One Targeted Strain Has Mutated
The Centers for Disease Control and Prevention has issued an advisory to American doctors that the current version of flu vaccine being used will be less effective than expected because one of the strains of the virus targeted by the vaccine has since mutated into a new form. The CDC continues to recommend getting the vaccination, because it will still provide protection against other strains of the virus, and can lessen the severity of the effects of the mutated strain. It also endorses the use of antiviral drugs such as Tamiflu and Relenza to limit complications for those who suffer severe flu symptoms. One silver lining: the latest CDC figures indicate that flu activity nationwide is lower than usual this year.
Making It Mandatory
New York City has joined New Jersey, Connecticut and other states in requiring children in licensed day-care centers and preschools to receive flu vaccines. Rhode Island will enact a similar law in 2015. Evidence suggests that requiring flu vaccinations for preschoolers is effective, say researchers at the Yale School of Public Health in CT where a flu-shot law was enacted in 2010. Mandatory vaccination has a positive impact outside of preschools, says Yale Professor James Hadler. It also helps protect those who can’t be vaccinated for medical reasons. Detractors say that because the vaccine in any given year is only about 60% effective, it’s not worth forcing people to get it. The CDC recommends flu vaccinations for all healthy people over the age of 6 months.
61% of Hospitalizations
Adults aged 18-64 were the hardest hit group this flu season accounting for 61% of hospitalizations and about 60% of flu deaths compared with 18%, 30% and 47% for the three previous seasons, reports the Centers for Disease Control. "One of the reasons flu is hitting young adults hard is such a low proportion get the flu shot," said CDC Director Tom Frieden. People with underlying illness such as diabetes, lung problems and obesity were at highest risk. According to Anne Schuchat, National Center for Immunization and Respiratory Diseases, only about 15% of adults hospitalized with flu didn’t have an underlying medical issue. The CDC says this year’s flu season will continue for several more weeks, especially in the Northeast and West Coast.
Flu season has begun in the U.S. with flu activity increasing nationwide and six southern states reporting high numbers of cases. They are AL, LA, MO, MS, OK and TX, say CDC officials. The strain of flu that’s dominating early in this season is the H1N1 virus, the same strain that caused the flu pandemic in 2009. H1N1 sickens mostly younger adults, ages 18-49, and those ages 49-64. CDC officials have already received reports of serious respiratory illness and death in these age groups. The CDC reports that it’s too soon to gauge the seriousness of this year’s flu season or how well this year’s vaccine matches the prevalent strains. However, they still recommend that everyone older than six months of age get an annual flu shot. Flu season usually peaks in the months of January and February.
Fifty Percent Effective
A new high dose flu shot is more effective in seniors than the standard flu shot finds a new study. The high-dose flu shot is about 50% effective in people ages 65+ whereas the regular flu shot is about 30 to 40% effective in the same population. (The regular flu shot is about 60% effective in younger people.) The FDA licensed the higher-dose flu shot in 2009 after a study showed it to be more effective n seniors but this is the first study to measure how much protection the vaccine actually provides. The study involved 32,000 Canadian and American seniors, half of whom got the regular shot while half got the new shot. Follow-up calls and tests to confirm flu symptoms indicated that the high-dose shot was 24% more effective against all strains of the flu.
Protects Against, Uh, Flu, Too
Getting a flu shot may lower the risk of heart attack and other cardiovascular events for a year, finds research from the University of Toronto that looked at studies on the heart health of 6,735 men and women with the average age of 67. Half got a flu shot; half got a placebo or standard care. One-third of patients had heart disease while the rest had risk factors including high blood pressure or high cholesterol. Patients who had suffered recent heart attacks and who got flu shots had a 55% lower risk of having another major heart event. “This could be a vaccine against cardiovascular events,” said cardiologist Dr. Jacob Udell. He said it was his hope that the flu vaccine would prevent heart issues for “potentially everyone,” including those who had not had a recent heart event.
Stumped for Reasons
This season’s flu vaccine was largely ineffective in people 65+, says the Centers for Disease Control. This may explain why hospitalizations and flu-related deaths are among the highest recorded for this age group. Early estimates indicate that the vaccine was 9% effective for people aged 65+ and 56% effective for younger people. Researchers don’t know the reason for the vaccine’s failure but say that all vaccines are less effective as people age. But seniors should not eschew the vaccine. "We obviously need a new and better vaccine but this is the one we have now. It's still prevented many hospitalizations and deaths,” says William Schaffner, Vanderbilt U. People 65+ are at high risk of being hospitalized or dying of flu. Even moderate protection is helpful, says the CDC’s Joe Bresee.
No Sign of Peaking Yet
Twenty-nine states reported high levels of flu, up from 16 the previous week, according to the Centers of Disease Control’s latest figures that indicate no sign of a peak. “I think we’re still accelerating,” says the CDC’s Tom Skinner. Forty-one states reported widespread activity, up from 31 in the last report. While the CDC’s numbers, based on doctor visits, can lag about two weeks behind real-time activity, Flu Near You, a new tracking tool, may offer more immediate data. It also indicates that a number of people who were vaccinated still developed confirmed strains of the flu. The CDC says it’s not yet possible to know whether that’s happening more regularly this season but it seems that this year’s vaccines are well matched for the strains of the virus that are circulating this year.
No Shot, No Job
Eight Indiana hospital workers were fired after refusing to get flu shots under a new hospital policy that makes the vaccine mandatory for staff and volunteers. The policy is intended to protect patients from the virus, which could be fatal. The new requirements came as a recommendation from the Centers of Disease Control, the American Medical Assn. and other major health agencies. Joyce Gingerich, who refused the shot citing religious beliefs said, “I knew that I could not compromise my personal belief system for a job.” Under the new policy, hospital staff had the option to file medical or religious exemptions from the vaccine. Gingerich and the other abstaining employees hired an attorney to write their exemption recommendations which were rejected by hospital officials.
Early Widespread Activity
This flu season could be a bad one say medical experts who cite an earlier start with widespread activity across the US, particularly in the south and southeast. To date, the percentage of people who sought medical care for flu-like symptoms has reached the national baseline of 2.2%. This is the earliest this has happened in nearly a decade. High levels of flu activity have been reported in AL, LA, MI, TN and TX with 30 states reporting activity ranging from widespread to local, up from 8 states that reported local activity last week, says the CDC. In fact, last year’s flu season started late and experienced an uptick in February, prompting experts to predict a bad flu season. They urge people to get flu shots now saying the key to preventing the flu is getting the shot.
Get Em Early
Flu season begins in October and the Centers for Disease Control urges everyone, 6 months and up, to get their flu shots now. It takes 2 weeks for protective antibodies to build up in the body and therein lies the urgency. Last year 46% of the population got flu shots; only 47% of pregnant women, who are at increased risk for hospitalization if they get the flu, got shots. Several vaccination options are available including an intradermal shot that uses a short, thin needle and a nasal spray vaccine that’s recommended for healthy people ages 2-49. The latter is not recommended for pregnant women. The vaccine is only about 60% effective; getting it does not guarantee you’ll be flu-free. However, it’s be best way to protect against the flu and lessens symptoms should you contract the virus.
Three Strains Targeted
The Food and Drug Administration has approved a new flu vaccine for the upcoming flu season. The new vaccine was designed in conjunction with The World Health Organization and the Centers for Disease Control and Prevention to target three viral strains most likely to cause flu. "There is always a possibility of a less than optimal match between the virus strains predicted to circulate and the virus strains that end up causing the most illness," says the FDA. But even if this is the case, “the vaccine may reduce the severity of the illness or may help prevent influenza-related complications." The CDC estimates that between 5% and 20% of Americans get the flu each year and recommends that people over 6 months of age get the flu vaccine.
More Viruses = More Immunity
Results from experiments conducted in Canada suggests that the number of influenza viruses that infect mice the first time around determines their ability to fight off other strains of the flu after that first exposure. Mice were inoculated with a high or low dose of influenza A (H3N2), and although there was more morbidity and inflammation in the high dose group, they were able to mobilize more CD8+ T cells, which kill virally-infected cells, into their lungs and made more memory CD8+ T cells compared to the mice in the low dose group. Mice from both groups were re-infected two months later and those who initially received the higher dose handled the infection better. Researchers hope these results him them in developing a flu vaccine that protects people against multiple strains.
More Universal Flu Vaccine Hope
Research conducted at Children's Hospital Boston found CH65, a flu antibody which neutralizes 30 to 36 influenza strains, adding to hopes that a universal flu vaccine is on the horizon. Each year before flu season scientists have to figure out which strain the vaccine should target and hope they are right but this antibody and FI6 which was recently discovered to fight all the A flu viruses could make that process obsolete. Like FI6, it came from a human donor cells and works by binding to hemagglutinin, a viral protein that regularly mutates and drives the annual development of the vaccine. Lead author Stephen Harrison was excited about these results and is optimistic that this knowledge will give scientists the ability to make a vaccine that will protect against all flu strains.
Closer to Universal Flu Vaccine
Studies in mice show that the antibody FI6, isolated from plasma cells screened for that particular antibody, protects against all 16 subtypes of influenza A viruses. Vaccinated mice were protected from large viral doses and researchers believe this is a huge step towards a universal flu vaccine, eliminating the need to develop a vaccine against the strain likely to predominate before each flu season. The antibody targets a viral protein called hemagglutinin which often mutates and gets killer cells to the infected cells on top of neutralizing the virus. Although most strains are not pathogenic, some can be deadly for individuals with weakened immune systems. Researchers believe a universal flu vaccine may be available in 5 years.
Covers More Strains, Last Longer
By trying to develop a vaccine to prevent HIV, Bionor Pharma, a pharmaceutical company in Norway is developing a flu vaccine that works by destroying cells that get infected by the virus, preventing its spread. When the virus infects cells, protein fragments called peptides are expressed on the cell’s surface. Most strains of influenza have peptides with similar regions. Theoretically, this would allow for a vaccine to be developed that teaches the immune system to recognize and destroy these peptides, regardless of the influenza strain which can mutate. This may also make the yearly flu vaccine that is developed based on what the predicted strain might be obsolete. The company has many years of research and clinical trials before such a vaccine could be approved and put on the market.
Unlimited Quicker & Non-Allergic
Flu vaccines made from virus that is grown in cells protected 80 percent of people against the flu during the 2008-2009 season compared to people who were injected with a placebo. Seventy-three percent of people given the traditional egg-based vaccine were protected. There are several advantages over the 50 year old technique such as being able to produce an unlimited supply of vaccine, less time to produce it and those who are allergic to the eggs can receive it. Although predictions about H1N1 being more lethal than previous strains never came true, there is a concern that in a pandemic the demand would not be met with the current method of manufacturing. A large-scale human clinical trial that will prove its effectiveness has yet to be performed.
Coming to a Town Near You?
Have you had a flu shot yet? Flu season is well underway, according to a report from the Centers for Disease Control and Prevention. The current data says that five states reported widespread cases of influenza at the end of December, up from zero reports of the illness mid-month. The states reporting the most cases of influenza are Alabama, Georgia, Mississippi, Virginia and New York. Health officials estimate that there about 23,600 flu-related deaths annually. The CDC report also states that tests of more than one hundred virus samples show that this season’s flu strains seem to be well-matched to the current flu vaccine.
Mom’s Shot Protects Infants
A three-year study conducted at Yale School of Medicine showed that women who got the influenza vaccine when pregnant were 91.5 percent effective at keeping their infants from being hospitalized due to the virus. Researchers looked at infants with influenza hospitalized at Yale-New Haven Hospital and compared them to a matched group of infants that did not have the virus. There is no vaccine for infants under 6 months old, so these results are great news to researchers looking for ways to protect them. Influenza can be very serious in pregnant women and this study demonstrated another benefit of vaccinating pregnant women. The complete study can be found in the December 15 issue of Clinical Infectious Diseases.
Adult immunizations are far below what they should be, says data from the Centers for Disease Control and Prevention. Despite CDC recommendations that everyone over six months of age get a flu shot, one-third of people over the age of 18 were immunized last year. The CDC recommends that all adults over 60 get a shingles vaccine, but only 10 percent of that group received it. Says Dr. William Schaffner, president, Natl Foundation for Infectious Diseases, "the system is uncoordinated, meager and, it turns out, quite unsatisfactory." While the new healthcare law makes adult immunizations a priority, it’s not perfect. For example, in 2011, Medicare beneficiaries will receive some preventive services for free, but not vaccines. This issue is under review with a study due next spring.
Not for Infants
In a departure from previous recommendations, the US government is urging everyone over the age of six months to receive a flu vaccine. This year’s vaccine protects not only against H1N1 but also against two other strains of influenza. Previously, the recommendations focused on vaccinating people in high-risk groups, such as medical workers, or those in contact with high-risk people. The Advisory Committee on Immunization Practices, a panel set up by the Centers for Disease Control and Prevention, issued the recommendation. They cited last year’s H1N1 outbreak, which affected people not usually in high-risk groups, as part of the reason for the new guidelines. The vaccination will soon be available at doctors' offices and local pharmacies.
As a Condition for Employment
"It is a good ideal for healthcare workers to get vaccines, but there is never enough"
- Chasity Myers in the comments
In a paper released by the Society for Healthcare Epidemiology of America (SHEA) and endorsed by the Infectious Diseases Society of America (IDSA), medical experts say that health care workers should receive mandatory flu vaccines to ensure patient safety. They emphasize that flu vaccinations be a condition of employment for all healthcare workers regardless of whether or not they have direct patient contact. In fact, they write, the only exemption should be due to medical contraindications. "Vaccination of healthcare personnel saves patients' lives and reduces illness. It also protects the individual worker from falling ill during influenza outbreaks and from missing work, which further impacts patient care,” says IDSA President Dr. Richard Whitley.
The Ultimate Flu Vaccine
NIAID is testing a flu vaccine that may end the need to produce a new one every flu season. The virus mutates a little every year, sometimes to a very virulent strain, such as H1N1, also known as “swine flu.” It would initially be given with the annual shot, but the hope is to end that. The vaccine is designed with much newer technology than grows the virus in chicken eggs. DNA based on the hemagglutin protein that is part of the virus is made and causes the body to produce an antibody to a part of the protein that is conserved between all strains. Flu strains from the years 1934 to 2007 were tested against the vaccine in ferrets and mice and they produced antibodies against them. The goal is to produce a vaccine that protects people for many decades or a lifetime.