Influenza Virus Mashup

Via Lusaka Times.com: Swine flu breaksout at Chipembi Girls. Excerpt:

Swine flu has broken out at Chipembi Girls’ High School in Chibombo district. 

Chibombo district Commissioner (DC) Colonel Philip Chabakale and the Provincial Education Officer Paul Ngoma confirmed the outbreak in separate interviews today. 

Mr. Ngoma could however, not confirm the number of reported cases and give further details as he had not yet received the report from Chipembi Girls High School administration. 

But Col. Chabakale revealed that 66 cases involving pupils were reported following complaints by a cross section of pupils at the institution of similar nature that included headache, flu, and sore throats among others. 

Col. Chabakale said that the 66 pupils were screened at Chipembi Health Center and all of them had signs and symptoms of swine flu. 

He further confirmed that the 21 samples that were taken for examination at the university Teaching Hospital (UTH) came out positive.

(Wed, 25 Nov 2009 03:09:00 +0000)

 

 

# 4075

 

 

Helen Branswell, medical and science correspondent for the Canadian Press, tracks down what is known about the suspect batch of GSK vaccine which has been pulled from use in Canada due to excess allergic reactions, and answers some questions about anaphylaxis.

 

For my American readers, THIS RECALL DOES NOT APPLY TO U.S. VACCINES. 

 

While answers about this batch of vaccine are still in short supply, Ms. Branswell asks and answers a number of general questions about anaphylaxis and vaccines.    

 

As with any Branswell article, this is well worth reading.

 

 

GSK says still no answer on whether H1N1 vaccine batch triggers more reaction

By Helen Branswell Medical Reporter (CP)

TORONTO — The investigation into whether a batch of H1N1 vaccine may have triggered a higher-than-normal rate of allergic reactions hasn’t yet come up with answers, vaccine manufacturer GlaxoSmithKline said Tuesday.

 

And health officials in Quebec said they are still trying to determine if the death of an elderly man who died of anaphylaxis after receiving a pandemic flu shot was triggered or hastened by the vaccination.

 

“Investigations being undertaken by GSK, Health Canada and the Public Health Agency of Canada (PHAC) have not yet been completed,” GSK spokesperson Megan Spoore said in an email about the pulled batch of vaccine.

(Continue . . . )

(Tue, 24 Nov 2009 20:54:00 +0000)

 

 

# 4074

 

It comes as no surprise that a certain percentage of people who are exposed to the pandemic flu virus go on to develop antibodies without experiencing clinical symptoms. 

 

With seasonal flu, it is expected that anywhere from 1/3rd to 1/2 of people exposed, never fall ill.

 

But when a new virus appears, until serology tests can be conducted, we don’t have a good handle on what percentage might remain asymptomatic.

 

 

Earlier this months I reported on New Zealand’s plans to test the blood of 2,500 people (see New Zealand To Conduct Seroprevalence Studies) to try to determine the actual rate of infection over the summer.  Other countries are doing so, as well.

Today we learn of a relatively small study, conducted in the UK, of school aged children to determine how many have elevated antibody titers to the novel H1N1 virus.  

 

The results are encouraging, in that a substantial percentage (about 1/3rd) of the children tested show antibodies to the virus, while only about 1 in 10 reported flu symptoms.   

 

This report from the BBC.

 

 

More children ‘than expected have had swine flu’

 

By Nick Triggle
Health reporter, BBC News

Up to a third of children in some areas may have had swine flu, but many will not have been ill, analysis shows.

The Health Protection Agency has reviewed blood tests which showed higher levels of infection among children than originally thought.

 

In hotspot areas, such as London and the West Midlands, a third of school-aged children may have had the virus, but only one in 10 or less got ill.

 

Across the UK, the figure is probably about a fifth, the HPA said.

 

The findings reinforce the fact the pandemic is a mild strain of flu.

 

Flu, whether it is seasonal or swine, always affects more people than actually get ill.

 

The ratio is normally about 50-50 and pandemic flu is probably not much different, the HPA said.

 

(Continue . . . ) 

 

Fergus Walsh, medical correspondent for the BBC, who writes the Fergus on Flu blog, has more at:

 

Up to a third of children in some areas have been infected

Fergus Walsh | 16:54 UK time, Tuesday, 24 November 2009

(Tue, 24 Nov 2009 19:41:00 +0000)

 

 

# 4073

 

Vincent Racaniello – who is a Professor of Microbiology at Columbia University Medical Center - gives us a virology lesson today on the much discussed H1N1 mutations announced in Norway last week.

 

He argues that the  change – an amino acid substitution (D225G) –impairs the `fitness’ of the virus to transmit to other hosts, and therefore isn’t as big of threat as some have suggested.

 

Since I am woefully out of my league here (despite listening to his excellent podcasts each week on TWiV), I’ll simply step aside and direct you to his informative blog entry.  

 

 

The D225G change in 2009 H1N1 influenza virus is not a concern

by Vincent Racaniello  on 24 November 2009

 

(Tue, 24 Nov 2009 14:15:00 +0000)

 

# 4072

 

 

Yesterday one of my readers left this question in the comments section of ECDC On Norway Mutation & Tamiflu Resistance. 

 

h1n1_watcher said…

regarding the concern about mutations there is one thing I don’t understand: If influenza viruses are constantly changing by genetic drift anyway, then why has this never led to a more dangerous form of the seasonal influenza during all those years and decades of constant genetic drift. i.e. ongoing mutation ?

The pathogenicity/CFR or virulence of seasonal influenza seems to be almost exactly the same every year for decades despite the fact that the virus is constantly mutating.

 

Why is this so ? and why is a pandemic virus supposed to be more prone to “dangerous” mutations than the seasonal ones ?

As far as I know the mutation (drift) rates are similar for both seasonal and pandemic viruses. Yet is has never been observed that a seasonal influenza virus has mutated to a more deadlier form. (Usually, the only consequence of the mutations is that we have to update our vaccines accordingly …)

h1n1_Watcher has posed some intriguing questions, and while I don’t have all of the answers, I’d like to take a stab at part of it.

 

While several points are raised, the recurring central issue is:

 

If influenza viruses are constantly changing by genetic drift anyway, then why has this never led to a more dangerous form of the seasonal influenza during all those years and decades of constant genetic drift. i.e. ongoing mutation ?

 

The problem here is, I don’t think we can make this assumption.

 

There have been great variations documented in the virulence (and transmissibility) of seasonal influenza viruses from one year to the next. 

 

The CDC statement that influenza kills 36,000 Americans every year is a bit misleading, because the death toll between 1990 and 1999 from which that estimate arose was calculated to range from a low of 17,000 to a high of 52,000.

 

And none of those were `pandemic years’.

 

Some of this variation can be attributed to years when the more virulent H3N2 virus was the dominant strain, as opposed to the milder H1 strain, but we’ve seen year-to-year variations in the virulence of the same seasonal virus.

 

I’m going to be drawing a good deal of material from an absolutely fascinating EID Journal article: Viboud C, Tam T, Fleming D, Miller MA, Simonsen L. 1951 influenza epidemic, England and Wales, Canada, and the United States.

 

 

Abstract (Excerpt)

 

Influenza is responsible for large increases in deaths in pandemic seasons when emerging viral subtypes with novel surface antigens become predominant, and also in some interpandemic seasons, when established subtypes exhibit antigenic drift (1).

 

The circulating viral subtype is associated with varying severity of influenza epidemics (2): in the last 2 decades in the United States, estimated excess death rates were on average 2.8-fold higher in A/H3N2-dominated seasons than in A/H1N1 and B seasons (3).

 

Within a given subtype, however, the strain-specific determinants of epidemic severity are still poorly understood. For instance in the United States in the same period, excess death rates varied nearly 4-fold among A/H3N2 seasons, even after adjustments for population aging (3). 

 

So, even over the past quarter century, we’ve seen major differences in the virulence of the same seasonal flu strain.

 

The most telling example, however, came in 1950-51.

 

The no-name epidemic of 1951 was one that, for a few weeks - mostly in England and Canada- proved to be deadlier than the 1918 Spanish Flu. 

 

For most of the world, 1951 remained an average flu year.  The dominate strain of influenza that year was the so-called `Scandinavian strain’, which produced mild illness in most of its victims.

 

In fact, if you look at the graph for the United States, running from 1945 to 1956, you’ll see nary a blip.

 

 

But in December of 1950 a new strain of virulent influenza appeared in Liverpool, England, and by the end of the flu season, had spread across much of England, Wales, and Canada.

 

Again, from the EID Study.

The 1951 influenza epidemic (A/H1N1) caused an unusually high death toll in England; in particular, weekly deaths in Liverpool even surpassed those of the 1918 pandemic. . . . . Why this epidemic was so severe in some areas but not others remains unknown and highlights major gaps in our understanding of interpandemic influenza.

 

According to this study, the effects on the city of origin, Liverpool, were horrendous.

 

 

In Liverpool, where the epidemic was said to originate, it was “the cause of the highest weekly death toll, apart from aerial bombardment, in the city’s vital statistics records, since the great cholera epidemic of 1849” (5). This weekly death toll even surpassed that of the 1918 influenza pandemic (Figure 1)

 

 

This extraordinary graph shows the excess deaths in Liverpool during this outbreak (red line),  while the black line shows the peak deaths during the 1918 pandemic.  This chart shows excess deaths by   A) respiratory causes (pneumonia, influenza and bronchitis) and B) all causes.

 

For roughly 5 weeks Liverpool saw an incredible spike in deaths due to this new influenza.   And it did not remain just in Liverpool.  While it appears not to have spread as easily as the dominant Scandinavian strain, it managed to infect large areas of England, Wales, and Canada over the ensuing months.

 

For reasons we don’t understand, this new strain never managed to spread much beyond England, Wales, and Canada.  It did not reappear the next flu season either.  It vanished as mysteriously as it appeared.

 

Another example, but one that affected the transmissibility and not the virulence of the seasonal virus, occurred in 1947.  The so-called `vaccine failure’ year, when a new H1N1 virus swept quickly around the world.

 

In what would later be described as the Pseudopandemic of 1947, a new variant  of the H1N1 appeared on military bases – first noticed in Japan – and quickly spread from there.   While it produced a generally mild illness (sound familiar?) there were apparently low levels of immunity in the population.

 

1947 is little remembered today, except by epidemiologists, because while widespread, this new flu strain produced few excess deaths.

 

While we tend to worry about mutations and antigenic changes to pandemic strains, the truth is, plain old seasonal influenza is quite capable of throwing us a curveball.   

 

It has in the past, and no doubt will do so again in the future.

 

My thanks for the question, and an opportunity to revisit one of my favorite influenza research papers. Hopefully this answers at least part of the reader’s question.

(Tue, 24 Nov 2009 12:48:00 +0000)

 

# 4071

 

 

More than 2 1/2 years ago I wrote a blog entitled It Isn’t Just Bird Flu, where I wrote about a number of possible pandemic and epidemic threats.   I opened with:

 

In this increasingly crowded world of ours, where there are large areas of poverty and poor medical care, there are literally scores of deadly pathogens that could spark the next epidemic, or pandemic.    Bird flu, or the H5N1 virus, is high on the list of diseases we watch, but it is by no means the only one out there.

 

When we prepare for a bird flu pandemic, we are also preparing for any other disease outbreak.

 

As it turned out, it was something other than H5N1 that leapt onto the global health stage, and many of our preparations for bird flu were quickly revised to deal with the swine flu threat.

 

The three years of pandemic planning have paid off, even if things haven’t always gone as smoothly as we’d like.  

 

The swine flu pandemic of 2009 – while not the killer strain we feared would come – has given us an opportunity to see where we need to make improvements in our response.

 

But it is important that we take these lessons to heart.   There is no guarantee that we have years or decades before the next pandemic strain emerges.  

 

No guarantees at all.

 

Among the avian influenza’s, H5N1 is currently our primary concern.  It is a novel virus, it has become endemic in birds in many countries, and it has shown that it can jump species and infect humans.  It has all of the criteria needed to spark a pandemic, save one: 

 

It hasn’t developed the ability to be easily transmitted from human-to-human. 

 

And perhaps there is some biological barrier to prevent that from ever happening.    We simply don’t know.  

But we do know that viruses are constantly mutating, adapting, and evolving.   What may not be possible today may become commonplace tomorrow.  

 

Which brings us to this report in Monsters & Critics today, where the WHO warns not to become complacent about avian flu.

 

 

WHO warns of resurgence of avian flu virus

Health News

Nov 24, 2009, 6:48 GMT

Manila - The World Health Organization (WHO) warned Tuesday of a possible resurgence of bird flu amid new cases of the disease in poultry in Egypt, Indonesia, Thailand and Vietnam.

 

The Manila-based WHO Western Pacific Office said the presence of the H5N1 virus in poultry placed those in direct contact with the birds at risk of getting infected with the disease.

 

It added that it was also closely monitoring the risk of the H5N1 virus combining with the H1N1 swine-flu virus to produce a new and deadlier strain.

 

‘We don’t know if this is possible, but we are certainly aware of the risk,’ said Shin Young-Soo, WHO regional director for the Western Pacific. ‘We are on alert for this development.’

 

(Continue . .  .)

 

 

Of course, there are other avian influenza viruses out there – and some of those may have pandemic potential as well.

 

Earlier this month we saw another rare human infection by the H9 virus in Hong Kong, something that has been detected several times in that region over the past decade.

 

H7N7 infected 89 people and caused 1 death in the Netherlands in 2003, while two other H7 viruses were detected in humans in the UK in 2006 and 2007.  And lastly H10N7  infected two infants in Egypt in 2004. 

 

The best overview of avian influenzas that I’m aware of is CIDRAP’s

 

 Avian Influenza (Bird Flu): Implications for Human Disease

 

While it may be due, in part, to better surveillance – we are seeing more species jumping zoonotic diseases than ever before.  

 

As man encroaches deeper into jungles and remote areas, and as he factory farms animals in crowded and often unsanitary conditions, he exposes himself to previously unknown animal borne diseases.

 

Consuming `bush meat’ is another potential source of zoonotic infection, something that  Nathan Wolfe: Virus Hunter  and a worldwide network of more than 100 scientists working with the Global Viral Forecasting Initiative (GVFI) hope to detect.

 

It was just this sort of human-animal interaction in Guangdong Province in 2002 that is believed to have precipitated the SARS outbreak which infected more than 8,000 people and killed roughly 800.  

 

SARS apparently came about due to the penchant of some prosperous Chinese to dine on exotic animals.  These animals were slaughtered, and served, in `Wild Flavor’ restaurants, particularly in Guangdong Province.

 

A previously unknown coronavirus, which subsequently was discovered in civet cats served in these establishments, was determined to be the likely cause of the SARS outbreak.  

 

SARS has since receded back into the wild, but the threat is certainly not gone.  It could seep back into the human population again.

 

Nipah and Hendra are two particularly nasty pathogens that have caused outbreaks in South East Asia and Australia.  In 2008 a new strain of ebola was discovered in Africa, and this year Ebola Reston (a strain which does not currently sicken humans) was found in pigs in the Philippines.

 

Earlier this year, a new arenavirus was isolated from 5 patients in South Africa and Zambia (see Lujo Virus: Newly Identified Arenavirus).

 

 

Ironically, in 1969, the Surgeon General of the United States, William H. Stewart, declared,  “The war against diseases has been won.” 

 

He clearly was an optimist.   

 

In the four decades since that proclamation, more than 3 dozen new zoonotic diseases have emerged or have been identified, including HIV, Hanta, Nipah, Hendra, West Nile Virus, Lyme Disease, H5N1, and now novel H1N1.

 

Old scourges are making a comeback as well. 

 

Some, like Tuberculosis seemed as if they would be beaten by modern antibiotics, but now have become resistant.  Polio continues to surface in Asia and Africa.  And Dengue, Malaria, and now Chikungunya are all marching around the globe.

While some of these may seem like rare and exotic tropical diseases, I would remind my readers that Key West, Florida has recently seen dozens of Dengue Fever cases.  Chikungunya showed up in Italy, of all places, a couple of years ago.

 

In  October of 2008  Lloyd’s issued a pandemic impact report for the Insurance industry, which can be downloaded here.

 

 

The Lloyds report takes pains to point out that while we worry about an influenza pandemic the most, there are other candidates out there that could spark a pandemic (or at least an epidemic).

They list:

• Hendra Virus
• Nipah Virus
• Cholera
• Small Pox
• HIV/AIDS
• Bubonic Plague
• Tuberculosis
• Lassa fever
• Rift Valley fever
• Marburg virus
• Ebola virus
• Bolivian hemorrhagic fever
• MRSA
• SARS

 

 

I could add Dengue, Chikungunya, and of course Pathogen X, the one we don’t know about yet, to this list.

Not all of these are capable of sparking a worldwide pandemic, of course.  Some, particularly the vector borne diseases and bacterial infections, are unable to spread globally the way that influenza viruses do. 

 

But all of these are capable of producing, at the very least, serious regional epidemics or localized outbreaks. 

 

Emerging infectious diseases are national, and global, security threats.  They can also have immense economic ramifications. 

 

Whether it is a new emerging disease, or an old foe making a comeback, the world must remain alert and prepared to deal with the next pathogenic threat.   

 

And that means funding public health initiatives and scientific research both domestically and around the world.

 

And if we had any sense, we’d do it with the same commitment and vigor as we fund our military.

 

Because, while I can’t tell you which threat is coming next, I can assure you that nature’s biological laboratory is open 24/7 and is fully capable of serving up plenty of nasty surprises down the road.

(Tue, 24 Nov 2009 00:19:00 +0000)

 

# 4070

 

 

In an announcement today Hong Kong authorities tell of a year-old boy hospitalized for 3 days last July who tested positive for the same mutation in the H1N1 virus as made headlines last week.

 

The amino acid change in the HA1 gene at position 222 (225 in influenza H3 numbering) from aspartic acid (D) to glycine (G) had been found in three cases of severe pandemic Influenza  in Norway.

 

The assumption by some has been that this mutation must increase the virulence of the virus because it was found in several severe cases in Norway, some with fatal outcomes.  

 

While it may indeed prove to be a factor in the virulence of H1N1, what we don’t have a good handle on is how many mild cases have occurred with this mutation? 

 

Without knowing that, it is very difficult to assess the relative dangers of this single amino acid substitution.

 

The case announced today would appear only to have been of moderate severity, as the child was only hospitalized for 3 days and has fully recovered.

 

The other key point here is that of 123 samples tested in Hong Kong, only one showed the mutation. 

 

Which would suggest it isn’t widespread in that community, and may simply be a spontaneous mutation.  

 

Also, the boy’s family did not fall ill, and the virus remained sensitive to antivirals. 

 

The significance of this mutation is not yet clear.  But each day brings us more data which will hopefully give us a better idea in the weeks and months to come. 

 

Two reports:

 

H1N1 flu virus mutation detected in HK

www.chinaview.cn 2009-11-24 07:33:52

HONG KONG, Nov. 23 (Xinhua) — Hong Kong’s Department of Health announced Monday that it had found the same mutation in a H1N1 flu virus sample as the one detected in Norway recently.

 

The department said that it had examined the genetic sequence of H1N1 flu viruses in its monitoring system. Out of the 123 sequences studied, one sample showed the same mutation as the Norway strain.

 

The virus was taken from a year-old boy who developed flu-like symptoms July 22. He was admitted to Prince of Wales Hospital July25 and discharged three days later. He has recovered.

 

Mutations are frequently encountered in influenza viruses. According to the World Health Organization, the same mutation of the virus has been found on the Chinese mainland and in other countries, including Brazil, Japan, Mexico, Ukraine and the United States.

 

The virus with this mutation remained sensitive to antiviral drugs, Tamiflu and Relenza. No evidence suggests these mutations are leading to an unusual increase in the number of H1N1 flu infections or a greater number of severe or fatal cases.

 

And an excerpt from the Hong Kong Standard

 

 

Mutated swine flu found in tot
Mary Ann Benitez
Tuesday, November 24, 2009

EXCERPT

The Department of Health announced last night that it found the same mutation in the boy, who developed symptoms on July 22 and tested positive for the virus on July 25 when he was admitted to Prince of Wales Hospital.

 

He was discharged on July 28 and recovered completely. His family members did not fall ill.

 

A department spokesman said: “The virus with this mutation remained sensitive to antiviral drugs oseltamivir [Tamiflu] and zanamivir [Relenza].“

 

The spokesman said there is no evidence that these mutations are leading to an unusual increase in the number of swine flu infections or a greater number of severe or fatal cases.

<SNIP>

 

Stene-Larsen added: “Based on what we know so far, it seems that the mutated virus does not circulate in the population, but might be a result of spontaneous changes.”

(Mon, 23 Nov 2009 20:52:00 +0000)

 

 

# 4069

 

Encephalopathy isn’t a distinct disease, but rather refers to a syndrome of diffuse brain dysfunctions, which may be associated with a variety of causes.

 

Viral and bacterial infections are among the common culprits, but encephalopathy may also be caused by trauma, prions, toxic chemical exposures, and even a thiamine deficiency (Wernicke’s Encephalopathy).

 

The overriding hallmark of encephalopathy is an altered mental state, although depending and severity of encephalopathy, common neurological symptoms such as progressive memory loss and changes in cognitive ability,  personality changes, inability to concentrate, lethargy, and loss of consciousness may be seen.

 

In recent years Influenza has been seen as a rare cause of encephalopathy.  

 

In an eMedicine article on Influenza by  Robert W Derlet, MD, Professor of Emergency Medicine, University of California at Davis School of Medicine encephalopathy is listed under clinical presentation:

 

Acute encephalopathy has recently been associated with influenza A virus. In a case series of 21 patients, Steininger et al described clinical, CSF, MRI, and EEG findings.4 Clinical features included altered mental status, coma, seizures, and ataxia. Of those who underwent further testing, most had abnormal CSF, MRI, and EEG findings.

 

The CDC’s MMWR (July 23rd issue) reported on 4 pediatric patients with the novel H1N1 virus who presented with neurological symptoms including unexplained seizures and altered mental status.

 

Neurologic Complications Associated with Novel Influenza A (H1N1) Virus Infection in Children — Dallas, Texas, May 2009

Neurologic complications, including seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders, have been described previously in association with respiratory tract infection with seasonal influenza A or B viruses (1–2), but not with novel influenza A (H1N1) virus.

 

On May 28, 2009, the Dallas County Department of Health and Human Services (DCHHS) notified CDC of four children with neurologic complications associated with novel influenza A (H1N1) virus infection admitted to hospitals in Dallas County, Texas, during May 18–28.

 

And as previously mentioned, even seasonal influenza has been linked to very rare neurological symptoms.  The editorial note from the MMWR stated that:

 

Considering that clusters of influenza-associated encephalopathy in children have been reported during previous community outbreaks of seasonal influenza (1–2) and that children appear to be infected with novel influenza A (H1N1) virus more frequently than adults (3), additional neurologic complications in children are likely to be reported as the pandemic continues.

 

Clinicians should consider influenza associated encephalopathy in the differential diagnosis of children with ILI and seizures or mental status changes, and remain aware of the potential for severe neurologic sequelae associated with seasonal or novel influenza A (H1N1) virus infection.

 

The incidence of neurological involvement with most influenza viruses appears to be quite low, although obviously not unheard of.

 

Earlier this month, Children’s Hospital of Pittsburgh reported 5 kids with encephalitis over the past 6 weeks. 

 

Today we learn via the Daily Yomiuri Online that a surprising number of H1N1 patients in Japan have presented with encephalopathy since July.   

 

In a normal year, Japanese health officials say they might see 40 to 50 such cases – but in the past four months they’ve seen more than twice that many.

 

A hat tip to Treyfish on FluTrackers for posting this link.

 

 

132 flu patients hit with brain disorders since July

 

The Yomiuri Shimbun

A total of 132 influenza patients in Tokyo and 27 prefectures have developed encephalopathy, or swelling of the brain, since July, according to the National Institute of Infectious Diseases.

 

Normally, only about 40 to 50 seasonal flu sufferers develop encephalopathy each year, meaning the latest figure has already more than doubled in four months since the new strain of flu began spreading.

 

Encephalopathy occurs when viruses cause the immune system to overreact, resulting in a swelling of the brain.

 

Though the ages of the 132 people in question range from 1 to 67, most were under 15.

 

By age, 7-year-olds constituted the largest group, with 22 sufferers. This is older than the average age for encephalopathy sufferers, who are most often aged between 1 and 3.

 

Further examination of 60 of the 132 patents revealed consciousness-related malfunctions.

 

The period over which these malfunctions occurred following the initial fever ranged from one day for 12 people, two days for 36 people, and four days for eight people.

 

The examination reconfirmed that in many cases, the serious symptoms occurred in the early stages of the disease.

 

Of 59 patients whose symptom development had ended, three, or 5 percent, died. Seven, or 12 percent, suffered aftereffects such as physical paralysis or mental or nerve disorders.

 

Forty-nine, or 83 percent, fully recovered.

 

Nobuhiko Okabe, chief of the institute’s Infectious Disease Surveillance Center, said: “If a patient exhibits such symptoms as slow responses or saying strange things, encephalopathy could be the cause. In such cases, patients should see a doctor immediately.”

(Nov. 24, 2009)

(Mon, 23 Nov 2009 19:52:00 +0000)

 

# 4068

 

The bottleneck in producing ample pandemic vaccine for the US, and the world, was caused in large part because we rely on the 50-year-old technology of growing antigen in chicken eggs.  

There are newer cell-based technologies on the horizon, but production facilities must be built, manufacturing problems solved, and these novel vaccines approved for use by the FDA.

Maggie Fox, Health & Science Editor for Reuters brings us word of a new factory in Holly Springs, North Carolina, that in a few years will hopefully be capable of producing as much as 150 million doses of adjuvanted cell-based vaccine within 6 months of a pandemic virus being isolated. 

 

The problems aren’t all technical or logistical, however.  

 

This cell technology is new, unfamiliar to most Americans, and the use of adjuvants in this country is currently viewed with suspicion.

 

The hope is, that we’ll come out of this pandemic season with a lot more safety data on the use of adjuvants.

 

Tens of millions of adjuvanted vaccines have already been delivered to the arms of people in Canada and Europe without apparent problems, and by the time this factory is ready to produce, it is hoped Americans may be more inclined to accept the product.

 

 

 

Next-generation flu vaccine plant to open in U.S.

Mon Nov 23, 2009 11:53am EST

 

* New factory first in U.S. to use cells to make flu shots

* Novartis hopes U.S. market will accept boosted vaccines

* First dose won’t come before 2011

 

By Maggie Fox, Health and Science Editor

 

WASHINGTON, Nov 23 (Reuters) - Novartis (NOVN.VX) will officially open the first next-generation flu vaccine plant in the United States on Tuesday, but it will be years before it makes its first vaccine.

 

The factory in Holly Springs, North Carolina, will use batches of dog cells to grow influenza vaccine, instead of the chicken eggs widely used now. While the cell method is only slightly faster, it can be scaled up more quickly.

 

Federal advisers to the U.S. Food and Drug Administration last week asked for more safety data on another cell-based vaccine, one made by privately held Protein Sciences Corp. But U.S. officials said the new Novartis shot is not as experimental.

 

“I see them as totally different. The whole point of pushing on cell culture was increasing capacity and surge capacity,” Dr. Bruce Gellin, head of the U.S. Health and Human Services Department’s National Vaccine Program Office, said in an interview.

 

HHS spent $487 million helping Novartis build the plant, which was planned before the current pandemic of H1N1 swine flu.

 

(Continue . . .)