Posted on 12/13/2003 1:01:22 PM PST by CathyRyan
For all the public concern over the rapid spread of the new Fujian strain of influenza, health officials and doctors say there is still no way to know whether this year's flu season is particularly severe or just off to an early start. And for all the clamor for dwindling supplies of vaccine, no one knows how effective the current vaccine will be against the Fujian strain.
But the flu season has already thrown some realities about the public health system into sharp relief, these experts say. It suggests that the country needs to be far better prepared to deal with influenza — either the conventional strains that cause serious illness each year, or a horrendous strain like the one that caused the 1918-19 pandemic, which killed at least 30 million people worldwide.
Influenza is arguably the most unpredictable of viruses, and protecting the public against it is a tricky balancing act. It involves a number of factors: inadequate scientific knowledge of the virus; educated guesswork in choosing what strains of influenza to include in each year's vaccine; time-consuming, old-fashioned manufacturing techniques; and skills in communicating with a skeptical public.
Such protection also depends on a strong public health system. But years of underfinancing have weakened the system. And confidence in it was scarred by the flawed emergency swine flu immunization program in 1976, which was halted after a relatively few of the 45 million people who had been vaccinated became temporarily paralyzed from Guillain-Barré syndrome.
More recently, gaffes and miscommunication about events like the anthrax attacks of fall 2001 left Americans unsure what to think about public pronouncements, and insecure about the nation's capacity to deal with a severe epidemic of SARS or a new strain of influenza.
Communication has improved since then. Still, the government had little to say about influenza this fall, while the health and human services secretary, Tommy G. Thompson, and his top aides visited African countries torn by AIDS. Only after their return did news conferences about influenza resume.
Government health officials have repeatedly warned about the inevitability of another influenza pandemic. Yet the government has yet to approve final plans to counter such a disaster.
No one knows why influenza has hit the western United States in particular, or why it happened so early this season. No evidence exists to suggest that the Fujian strain is more virulent than other strains that have caused past epidemics or that this season's influenza is worse than those of the past. Although the Fujian strain also struck early in Europe, the World Health Organization said it was not aware of unusually severe influenza this season outside the United States.
Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, put it bluntly: "No way will the Fujian strain cause a pandemic."
Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, says the vast majority of influenza cases are an annoyance, causing only a mild respiratory illness. But Dr. Gerberding also noted that influenza is lethal for 36,000 Americans on average each year.
The deaths are among the reasons health officials have been urging Americans to take influenza vaccine. An estimated 185 million Americans are eligible for it, but manufacturers produced enough vaccine for only 83 million Americans.
Each February and March, the World Health Organization and the United States government invite experts to meet independently to choose the three influenza strains they believe are most likely to cause outbreaks the following season.
The three strains are turned into the following season's vaccine, and W.H.O. provides the seed viruses free to all vaccine manufacturers.
The Fujian strain was detected too late to be included in this season's vaccine. Officials have said that the vaccine should still afford "some protection" against the Fujian strain but do not know how much.
Because the manufacture of influenza vaccine is entirely in the private sector in the United States, market forces determine the amount produced.
One reason for the gap between supply and demand this season is the perennial lack of response to pleas from health officials for most Americans to get flu shots. That consumer response forced manufacturers to discard 12 million of the 95 million doses produced last season at a loss of millions of dollars. So manufacturers produced 83 million doses for this season.
The time when the three strains are chosen is critical to vaccine production. One reason is that it takes tens of millions of chicken eggs to produce each season's vaccine, and they must be bought months in advance. Once production is complete, additional doses cannot be made without reducing the amount that could be produced for the next influenza season, Dr. Gerberding said.
Because the process is complex and even the best influenza vaccines are about 70 to 90 percent effective, a notch below the standard childhood immunizations, health officials have long urged researchers and industry to find new ways to produce influenza vaccine. Scientists have come up with promising new methods. But major problems, including those involving technology and intellectual property rights, are unresolved.
Dr. Barry R. Bloom, dean of the Harvard School of Public Health, said that because of industry's limited capacity to make vaccine, "we would be in terrible shape" if there was a pandemic of a virulent strain. "That is unlikely to change without government intervention," he said.
Soon after the swine flu episode in 1976, the government began drafting a plan for its response to a real pandemic. Then in 1993, it created a panel to come up with the plan. Many drafts have been prepared as the science has changed, but there is no final one, said Dr. Bruce G. Gellin, the director of the government's National Vaccine Program Office.
Critics say an official plan is needed. But even a draft, Dr. Gellin said, has been useful as a blueprint for preparing against a bioterrorism attack and in dealing with SARS.
"We need to diversify our manufacturing base and develop new techniques to improve our chances of success," Dr. Gellin said. "Ideally, that would produce a vaccine that would be given once and protect against all influenza viruses."
The vaccine has Panama for the fourth year in a row, which won't do much for Fujian. This year's vaccine is just to let everyone think they are doing something constructive.
Fujian left its calling card last season and as expected, it has returned with a vengeance and the vaccine will do little.
Might be a different strain than what I'm seeing in Oklahoma.
We are seeing a lot of sick kids and young folks, but none of our elders or diabetics (who got the flu shot early) have come down with it...there is a bad chest cold going around, so some of our older patients who smoke or have asthma are wheezing and quite sick, but no GI symptoms or body aches and pains like the flu...
Nationwide Fujian / Panama ratios are about 3/1. I think it was 50/50 in Oklahoma. The season is still pretty early. When Fujian arrives, you will know it. Many of the fatalities had been immunized.
If it were Fujian could that give us some immunity to that particular strain, as opposed to people who have never been exposed to it? Are you following me?
I know there is no real way to know, just curious.
Modesto Police Officer May Have Become Victim of Flu Outbreak Sue McGuire for KCBS-740 AM
(KCBS)--A Modesto Police officer, who had been suffering from flu type symptoms, died suddenly Saturday, apparently becoming the latest victim of the flu outbreak affecting California.
Modesto Police Detective Doug Ridenour says 32-year-old Officer Michael DuFour's family found him unconscious on the floor early Saturday morning. "The fire department got notified by the emergency response crews after they responded to a home here in Modesto that one of our officers, he had apparently collapsed and stopped breathing. They started CPR, the family did, but once the medical folks got there, they pronounced him dead a short time later at the house," said Ridenour.
DuFour had called in sick the past two days.
The Stanislaus County Coroner's office is conducting an autopsy to determine the exact cause of death.
The number of deaths with suspected links to the flu outbreak have continued to climb in the state.
A 16-year-old boy who tested positive for the flu has died in a San Diego county hospital. Two other deaths in the county may also be related to the flu. County officials confirm a 56-year-old San Diego man died December 3rd of flu induced pneumonia and it's suspected in the death Tuesday of a 13-year-old girl. A seven-year-old Bakersfield boy died Sunday and an elderly San Luis Obispo resident died of the flu last week.
People concerned about the flu are crowding Bay Area emergency rooms but many of the cases involve people with the common cold that easily can be treated at home.
Amy Nichols, the infection control manager at Alta Bates Summit Medical Center in Oakland and Berkeley says it's important to know the difference between a cold and flu because it could save your life. "It stays with you longer and there are other things that can occur in the wake of being infected with the influenza virus that can put you at risk for a more severe disease like pneumonia," she said.
Knowing the difference between the flu and the cold could also ease the burden placed on emergency rooms in the area.
Nichols says the flu is a respiratory infection that leaves victims with high fevers and low energy for more than a week. A cold does not last nearly as long and the fever isn't as bad. For people who have a fever for more than three days, they should seek medical care.
If you look at last year's CDC flu summary, you will see that 100 H3N2 were subtyped. 93 were Panama and 7 "had reduced titers". Those that had reduced titers were Fujian. Thus, Fujian was running at about 7%, but it came up late, so the percentage of later cases was higher.
Everything about Fujian was classic. It came up late in the season and was gaining strength. It also had mutations in key positions (matching sequences of pigs and ducks as well as human isolates from just after the 1968 Pandemic).
The science was a no-brainer. The early appearance and severity this season was NOT unexpected (to anyone paying attention). The vaccine wasn't working well and the virus was beginning to take off last season.
If you had Fujian last year you will be much better off you would be from getting a Panama flu shot this year.
Although Fujian did make at brief appearance at the end of last season, it is quite new, although it does have some of the mutations seen in human isolates after the 1968 pandemic (those born after 1968 should be paying attention).
There are some old flu stories that go back to 1918, but Fujian is quite new and there will be many more stories.
I don't think so. My mother has it and is sicker than she's ever been before. (This is a woman who's survived a LOT.) My daughter's best friend went into the hospital last week with a fever of 106. (No, that's not a typo... 106.) My MIL is a nurse and she's been introduced to her first case of this flu. For the first time in 25 years of nursing, she's very concerned. OTOH, I've seen folks in close contact with these cases who get sick, but no more than normal. I think it's hitting some people harder than usual this year.
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