Flu Shot Unable to Combat Virus Strain

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Flu Shot Unable to Combat Virus Strain

37 minutes ago

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By DANIEL Q. HANEY, AP Medical Editor

Late last winter, a committee of vaccine experts designing this season's flu

shot considered their choices. They had two, and both seemed bad.

AP Photo

AP Photo

Slideshow: Flu Outbreak

In Health

Chronic Heartburn

Need Relief?

More from Health:

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Should they stick with last year's formula, even though a new strain of the

bug was ominously building strength? Or should they try to make a new

vaccine and risk complications or delays that could result in a shortage or

maybe even no vaccine at all?

In the end, the committee voted 17-1 to bring back last year's version, even

though they feared they were telling millions of Americans to roll up their

sleeves for shots that might not work very well.

Many of them probably agreed with Dr. Theodore Eickhoff of the University of

Colorado, who said: " For the first time in many years of participating in

these deliberations, I must add I am very uncomfortable with the

recommendation. "

What Eickhoff and the others dreaded is exactly what happened: that new

strain of flu became the dominant variety, accounting for three-quarters of

all cases as the disease got an unusually early start this fall.

About 83 million doses of vaccine were made, but no one really knows how

much protection from illness it gives. It almost certainly will not be the

usual 70 percent to 90 percent, and some experts fear it is below 50

percent.

" We agonized. We asked repeatedly 'Is there another choice?' " remembered Dr.

s, who chaired the panel and heads infectious diseases at Emory

University. " The bottom line is, we weren't really given a choice. "

Their experience shows the frustrating and often imprecise nature of

humanity's labor to stay ahead of this perennial nuisance and sometime

killer.

The flu virus mutates constantly. The Food and Drug Administration (news -

web sites), with the help of its expert committee, must decide in late

winter what varieties will be the biggest threats. Picking the best

combination is a mixture of science, luck and seat-of-the-pants instinct.

" By the time you know what's the right strain, you can't do anything about

it, " said Dr. Decker, head of scientific affairs at Aventis, one of

the three U.S. vaccine makers.

The first inkling of something worrisome dawned on flu experts at the end of

January. Just two weeks before committees were scheduled to meet at the

World Health Organization (news - web sites) in Geneva and the FDA in

Rockville, Md., to settle on the makeup of this fall's vaccine, scientists

who track the flu noticed a new strain was gathering mass.

The vaccine could theoretically protect against several strains of the

virus, but because production is slow, the shot is limited to just three.

Any of these flu bugs can make people very sick, but since it emerged in

1968 the one most likely to result in pneumonia or death is a type called

H3N2.

Flu viruses are categorized according to the makeup of their two key

proteins, hemagglutinin and neuraminidase, the " H " and " N " in their names.

Changes in the virus' hemagglutinin is especially troublesome, since this is

the protein the human body aims for when it makes antibodies to fight off

the flu.

For five years, the vaccine had protected against an H3N2 strain called

Panama. Now that virus had mutated. A version with two differences in its

hemagglutinin was causing outbreaks in Asia and had also turned up in Europe

and North America.

The FDA's committee met in February and heard the bad news: The current

vaccine might not reliably keep people from catching this emerging strain,

called Fujian.

Nobody knew if the new strain would die out or gain strength, but Dr. Roland

Levandowski, the FDA's flu vaccine expert, warned that new flu variants

sometimes spread rapidly.

The WHO had already postponed its decision on H3N2. The FDA committee did

the same.

When the FDA committee met again in March, the situation was, in some ways,

even worse. Ten 10 percent to 20 percent of H3N2 viruses around the world

were Fujian. But the Centers for Disease Control and Prevention (news - web

sites) was having trouble isolating a sample that could be the basis of a

vaccine.

" This is a very urgent issue, " CDC flu chief told the committee.

" We've been working on this very intensively for what seems like a very long

time. We're very disappointed. "

Still ahead were many other steps, as well. The Fujian strain's

hemagglutinin and neuraminidase genes would have to be transferred into tame

flu viruses that grow nicely in hens' eggs so vaccine makers could produce

them in bulk. Even then, it would take weeks to know if the process would

reliably generate the vast quantities needed.

" It became, Do we go with a vaccine we know will be partially effective? "

remembered Eickhoff. " Or do we wait around and try to identify a possible

candidate strain? "

When the vote came, only Palese, head of microbiology at Mount Sinai

School of Medicine in New York, chose to switch to the Fujian strain despite

the unknowns. He worried that an ineffective formula would give the flu

vaccine a bad name because many people might get sick.

The WHO made the same decision as the FDA. In hindsight, was it correct?

Decker recalled what happened in 2000. Delays resulting from a switch to a

new strain, along with a virus that produced poorly, contributed to a

vaccine shortage.

A last-minute change to Fujian this year " could easily have meant not only a

severe shortage but also the wrong vaccine, " he said. " Right now, people are

saying, 'You idiot, why didn't you choose Fujian?' But what if Fujian had

petered out? "

___

[Guest guest]

This is a good article, a. I wish deciding on the makeup of the

influenza vaccine weren't such a crapshoot.

[ ] Flu Shot Unable to Combat Virus Strain

Flu Shot Unable to Combat Virus Strain

37 minutes ago

Add Health - AP to My

By DANIEL Q. HANEY, AP Medical Editor

Late last winter, a committee of vaccine experts designing this season's

flu

shot considered their choices. They had two, and both seemed bad.

AP Photo

AP Photo

Slideshow: Flu Outbreak

In Health

Chronic Heartburn

Need Relief?

More from Health:

? Check Your Symptoms

? How Is It Diagnosed?

? Available Treatments

Should they stick with last year's formula, even though a new strain of

the

bug was ominously building strength? Or should they try to make a new

vaccine and risk complications or delays that could result in a shortage

or

maybe even no vaccine at all?

In the end, the committee voted 17-1 to bring back last year's version,

even

though they feared they were telling millions of Americans to roll up

their

sleeves for shots that might not work very well.

Many of them probably agreed with Dr. Theodore Eickhoff of the

University of

Colorado, who said: " For the first time in many years of participating

in

these deliberations, I must add I am very uncomfortable with the

recommendation. "

What Eickhoff and the others dreaded is exactly what happened: that new

strain of flu became the dominant variety, accounting for three-quarters

of

all cases as the disease got an unusually early start this fall.

About 83 million doses of vaccine were made, but no one really knows how

much protection from illness it gives. It almost certainly will not be

the

usual 70 percent to 90 percent, and some experts fear it is below 50

percent.

" We agonized. We asked repeatedly 'Is there another choice?' " remembered

Dr.

s, who chaired the panel and heads infectious diseases at

Emory

University. " The bottom line is, we weren't really given a choice. "

Their experience shows the frustrating and often imprecise nature of

humanity's labor to stay ahead of this perennial nuisance and sometime

killer.

The flu virus mutates constantly. The Food and Drug Administration

(news -

web sites), with the help of its expert committee, must decide in late

winter what varieties will be the biggest threats. Picking the best

combination is a mixture of science, luck and seat-of-the-pants

instinct.

" By the time you know what's the right strain, you can't do anything

about

it, " said Dr. Decker, head of scientific affairs at Aventis, one

of

the three U.S. vaccine makers.

The first inkling of something worrisome dawned on flu experts at the

end of

January. Just two weeks before committees were scheduled to meet at the

World Health Organization (news - web sites) in Geneva and the FDA in

Rockville, Md., to settle on the makeup of this fall's vaccine,

scientists

who track the flu noticed a new strain was gathering mass.

The vaccine could theoretically protect against several strains of the

virus, but because production is slow, the shot is limited to just

three.

Any of these flu bugs can make people very sick, but since it emerged in

1968 the one most likely to result in pneumonia or death is a type

called

H3N2.

Flu viruses are categorized according to the makeup of their two key

proteins, hemagglutinin and neuraminidase, the " H " and " N " in their

names.

Changes in the virus' hemagglutinin is especially troublesome, since

this is

the protein the human body aims for when it makes antibodies to fight

off

the flu.

For five years, the vaccine had protected against an H3N2 strain called

Panama. Now that virus had mutated. A version with two differences in

its

hemagglutinin was causing outbreaks in Asia and had also turned up in

Europe

and North America.

The FDA's committee met in February and heard the bad news: The current

vaccine might not reliably keep people from catching this emerging

strain,

called Fujian.

Nobody knew if the new strain would die out or gain strength, but Dr.

Roland

Levandowski, the FDA's flu vaccine expert, warned that new flu variants

sometimes spread rapidly.

The WHO had already postponed its decision on H3N2. The FDA committee

did

the same.

When the FDA committee met again in March, the situation was, in some

ways,

even worse. Ten 10 percent to 20 percent of H3N2 viruses around the

world

were Fujian. But the Centers for Disease Control and Prevention (news -

web

sites) was having trouble isolating a sample that could be the basis of

a

vaccine.

" This is a very urgent issue, " CDC flu chief told the

committee.

" We've been working on this very intensively for what seems like a very

long

time. We're very disappointed. "

Still ahead were many other steps, as well. The Fujian strain's

hemagglutinin and neuraminidase genes would have to be transferred into

tame

flu viruses that grow nicely in hens' eggs so vaccine makers could

produce

them in bulk. Even then, it would take weeks to know if the process

would

reliably generate the vast quantities needed.

" It became, Do we go with a vaccine we know will be partially

effective? "

remembered Eickhoff. " Or do we wait around and try to identify a

possible

candidate strain? "

When the vote came, only Palese, head of microbiology at Mount

Sinai

School of Medicine in New York, chose to switch to the Fujian strain

despite

the unknowns. He worried that an ineffective formula would give the flu

vaccine a bad name because many people might get sick.

The WHO made the same decision as the FDA. In hindsight, was it correct?

Decker recalled what happened in 2000. Delays resulting from a switch to

a

new strain, along with a virus that produced poorly, contributed to a

vaccine shortage.

A last-minute change to Fujian this year " could easily have meant not

only a

severe shortage but also the wrong vaccine, " he said. " Right now, people

are

saying, 'You idiot, why didn't you choose Fujian?' But what if Fujian

had

petered out? "