Fighting Flu

Last night I participated in my annual healthcare lottery. Fortunately for my finances, this didn’t involve scratch cards, ticket stubs or wheel spinning of any kind, nor will it bring me great riches, a new car or a timeshare condo. Instead, if my gamble pays off, I might be spared the flu this winter season.

However, this may be one of the last years that I have to keep my fingers crossed that the vaccine might work.  In future years getting a flu shot may become a safe bet.

In a significant step against the disease that affects billions of people each year, scientists at Oxford University in the UK, just announced that they have successfully tested a universal flu vaccine that could work against all known strains of the illness.

This new vaccine targets a different part of the flu virus to traditional vaccines, meaning it does not need expensive reformulation and guess work  every year to try and match the most prevalent strains of the virus that are circulating the world.

The team, led by Dr Sarah Gilbert at the Jenner Institute, developed a vaccine that targets proteins inside the flu virus that are common across all strains, instead of those that sit on the virus’s external coat, which are liable to mutate.

If used widely, a universal flu vaccine could prevent pandemics, such as the swine flu outbreaks of recent years, and could even end the need for a seasonal flu jab.

A universal vaccine would save the time and money now needed to create vaccines to fight whatever particular virus has emerged in any given year.  The process of developing a seasonal vaccine takes at least four months and if the flu strain is highly pathogenic the delay means people get sick and die before the vaccine is ready.

“If we were using the same vaccine year in, year out, it would be more like vaccinating against other diseases like tetanus,” said Gilbert. “It would become a routine vaccination that would be manufactured and used all the time at a steady level. We wouldn’t have these sudden demands or shortages – all that would stop.”

While traditional vaccines prompt the body to create antibodies, Gilbert’s vaccine boosts the number of the body’s T-cells, another key part of the immune system which can identify and destroy cells that have been infected by a virus.

In her trial, Gilbert vaccinated 11 healthy volunteers and then infected them, along with 11 non-vaccinated volunteers, with a strain of flu virus.  She then monitored the volunteers’ symptoms twice a day.  Her results showed that the vaccine worked as planned.

“Fewer of the people who were vaccinated got flu than the people who weren’t vaccinated,” said Gilbert. “We did get an indication that the vaccine was protecting people, not only from the numbers of people who got flu but also from looking at their T-cells before we gave them flu. The people we vaccinated had T-cells that were more activated. The people we hadn’t vaccinated had T-cells as well but they were in a resting state so they would probably have taken longer to do anything. The volunteers we vaccinated had T-cells that were activated, primed and ready to kill. There were more T-cells in people we vaccinated and they were more activated.”

The trial proved two important things about the vaccine: First, it showed that it was safe; and second it proved that giving people flu virus in the presence of lots of T-cells induced by the vaccine was absolutely fine.

“What we’ll probably do is take the existing flu vaccine and mix in the new virus-vector vaccine, so you get both good antibodies and good T-cells. As well as giving you the antibodies for this season’s strain of flu, we’ll give you some T-cells that will cover this season, next year, and thereafter. It may not be 100% effective against all strains, but at least if there were a pandemic coming around, it would cover you for any strain.”

It is also believed that the vaccine could provide better protection against flu for older people. Traditional flu vaccines are effective in about 70-80% of young people, but only 30-40% of older people, because the older people’s immune systems are less efficient at making new antibodies.

The next step for the new vaccine is a larger scale trial comparing several thousand people who are given and not given the vaccine.

Although that means a commercial product is still some years away, this study represents some potentially very exciting findings not only for flu but possibly for other infectious diseases.

SRxA’s Word on Health looks forward to bringing you this news as it happens.

Not so Rotten Eggs!

As someone who stood in line for 3 hours to receive my H1N1 vaccine last year, only to be turned away by an officious clipboard wielding nurse, this Word on Health blogger just had an “I told you so” moment!

According to new recommendations by the American Academy of Allergy, Asthma & Immunology (AAAAI), anyone with a history of suspected egg allergy should first be evaluated by an allergist or immunologist for appropriate testing and diagnosis but can probably receive the vaccination.

Matthew J. Greenhawt, M.D., and James T. Li, M.D., Ph.D., from the Department of Internal Medicine at Mayo Clinic, have co-authored the guidelines based on recent studies that show that even the most egg-allergic individuals can receive the flu vaccine safely under the care of their allergist/immunologist.

As I know only too well, in the past, people with egg allergy were told they could not have the flu vaccine because it contained egg protein which could potentially trigger an allergic reaction. However new research shows that not only do flu vaccines contain only tiny amounts of egg protein, the vast majority people with egg allergies don’t react.  Indeed it seems that many people with diagnosed or suspected egg allergy can receive the influenza vaccination successfully, if simple precautions are followed.

These include:

• Anyone with a history of suspected egg allergy should first be evaluated by an allergist or immunologist for appropriate testing and diagnosis
• Patients with a confirmed egg allergy can then receive the vaccine safely using one of two protocols: a two-step graded challenge or a single, age-appropriate dose

“It is not necessary to withhold influenza vaccination from egg-allergic patients,” says Greenhawt. “Our recommendations provide two flexible approaches to vaccination. Each approach is backed with recent evidence that it is safe. Most allergists should be able to identify with one of our recommended approaches and, as such, be able to vaccinate their egg-allergic patients with confidence.”

So, Nah! Nah! Na! Nah! Nah! to you officious nurse.  Who has egg on their face now?

Do you have vaccine stories to share?  Word on Health would like to hear them.

The end of swine flu?

Word on Health breathed a big sigh of relief earlier this week when the World Health Organization (WHO) declared the official end of the influenza A (H1N1) pandemic.

According to WHO the virus has largely run its course and we are now in the “post-pandemic period.” In other words, the virus is now expected to take on the behavior of the seasonal flu virus.

Does that mean we can expect to see few people wearing surgical masks in airplanes and on the Metro?  Will it be safe to leave our homes and desks without our bottles of hand sanitizer?

Can we revise our infectious disease presentations once again and consign H1N1 to the box of viruses of former concern, along with Ebola and SARS?

Was all the fuss worth it?

Responding to concerns that the agency acted too hastily in declaring a pandemic  last June, the WHO said it was “the right call.”  WHO Director-General Margaret Chan added that “we have been aided by pure good luck.” Chan noted,  if the virus had mutated then the current death toll of around 18 500 could have been much higher.

For those of you who can’t quite shake off the fear of H1N1, the good news is that the regular 2010 flu shot will contain protection against swine flu too.