An unusual study done in 49 remote Hutterite farming colonies in western Canada has provided the surest proof yet that giving flu shots to schoolchildren protects a whole community from the disease. 

Although previous studies have demonstrated what scientists call “herd immunity,” none have been so incontrovertible, because they were done in less isolated places with more sources of flu passing through. 

Also, only one other study, done 42 years ago, immunized over 80 percent of a community’s children, as this one did. Success repeated in many separate communities with very high vaccination rates implies that the shots themselves — rather than luck, viral mutations, hand-washing or any other factor — were the crucial protective element. 

The study, done by scientists from several Canadian universities and St. Jude’s Children’s Research Hospital in Tennessee, was paid for by the governments of Canada and the United States. It was published online Tuesday by The Journal of the American Medical Association. 

“This is quite a definitive study, and it took a Herculean effort,” said Dr. Carolyn B. Bridges, an expert in influenza epidemiology at the Centers for Disease Control and Prevention. “My hat’s off to them.” 

Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases, which supported the project, called it “a really nice study” and added that, even though it was done with seasonal flu shots in the 2008-9 winter, its results validated the American government’s decision to vaccinate children first during the recent swine flu pandemic. 

“Not only was that clearly needed to protect the kids, but they probably wound up protecting the older people, too,” Dr. Fauci said.

Via Google News, Helen Branswell of The Canadian Press provides excellent analysis of this report.

The Hutterites are very interesting people: Like the Amish, they’re Anabaptists, but they’re high-tech. You might call them Christian communists: They live communally with very little personal consumption, but their readiness to use the latest technology makes them extremely productive farmers. Their high birthrate, combined with limits on the size of their communities, means they’re always looking for new land for new communities. This, plus their agricultural success, often annoys their rural neighbours.

Annoying or not, the Hutterites offer an alternative way of life we might learn from.

# 4416

The recent push to vaccinate children against seasonal influenza every year is based, in part, on the idea that kids are very efficient spreaders of the virus – and that if you can reduce their susceptibility to infection – you can reduce the influenza burden on the entire community.

Today we’ve a new study out of Canada that seems to support this theory, suggesting that vaccinating kids helps protect the entire community.

Helen Branswell of the Canadian Press brings us the details, and I’ve included the NIAID press release as well.   Follow the link to read Helen’s article in its entirety.

Want to reduce amount of flu in adults? Vaccinate kids, study shows

By Helen Branswell Medical Reporter (CP) – 2 hours ago

TORONTO — A landmark study looking at how to limit the spread of influenza has shown what experts have long believed but hadn’t until now proved: Giving flu shots to kids helps protect everyone in a community from the virus.

 

The study, led by Dr. Mark Loeb of McMaster University in Hamilton, Ont., showed the risk of catching the flu was lowered by nearly 60 per cent in communities where a substantial portion of kids aged three to 15 got flu shots.

 

That level of indirect protection is nearly as good as what healthy adults might expect from getting a flu shot themselves and is perhaps better than what a senior with a waning immune system might expect from a flu vaccination.

(continue . . .)

 

Vaccinating Children against Flu Helps Protect Wider Community

Trial Results in Rural Canadians Show Effect of Herd Immunity

WHAT:

Results of a clinical trial conducted in a largely self-contained religious community during the 2008-09 influenza season show that immunizing children against seasonal influenza can significantly protect unvaccinated community members against influenza as well. The study was conducted to determine if immunized children could act as a barrier to limit the spread of influenza to the wider, unvaccinated community, a concept known as herd immunity.

 

Researchers recruited volunteers from 46 Canadian Hutterite religious colonies that have limited contact with surrounding, non-Hutterite populations. A total of 947 children between 36 months to 15 years of age participated in the trial; 502 children in 22 colonies received 2008-09 seasonal influenza vaccine, while 445 youth in the other colonies received hepatitis A vaccine. The hepatitis A vaccine served as a control vaccine for comparison.

 

In the six months after the children were vaccinated, 119 of 2,326 unvaccinated community members (who were of all ages) developed laboratory confirmed cases of influenza. Of these, 80 of 1,055 were from colonies where children received hepatitis vaccine, while 39 of 1,271 were from colonies where children received the influenza vaccine.

 

The researchers found that influenza vaccination was 61 percent effective at indirectly preventing illness—that is, protecting via herd immunity—in unvaccinated individuals if they lived in a colony where approximately 80 percent of the children had received flu vaccine. The findings, they write, “…offer experimental proof to support selective influenza immunization of school aged children…to interrupt influenza transmission. Particularly, if there are constraints in quantity and delivery of vaccine, it may be advantageous to selectively immunize children in order to reduce community transmission of influenza.”

 

Mark Loeb, M.D., of McMaster University, Hamilton, Ontario, led the trial. The research was funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and by the Canadian Institutes for Health Research.

 

Visit the NIAID Web site to see an illustration showing how vaccination generates herd immunity. 

ARTICLE:

M Loeb et al. Effect of influenza vaccination of children on infection rates in Hutterite communities. JAMA 303:943-50 DOI: 10.1001/jama.303.10.943 (2010).

Credit NIAID

# 4415

Every few months we seem to see a new press release or news story about some whiz-bang invention, discovery, or experimental drug that promises to revolutionize the way we treat or prevent influenza.   

Often these stories are about discoveries that hold genuine promise, but that are still some time away from practical application. 

This morning we’ve a press release and some news stories about a Korean company working on Human Monoclonal Antibodies (moAb) that are designed to work against a wide variety of influenza viruses. 

This from The Korean Times.

New Anti-Influenza Drug Being Developed

By Bae Ji-sook
Staff Reporter

Celltrion has developed a drug based on “human monoclonal antibodies” that can be effective against multiple influenza viruses, the biopharmaceutical company said Tuesday.

 

The company tentatively called the drug a Super Flu-Antibody Therapy.

 

This is the first time a drug effective against multiple viruses has been developed in Korea. Celltrion expects to release the product next year, ahead of major rivals in the U.S. and other countries who have also been successful in developing substances that are effective against one or more viruses.

 

(Continue . . . )

 

If all of this sounds a tad familiar, it may be because a little over a year ago researchers at the Dana-Farber Cancer Institute (Dana-Farber), Burnham Institute for Medical Research (Burnham) and the Centers for Disease Control and Prevention (CDC) reported the identification of human monoclonal antibodies (mAb) that worked against a wide range of influenza viruses, including the H5N1 bird flu virus.

See Research: Monoclonal Antibodies Against Influenza

 

These antibodies targeted a highly conserved stem region of the H5 hemagglutinin (HA) which prevented the virus’s entry into a cell, and this portion of the virus is consistent across many (but not all) influenza strains.

Potentially a `magic bullet’ against influenza, assuming that it works as well (and as safely) in humans as it did in laboratory mice.

These monoclonal antibodies would not work like a vaccine, which confer relatively long-term protection.  Rather, a single injection is expected to serve as a treatment, or to work as a temporary prophylaxis.

Monoclonal antibodies are viewed by many researchers to hold promise for influenza treatment, but human trials have not been conducted, and substantial uncertainties exist.

Celltrion, Inc has released an optimistic sounding press release today on their latest monoclonal antibody research on mice, promising to move forward with clinical trials `as quickly as possible’.  

You can read the release at the link below.

Successful Development of Broad Spectrum Human Monoclonal Antibodies Against Major Influenza Viruses (H1N1 and H5N1)

Even if successfully brought to market in the next few years, monoclonal antibodies are not likely to become a panacea against a pandemic.  These are injectable, short-lived medications that are likely to remain expensive and limited in availability for the foreseeable future.  

Regardless of how these clinical trials turn out, or whether monoclonal antibodies prove to be a practical treatment for influenza down the road, this is another important step forward in our understanding of how influenza viruses work.

And that, over time, will no doubt pay big dividends.

Turkey has held talks with pharmaceutical companies to return unused swine flu vaccines after the H1N1 virus was reported to be gradually decreasing within the country. 

Turkish Health Minister Recep Akdağ said on Tuesday that Turkey had ordered 43 million doses last year but ended up buying only 17 million doses. 

“We held talks with manufacturers to give a significant part back,” Akdağ said. “However, we will keep 2-3 million doses in reserve for emergencies.” 

In January, Akdağ said the H1N1 virus, commonly known as swine flu, killed over 600 people in Turkey this winter. Now he said, “The swine flu pandemic has almost petered out in Turkey.” 

The number of deaths caused by swine flu was 415 in Turkey as of mid-December when the health ministry officials last announced the number of deaths.

It’s interesting that the Turkish government simply stopped talking about H1N1 deaths while another 200 persons died in a matter of weeks.

# 4414

The American College Health Association (ACHA) has long had an interest in pandemic preparation, prevention - and over the past year - pandemic surveillance.  

Their weekly update of ILI (Influenza-like-illness) activity on campuses around the country have been a ready barometer of the spread of novel H1N1 over the past year. 

A couple of years ago I was fortunate enough to spend three days at their 2008 annual convention on behalf of the Readymoms Alliance  talking to hundreds of visitors about pandemic issues.  

It was almost a year ago when tens of thousands of college spring-breakers descended upon the beaches of Mexico, this coming at a time when the novel H1N1 virus was starting to circulate widely in that region.  

While the virus would undoubtedly have spread to other countries without hitching a ride home with spring breakers, these college vacationers proved an extremely efficient form of conveyance.

This year, the ACHA in conjunction with the CDC, has issued a letter to students about to embark on Spring Break, urging that they avail themselves of the pandemic vaccine, and that they take common sense steps to avoid infection.

 

American College Health Association Spring Break Vaccination Letter

March 5, 2010

Don’t let influenza spoil your plans for Spring Break.

Although flu activity has declined in recent weeks, 2009 H1N1 Influenza viruses continue to spread in the United States and abroad, causing illness, hospitalizations and even deaths. Recently, several colleges and universities have reported increased influenza activity on their campuses. Flu activity is difficult to predict, but experts at the Centers for Disease Control and Prevention (CDC) expect that flu activity — caused by 2009 H1N1 or seasonal flu viruses — will continue for weeks, and parts of the world may even see big outbreaks. This season the 2009 H1N1 virus has hit young adults especially hard in terms of illness, as most young people do not have immunity to the virus. For these reasons, the CDC and the American College Health Association (ACHA) continue to encourage all students, faculty and staff at universities and colleges to protect themselves against 2009 H1N1 by getting vaccinated. In the spring of 2009, we saw the spread of 2009 H1N1 result in a lot of illness following travel associated with “Spring Break.” With the 2010 “Spring Break” coming up and large numbers of students expected to travel both domestically and internationally, getting vaccinated against 2009 H1N1 influenza is especially important.

 

The 2009 H1N1 influenza vaccine is readily available both on and off campus at school health clinics, doctor’s offices, state and local health departments and many pharmacies. Vaccination is the best way to protect yourself against 2009 H1N1 flu. And this protection is especially important if you have a health condition, such as asthma, diabetes, heart disease, pregnancy and other conditions that increase your risk of serious flu-related complications or hospitalization.

 

In addition to getting vaccinated, you can also take the following steps to help protect you from getting or spreading the flu and other illnesses while you’re on break:

• Talk to your health care provider not only about 2009 H1N1, but also other recommended, routine vaccinations you may need if traveling, especially overseas.
• Visit the CDC’s Travelers’ Health website (www.cdc.gov/travel) for more information and healthy travel recommendations to prevent influenza and other illnesses during travel. You can also find special information about spring break travel.
• Stay away from people who appear sick or are coughing or sneezing. The main way the flue spreads is through the droplets of coughs and sneezes.
• Practice good hygiene by washing your hands often with soap and water, especially after coughing and sneezing. If soap and water is not available, alcohol-based hand rubs are useful.
• Cover your coughs and sneezes with a tissue.
• Wash your hands often.
• Don’t share drinking glasses or utensils – avoid drinking beverages mixed in a common container or eating after others.
• Stay home (or away from others) if you are sick for 24 hours after your fever is gone to prevent others from getting sick too.

Spring Break is a time for rest, relaxation and fun with friends and family. Take the opportunity to get vaccinated before leaving for Spring Break and protect yourself, friends and family against 2009 H1N1 flu. Don’t let influenza spoil your plans — get vaccinated against 2009 H1N1.

Britain is to give 42m condoms to South Africa in response to a request for an extra billion as part of an HIV prevention drive before the World Cup, the government will announce today. 

The request for British help in stockpiling sufficient condoms for the expected influx of thousands of football supporters in three months’ time was made during President Jacob Zuma’s recent visit to the UK to meet the Queen. 

“Obviously there’s a big focus on the World Cup coming up and a huge increase in the number of people coming into South Africa,” said the international development minister, Gareth Thomas, who will announce the £1m funding today at an emergency summit in London on HIV prevention and treatment. 

“The South Africans have identified themselves the need to get more condoms in place. South Africa specifically asked for British assistance and we are responding to that request.” 

He pointed out that the fans would inevitably spill over into neighbouring African countries with high HIV rates, which would also need to take precautions. 

The South African government estimates that up to half a million visitors could travel to the country, raising fears of a rise in prostitution and sex trafficking from neighbouring countries and eastern Europe, and creating a potential HIV timebomb. 

Last week South Africa’s Central Drug Authority warned that 40,000 prostitutes were expected to arrive for the month-long tournament. 

South Africa is embroiled in a struggle to combat the world’s biggest HIV caseload and to convince its population of the importance of safe sex. 

The South African health minister, Aaron Motsoaledi, expressed concern that the message was being ignored because people believe HIV can now be easily treated.

The latest outbreak of bird flu has affected the provinces of Dien Bien and Nam Dinh in the north, Nghe An and Khanh Hoa in the central region, and Soc Trang and Ca Mau in the south, Ministry of Agriculture and Rural Development representative Hoang Van Nam told a meeting in Ha Noi yesterday.

“Bird flu has continued to spread in these provinces and killed thousands of poultry since its re-emergence in December, despite efforts to prevent contagion,” Nam told the gathering of governmental experts and representatives from the UNDP and non-governmental organisations. 

Nguyen Huy Nga, director of the Ministry of Health’s Department of Preventive Medicine and Environment, said that since the first bird flu case in 2003, 115 human cases had been reported in Viet Nam, 58 of which resulted in deaths. 

In 2010, three human cases have been reported in the provinces of Khanh Hoa, Tien Giang and Tuyen Quang, resulting in one death. 

The threat of a human epidemic of bird flu has risen due to the continued presence of the virus among poultry and because public awareness of proper handling and preparation of poultry remained low. 

The risk was particularly high in the Cuu Long (Mekong) Delta region as ducks were migrating during harvest time. 

About 95 per cent of human cases showed the person had a history of exposure to poultry infected with the A/H5N1 virus, Nga said, noting that the evidence of human-to-human transmission remained scant – although there were instances in which groups of infected persons had lived in the same households. 

The Integrated National Operational Programme for Avian Influenza 2006-10, commonly known as the Green Book, would help reduce the health risk to humans from bird flu by instituting methods to control the disease at its source in domestic poultry, detecting and responding promptly to human cases, and preparing for the medical consequences of a human pandemic, said Deputy Minister of Agriculture and Rural Development Bui Ba Bong. 

The total cost for the programme from the State budget, public sector and ODA was estimated at US$250 million, Bong said.

Swine flu cases in Egypt are substantially declining, with the rate of weekly reported cases falling to almost half, the Ministry of Health announced. 

“Swine flu in Egypt is declining, the number of reported cases this week went down to 22, in comparison to 44 cases reported last week,” said Amr Kandil, deputy Minister of Health for Preventive Medicine.  

The total number of cases is 16,125, according to the latest swine flu report. Three deaths were reported last week, bringing the total number of fatalities to 272. 

The World Health Organization echoed a similar view. “In North Africa and West Asia, influenza activity is low,” it said in its situation update released on Friday March 5. 

Around the country, the rate of swine flu cases reported has been declining and will continue to do so until April, Abdel Rahman Shahin, official spokesman of the Ministry of Health, had said previously. 

Out of the 22 cases of swine flu reported this week, only seven were reported in schools. 

Due to the substantial decline, the Ministry of Health is currently considering not shutting down any classrooms where the virus appears and limiting the precautionary measures to giving the students who show swine flu symptoms one week off, explains Kandil.

One month after the situation had stabilized; new cases of the influenza A, H1N1 commonly known as Swine flu have been confirmed in Burera district, Northern Province. 

This was revealed yesterday, by Dr. Justin Wane, the Head of the Swine flu response team in the Ministry of Health. According to Wane, at the beginning of February, the infection rate went down completely with only one or two cases reported in a week. 

However, with the seasonal flu at hand, infections were projected to increase. 

“We received reports that cases of swine flu in Burera were on the increase. Samples were taken for testing and at the beginning of last week, there were six laboratory confirmed cases in this district,” he said. 

“We are still conducting more tests so we are yet to have an updated report. There number of seasonal flu cases at the moment is also high and one problem we are facing is that most people are confusing these common flu infections to the influenza A H1N1.”

Segundo dados de diversos jornais da região, com informações coletadas por colega leitora do blog que gentilmente enviou os links, o estado do Pará já possui ao menos 9 casos confirmados de óbitos causados pela gripe suína (H1N1) apenas neste ano.

According to data from various regional journals, collated by a colleague-reader who kindly sent the links, the state of Pará now has at least 9 H1N1 deaths so far this year.

The rest of the post provides details on the cases. And it raises a worrying issue: Without the efforts of individuals like Mauricio Beltran and his colleague, even ordinary Brazilians would have little sense of what’s going on in their own country.

It’s just another example of a problem I’m increasingly aware of since I started covering other diseases like dengue and malaria: Outside the immediate hot zone of an outbreak, no one cares—or even wants to know. If all politics is local, so are pandemics.