H1N1 to outpace vaccine in fall

WRHA plots response as flu season approaches


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A fully licensed vaccine against H1N1 flu may not be ready until the end of the year, months after a second wave of flu is expected to hit Canada in the fall, World Health Organization officials said Monday.

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Hey there, time traveller!
This article was published 14/07/2009 (4946 days ago), so information in it may no longer be current.

A fully licensed vaccine against H1N1 flu may not be ready until the end of the year, months after a second wave of flu is expected to hit Canada in the fall, World Health Organization officials said Monday.

That would leave Canada and other nations to decide whether to invoke emergency measures and vaccinate people with only limited information about safety and dosing.

In anticipation of late arrival of the H1N1 vaccine, the Winnipeg Regional Health Authority is considering setting up vaccination clinics early in the fall to inoculate Winnipeggers for the regular, seasonal flu. Instead of holding clinics over a series of weeks as it normally does, the WRHA could try to squeeze those clinics into a few days.

That would do two things, said spokeswoman Heidi Graham. First, it would get regular flu shots done and out of the way before an H1N1 vaccine needs to be doled out. And it would give the WRHA a dry run on a blitzkrieg-style vaccine program so it will be better prepared for a mass outbreak requiring quick action. But, Graham cautioned the idea is just one response the WRHA is looking at.

While the National Microbiology Lab in Winnipeg has done research on test vaccines, it’s not making the vaccine. That’s being done by a private firm.

A vaccine rushed into distribution against swine flu in 1976 in the U.S. caused high rates of Guillain-Barre syndrome, a rare and potentially paralyzing neurological disorder.

Vaccines today "are much better purified than the way they were in 1976, so we really don’t think that it is likely that we will have this side-effect again," said Dr. Marie-Paule Kieny, director of WHO’s initiative for vaccine research.

"But to be absolutely honest, of course, it’s only when you have a large-scale distribution of vaccine that you know with certainty the safety profile of the vaccine."

An expert WHO advisory group has determined that the H1N1 flu pandemic is "unstoppable" and that all countries will need access to a vaccine. The committee is recommending all countries immunize health-care workers first "in order to maintain a functional health system as the pandemic evolves," Kieny said.

The group stopped short of recommending who should be next in line for shots, saying it will be up to individual countries to determine based on their own national strategy.

But the panel targeted several groups for consideration: pregnant women, who are at higher risk of severe disease and death from human swine flu; anyone over six months of age with a chronic health condition such as diabetes, asthma, heart disease or chronic respiratory disease; healthy young people, aged 15 to 49, who have, surprisingly, been shown to be at increased risk of death from swine flu; and healthy children to reduce the disease spread. Children are one of the main vectors of transmission because they gather in groups.

Obese people also made the list of groups worth considering for vaccination. U.S researchers on Friday reported a strikingly high prevalence of obesity in intensive-care patients infected with pandemic H1N1.

The Public Health Agency of Canada is working on a vaccine priority list, deciding where the first batches should go and who should get the injections first. The "attack rate" has been particularly high in young people, with most of those infected under the age of 20.

Dr. Theresa Tam, director general of infectious diseases, said officials are working with regulators to look at ways to "essentially reduce any time required for getting the vaccine out."

"It’s important still to have some of the initial clinical trial data," Tam said. "But if we have only limited information — which I expect we will — then collecting safety data and collecting data on effectiveness as the program rolls out will be very key, and we can potentially adjust our strategy accordingly."

Tam said officials expect vaccinations will begin in early November. The first vaccine doses are already available for testing in humans, "but they are by no means ready to be licensed yet," Kieny said.

As well, flu vaccine is usually grown in fertilized chicken eggs, but yields, so far, have been "poor," Kieny said. WHO’s lab network is trying to generate new vaccine viruses from other viruses isolated from patients. The hope is that at least one of them will produce high yields.

Kieny said vaccines will be available starting in September, but that clinical trials testing safety and dosing will take time. Surveillance networks will need to be put in place or strengthened once the vaccine is deployed, so that any signal "some of the vaccine might not be safe — which we don’t expect, but you never know — would be shared with the international community as soon as possible."

Several vaccine manufacturers, including GlaxoSmithKline, which is under contract to provide pandemic flu vaccine for Canada, are developing vaccines containing adjuvants — powerful compounds that boost the immune response so less vaccine is needed.

So far, 9,717 lab-confirmed cases of H1N1 flu, including 894 hospitalizations and 39 deaths, have been reported in Canada.

— Canwest News Service with files from Mary Agnes Welch and Reuters



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