencies in South Kalimantan were Tanah Laut, Banjar, Barito Kuala Hulu Sungai Tengah and Banjarbaru, causing thousands of chickens to eliminated to curb the virus spread.

About the sort of bird flu attacking Indonesia, a veterinarian in West Java town of Garut said on Tuesday that it was classified as "highly pathogenic avian influenza" (HPAI).

In the West Java district of Garut alone, there were at least 75 cases of HPAI between 2006 and 2010 in which more than 2,893 chickens suddenly died, Dida K.Endang said.

The attacks in 48 villages of Garut district over the past four years had sparked fears of human infection, said the head of Garut`s veterinary office recently.

To protect local residents from the worst possibilities, a total of 7,000 infected chickens were culled.

Local authorities paid the owners a compensation of Rp12,500 (US$ 1,4) for every culled chicken, Endang said.

However, not all people voluntarily gave their ailing chickens for culling.

Instead of burning the infected chickens, many Garut residents throw them into rivers, creeks, or ponds. Worse still, some even consumed the infected chickens, he said.

According to the World Health Organization (WHO), avian influenza or "bird flu" is a contagious disease of animals caused by a virus that normally infect only birds and, less commonly, pigs.

The WHO has warned that the infection with avian influenza could spread very rapidly through poultry flocks.

Indonesia has 33 provinces. Only three have been confirmed free from the threat of bird flu.

Indonesia has been dealing with bird flu since 2005. However, the H5N1 type of influenza is also known to have attacked chickens and birds in other Asian countries, such as Thailand, Cambodia, China, and Vietnam. (PNA/Antara)

2 more birds tested positive for flu ​

http://www.southasianmedia.net/index_story.cfm?id=639035&category=Frontend&Country=BHUTAN

THIMPHU: Two more birds were tested positive in Pasakha yesterday. This has led to culling of another 51 chicken in Pasakha. The operation was conducted in the vicinity of Pasakha town and the colony of Bhutan Chemicals and Carbide Limited. The two affected areas of Rinchending and Pasakha are under strict vigilance. Movement of both people and poultry is being controlled by Bhutan Agriculture and Food Regulatory Authority (BAFRA).

In the meantime, a group of health experts are monitoring the health of the people in the affected areas. To further control the spread of the virus, people are requested to report to the nearest livestock or BAFRA office incase of contacts with dead birds.

Scientists easily create hybrid virus​

http://www.fiercevaccines.com/story/scientists-easily-create-hybrid-virus/2010-02-25

A simple, single gene swap was all it took to create a hybrid bird and swine flu virus, according to an international team of scientists. Dr. Yoshihiro Kawaoka, professor of pathobiological sciences in the School of Veterinary Medicine at the University of Wisconsin-Madison, says that the prospect of a bird/swine flu virus--which would be much more lethal than the current pandemic--makes it essential for close global monitoring of new outbreaks. Report

Read more: http://www.fiercevaccines.com/story/scientists-easily-create-hybrid-virus/2010-02-25#ixzz0gZBxDezV

willdo said:

Man that was awkward to get out. Basically, the vaccine didn't work well last year and keeping it pretty much the same while knowing that the virus has evolved further, (or our understanding of the virus has evolved further, seeing how some of these markers were present in the past epidemics), makes the target vaccine for this next season pretty much useless? Right?

Click to expand...

I'm not an expert either, just studying pandemic stuff as much as I can, and I think that's correct.

Makes you wonder about the motives of the WHO and the CDC.

High School Absenteeism Linked To H1N1 Wave 3 Start
​

http://www.recombinomics.com/News/02251002/H1N1_Wave3_HS.html

Blood tests on Pittsburgh residents found 45 percent of people aged 10 to 19 years had antibodies against the new H1N1 flu strain. About 22 percent of people across all groups developed immunity to the virus by early December and a quarter of those born in the 1920s may have already had protective antibodies before the pandemic resulting from prior flu infection, researchers at the University of Pittsburgh found.

The above comments on H1N1 antibody frequencies in Allegheny County indicate that H1N1 rapidly spread through the Pittsburgh, Pennsylvania metropolitan area last fall, especially among school aged children, aged 10-19. Although there were few school closures or deaths a few schools were highlighted in media reports and in one middle school daily absenteeism rates were between 19-29% for at least 9 days, suggesting attack rates approached 100% since many who were affected did not develop a high fever and were not absent.

Other areas reported closures of entire school districts suggesting these high levels were present nationwide during the fall peak in activity. That peak began with school opening in August for many areas of region 4, and recent reports suggest a new wave may have begun there which has now started to spread nationwide. Although media reports had announced the end of the pandemic and some politicians questioned whether there was a pandemic, prior pandemics had a fall and winter wave and eliminated the seasonal flu that had been circulating.

Pandemic H1N1 has eliminated seasonal influenza A, which sets the stage for a new wave, which may be beginning. The fall wave was generated because most of the target population had no existing immunity to the new H1N1 and the development of immunity led to the end of the fall wave. However, low reactors have been identified pointing toward the emergence of a new wave with H1N1 that avoids the immunity generated against the H1N1 circulating in the fall.

One of the low reactors, D225G, was tightly linked to fatal cases in the fall, and recent sequences from Italy and Russia pairs that change up with another low reactor change, G158E, raising concerns that such recombinants can evade the existing immunity and generate cases which are more severe and fatal.

Recent reports in Tennessee and North Carolina have described patients with a higher frequency of ICU admissions and deaths and recent increases in other states in Region 4 raise concerns that these trends could spread. A 52% rise in weekly cases in colleges has been reported and the highest number was in North Carolina. Moreover, junior high schools are now reporting double digit absenteeism in Washington state. These increases in populations that were targeted in the fall raise additional concerns regarding the emergence of variants that have escaped the immunity generated last fall.

Sequence data on the emerging H1N1 would be useful.

Antigenic and genetic characteristics of influenza
A(H5N1) and influenza A(H9N2) viruses and candidate
vaccine viruses developed for potential use in human
vaccines​

http://www.who.int/csr/disease/avian_influenza/guidelines/h5n1virus/en/index.html

February 2010

This summary provides a review on the influenza A(H5N1) and A(H9N2) virus activity and virus characterization, and describes the current status of the development of new A(H5N1) and A(H9N2) candidate vaccine viruses. It is meant to provide guidance for national authorities and vaccine companies on the selection of candidate viruses for use in vaccine development.

Full text - February 2010 [pdf 318kb]

Novel inhaled drug found effective against H5N1 avian influenza virus​

http://sify.com/news/novel-inhaled-...nza-virus-news-international-kc0pkdiehfg.html

Researchers have found a novel compound highly effective against the pathogenic H5N1 avian influenza virus, including some drug-resistant strains.

The work by a University of Wisconsin-Madison virologist has been published in the Public Library of Science journal PLoS Pathogens.

The study suggests that the compound CS-8958 is a promising alternative antiviral for prevention and treatment of bird flu.

Antiviral drugs are a primary countermeasure against human influenza viruses, including the highly pathogenic H5N1 avian influenza virus, which causes bird flu. Emerging strains resistant to existing drugs, particularly oseltamivir (Tamiflu), pose a threat and make the development of alternate antivirals a pressing public health issue, says Yoshihiro Kawaoka, a professor of pathobiological sciences at the UW-Madison School of Veterinary Medicine and senior author of the new study.

Kawaoka and a group of researchers from Japan, Vietnam, and Indonesia tested a novel neuraminidase inhibitor R-125489 and its prodrug CS-8958, which had previously shown potent activity against seasonal influenza viruses in laboratory animals. orking with mice, the researchers found that a single intranasal dose of CS-8958 given two hours after infection with H5N1 influenza virus resulted in a higher survival rate and lower virus levels than a standard five-day course of oseltamivir. CS-8958 was also effective against highly pathogenic and oseltamivir-resistant strains of H5N1 virus.

In addition to its therapeutic use, CS-8958 also protected mice against lethal H5N1 infection when given seven days before infection with the virus.

"This compound requires only a single administration for both treatment and prophylaxis. Such prophylaxis would be highly desirable for seasonal influenza as well as a potential pandemic ituation," says Kawaoka. (ANI)

Link to next weeks thread:

2/27-3/5/10 Bird, Other Flu Weekly Thread:Widespread Tamiflu Resistance in Japan

http://www.timebomb2000.com/vb/showthread.php?t=355845