More on vaccines
There is a lot of hope and expectation resting on a vaccine for H1N1 swine flu. Global vaccine manufacturers have received the seed virus and are growing this to produce doses for clinical trials.
One key player will be Sanofi Pasteur, the world's biggest producer of vaccines. It has around 45% flu vaccine market worldwide.
Company spokesman Dr Albert Garcia explained that last year the company produced 170 million doses of seasonal flu vaccine, with around 130 million doses for northern and 40 million doses for southern hemisphere.
I wrote last week about Novartis and Baxter, who are both producing some flu vaccine using cell culture. But Sanofi Pasteur relies wholly on the slower and seemingly outdated process of growing the vaccine in fertilized chicken eggs. Why?
"We find egg-based technology is the most reliable method for producing flu vaccines in bulk" said Dr Garcia. "It is very robust." In other words, if something is not broke, why try to fix it?
Flu vaccines have been created successfully for decades using eggs. Cell culture production is much more recent and is still an emerging technology which has experienced teething problems. But it is several weeks, even months faster, important in a pandemic.
So how much vaccine might be available? By my reckoning, it takes three eggs to produce a trivalent seasonal flu jab - one egg per strain of flu. So does that mean the company can produce not 170 million doses in the coming twelve months, but 510 million?
Dr Garcia said: "It's not so simple". He explained:
"We don't know what the yield of H1N1 vaccine will be, nor do we now how many micrograms of vaccine will be needed in each dose. The aim will be to produce as many doses as possible in order to protect the maximum number of people. But it all depends on the outcome of the clinical trials."
It's also not clear whether people will require one or two jabs. Against seasonal flu one vaccine is given each autumn, but it's been presumed that two doses will be required to give protection against a pandemic strain.
Sanofi Pasteur is one of the few manufacturers producing seasonal doses for the southern hemisphere (along with CSL in Australia).
So what will happen to this autumn's production - due to start in October - of next year's doses of seasonal flu vaccine, due to be distributed in spring 2010?
Interestingly, it seems the WHO has not yet made a decision about whether to sacrifice this production by asking SP and CSL to switch entirely to making H1N1 swine flu.
"We are at the disposal of the WHO" says Dr Garcia. "We have not had a request to switch totally to H1N1 pandemic vaccine."
That decision doesn't need to be taken yet, until clinical trials of the H1N1 vaccine have been completed. But by September, someone will have to decide whether to abandon seasonal flu vaccine for the time being, and concentrate on swine flu.
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"But by September, someone will have to decide whether to abandon seasonal flu vaccine for the time being, and concentrate on swine flu."
That, of course, might have some significant implications for the over 65s, who are generally perceived at significant risk of seasonal flu - (which is why they get flu jabs each autumn) - though are perceived to be at low risk of contracting H1NI due to presumed immunity.
It may also be something of a 'trade-off' of risks for people who are vulnerable due to an underlying health problem such as respiratory disease, heart problems, immumo-deficiency. etc.
I think people are beginning to realise that there are no simple answers and there won't be a 'one-size-fits-all" approach to this infection.
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As a pensioner I keep up with up to date NHS and Government health news through the internet, usually through the Health & Wellness section on http://www.pensioners.co.uk/ the government information tells me that Tamilflue will control the situation this winter ? do we need any other type of vaccine.
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Fergus, we seem to be quite dependent on you for information even though other sites offer current events. It was quite uncomfortable finding that you were not updating your blog for the last few days. I don't believe there is a conspiracy of silence, more likely that the health authorities are hoping someone else does the job so that they can get on with the real business of containing the flu situation. Fergus, it looks like you are the designated bearer of good or bad news, by popular vote from us lot. KEEP GOING PLEEEEEEAAAAASExxxx
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Considering our Borough is not closing schools or offering any testing for Swine flu, therefore allowing the virus to run amok amonst the population, killing the ones with 'underlying extreme health conditions' and letting the rest survive, surely a vaccination will not be needed as everyone will have got over it by the time it is ready to be given out?
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Oh god....
1. There is no conspiracy theory.
2. The coverage isnt as overbearing as it was previously due to the virus being incredibly weak.
3. Fergus is doing absolutely nothing wrong, just posting things whenever he feels like it, there is no media blackout whatsoever.
4. The people who have died in this "pandemic" would of died of seasonal flu.
5. Death rate 0.00024 in the US based on NY figures.
6. Here - http://crofsblogs.typepad.com/h5n1/ For all you people obsessed with trying to scare yourselves into oblivion discussing a mild infuelnza virus with less chance of mutating to a virluent strain than seasonal flu, you will like the constant updates on that website.
7. Sensible old grannie, ive seen you posting about some absurd things. First there was an ebola type virus, i have no idea why you were even mentioning this, it has no correlation whatsoever and seemed completely out of context. The second was a bird virus that has killed a few birds in Ireland. Do you have any idea how common these things are? The world has been around for billions of years, humanity has been around for hundreds of thousands, we are still here.
8. If anyone else mentions how the NHS has apparently failed in this outbreak il go crazy. This has to stop. What do you expect them to do exactly? Stop every incoming plane into the country and quarantine the hundreds of thousands of people who arrive in the UK every week, for a mild influenza virus? Or do you expect to shut universities, schools and colleges, stop public gatherings, to control a influenza virus less dangerous than seasonal flu that millions catch every year? Get your heads out of the sand people. Id hate to see how you would cope if this was H5N1, or something severe.
To sum up. NHS doing a brilliant job of getting on with everyday life as usual, Fergus has better things to do than post constant updates about a mild influenza virus to satisfy people with health anxiety and scare them even more. The virus is mild as heck, the thing isnt going to kill millions, you will all be here next year going "oh no its now horse flu mixed with fish flu mixed with yellow parrot fever. Everything is fine, as usual. And will be for the considerable future.
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I am very concerned about the new policy regarding the treatment of swine flu - namely the decision not to test for the condition anymore, to give patients no opportunity for face to face contact with a health professional, and to make them find a "flu friend" in order to get Tamiflu from pretty far-flung distribution centres - and I am wondering whether this is something which urgently needs national debate.
On July 2 - last Thursday - the government announced its new direction in the treatment of the pandemic and on that very evening my five-year-old son awoke with vomiting, high fever and sore throat. I too became ill the following day. We were alarmed because we have a younger child with the sort of "serious underlying medical problems" which can cause the flu to be very serious. As a result we had numerous conversations on the phone with doctors, all of whom diagnosed - over the phone - swine flu. As the illness progressed I had strong doubts that it was swine flu and insisted on going into the GP for a swab test, which is no longer offered as standard.
The result - after surviving six of the seven days I was told I had to stay indoors with the whole family (both children were excluded from school on the first suspicion of swine flu) - was that it wasn't swine flu at all. As the "pandemic" is not being tested anymore, it's impossible to know how many other families will be given false confirmation of swine flu (and expensive drugs that take up a considerable amount of a GP's time to prescribe), but the impact on the economy in time of recession of parents (and non parents) being forced to take seven days off work for theirs, or their child's, slightest virus must be catastrophic.
Surely, as this flu pandemic seems reasonably mild in nature, a more efficient method of dealing with it that suits both patients AND doctors can be devised. What about a mobile service to visit anyone with suspected swine flu. They can be assessed, given Tamiflu on the spot if necessary and swabbed. If the test proves positive, they can be given advice on the necessity to stay at home for seven days, If it's negative, they are in a better position to be able to get back to work and school ASAP.
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#2 Wanera,
Tamiflu is an anti-viral NOT a vaccine.
#3 sensibleoldgrannie,
As the UK are no longer testing suspected flu sufferers - indeed they are trying to do some degree of infection control by asking people to phone, not visit, GP surgeries and the like - how would anyone have any meaningful figures for 'confirmed cases' any longer to publish on web-sites or elsewhere?
#4 osteogenesis,
I think what you really mean is that the health and local authorities are taking a balanced risk management approach to controlling the spread of infection. Such mechanisms as closing schools are substantially less effective once the virus has escaped 'into the wild'. Your comments about "therefore allowing the virus to run amok amonst the population, killing the ones with 'underlying extreme health conditions' and letting the rest survive" suggests that you really just don't understand either how infections like this spread or what the health professions and others are doing.
#5 SkylineOnFire,
Your #4 should surely read "might have died of seasonal flu".
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Skyline on fire,
I have not said there is a conspiracy theory, on the contrary, the information is out there and available but Fergus's blog is the most accessible and I have grown to like it. I found out about croftblogs some time ago and it has a continuous news feed of information, however, sometimes they get things wrong, until amendments are made to information received.
if I mentioned the fact that 50 swans were killed, it was because at the time, the cause of the deaths was not confirmed. Swans are a very good indicator of the H5N1 virus and it seemed reasonable to mention the mysterious deaths. H5N1 has been ruled out and it looks as if the swans died of botulism from contaminated sediment, however, further tests are being carried out.
I have done lots of research because this subject interests me and I like to be informed. I now have a good understanding of virology from learning step by step from a Californian University. I also have an excellent understanding of the effects of H5N1 on mute swans.
I do not recall mentioning ebola, and if I did it would of been in the context that other countries have worse things to contend with than H1N1.
Sutara,
Meaningful figures have gone to pot, but it would be a sign of country co-operation if all countries came forward with reasonable estimates of their situation during this pandemic. This particular flu although relatively mild, gives a clearer picture of the dynamics of flu transmission in the modern world.
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by the way skylineonfire,
Sometimes one has to read the subtext to notice a certain amount of irony. I know you think that we are all clueless, but you will find that most of us pretty clued up. Certain things cannot be said, for all sorts of reasons and therefore one is reduced to irony. I don't give a stuff about H1N1 until I get it. What I do care about is that we stay informed, we educate ourselves and we don't become too complacent. There are so many nuggets of useful information coming through this blog such as the issue of those with egg allergies who cannot take vaccine that uses egg as part of the manufacture, so. stop complaining and come up with something useful.
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sensibleoldgrannie,
As I mentioned somewhere else recently, other countries may, or may not, have adequately robust reporting structures in place or, indeed, have an interest in investing in such mechanisms.
Across the mix of nations on this planet, different governments will take very differing attitudes to health and welfare issues (some even very clearly wanting to suppress information from their own nationals) and also as to what their resources should be used for.
Yes, there is a political, as well as social and financial constructs and contexts to health care.
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The Sensibleoldgrannie wrote: "This particular flu although relatively mild, gives a clearer picture of the dynamics of flu transmission in the modern world."
Very sensible and very insightful. Surprisingly little is known about how disease spreads between people and communities, and how this relates to modern travel patterns and social lifestyles. Science knows quite a bit about the small scale (shedding of virus, binding of transmitted virus and the infection process) and the large scale (international travel patterns maps the disease spread between countries quite well for swine flu) but the scales in between are hard to study, particularly because for normal flu epidemics the picture is complicated in that only a small percentage of the population are susceptible. This mild infection is a great opportunity for us to learn more, and to put us in better position in which to control or mitigate a really nasty strain.
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This is an answer to SkylineOnFire: i wonder if you would have the same opinion if you would be pregnant and suffering from hyperemesis like myself.Before getting pregnant i specifically asked to be vaccinated against normal seasonal flu, knowing the risk it poses during pregnancy. I did that because i have medical studies and i am aware of the risks, but unfortunetly no doctor advised me to do so, so most women don't take this precaution beacuse doctors fail to give out a proper health advice and education. There are categories of people who are at high risk from any type of flu, even if it's a mild strain. NHS's rate of succes should be measured by how they deal with this category, because 90 % of the population is going to be allright without any help or involvement of the NHS. That does not mean the NHS should take any credit for these cases, but important is how they save those unfortunetes falling in a risk category.
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To swinefluconcern : in my opinion getting back to work or school with any kind of infectious disease, whether it is swine flu or anything else, before it is completely resolved is a gesture of disrespect to others.
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http://www.livescience.com/animals/top10_deadliestanimals-1.html - look at this animals kill more people than the swine flu are you going to worry about geting trampled on by an elephant next?
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13. At 1:26pm on 09 Jul 2009, capricornchristina wrote:
"in my opinion getting back to work or school with any kind of infectious disease, whether it is swine flu or anything else, before it is completely resolved is a gesture of disrespect to others."
In a perfect world, I would absolutely agree.
It's just that I suspect that some people will go back to work when they fell 'more or less' o.k. and may still be infectious. Though what actual degree of additional risk to others they present may not be as much as one might intially suspect.
The point is that now that the infection is 'out in the wild', people are very likely to pick it up from one source or another. It is probable that the person's colleagues will blame him/her for their dose of flu, but they really have no idea of where they contracted their infection from at all.
I'm afraid it's not all logically and mathematically 'neat and tidy' anyhow. Some people may have mild versions and think they just have a cold and not perceive themselves as being an infection risk to others. Some people will be asymptomatic.
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sensibleoldgrannie,
Well, here's your next set of numbers.
http://news.bbc.co.uk/1/hi/uk/8142833.stm
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