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As I speculated last week, as a durect result of tests showing only one vaccination might be required to confer full immunity to H1N1/2009 "swine" flu, the WHO is asking the wealthier nations to donate vaccine to the poorer nations.

I had speculated that the United States should seriously consider this option, as long as we could also gain a functional amount of "herd immunity."  Go back two or three blogs and you will find the story, dated 9/11/09.

Here is the story from Bloomberg.  Remember you can always count on this blogsite to give you good, informed speculation.  Share it with your friends!

One-Shot Swine Flu Results May Spur Vaccine Sharing, WHO Says

By Michelle Fay Cortez

Sept. 16 (Bloomberg) -- The World Health Organization is in talks with the U.S. and other developed countries about using pandemic flu vaccine from their stockpiles for poorer nations after studies suggested only one shot is needed for protection.

Half a dozen trials released in the past week found a single injection of swine flu vaccine protected most healthy adults from the virus known formally as H1N1, with infection- fighting antibodies produced in as little as eight days. U.S. regulators approved shots from four manufacturers yesterday, clearing the way for immunizations to start within weeks.

“This is all contingent on these early reports” from the studies, said David Mercer, acting head of the communicable diseases unit of the WHO’s European region, which met in Copenhagen this week. “It may be possible that a single dose is protective, which would double the number of people that could be immunized.”

Public health officials expected it would take two doses to trigger immunity to the infection, a novel mix of swine, avian and human influenza. Countries including the U.S., U.K., France, Belgium, Finland, Sweden and Australia have already placed orders for the vaccine. Additional studies are needed to confirm the finding that only one shot is needed and can ensure protection for children and other high-risk groups.

“Some countries may have excessive stocks of vaccine and some won’t see the demand they have expected,” said Thomas Zeltner, director of Switzerland’s Federal Office of Public Health. “What is needed here is a good dialogue to ensure the reasonable use of vaccination.”

Active Discussions

The U.S. is in “very active discussions” about donating some of its supply to countries that need it, said Nancy Cox, director for the flu division of the U.S. Centers for Disease Control and Prevention. The U.S. has about 600 million doses in advance purchase agreements from GlaxoSmithKline Plc, Novartis AG, CSL Ltd., AstraZeneca Plc and Sanofi-Aventis SA.

In a best-case scenario, the U.S. may need only half that amount, said Rebecca Martin, medical officer at the United Nations health agency’s European communicable diseases unit. It’s too soon to know if that will be the case, she said.

“We welcome the initial findings of some clinical trials,” WHO Director-General Margaret Chan said in a statement. “We cannot conclude now how many doses would be required for different groups.”

The U.K., which has ordered 132 million doses, is still planning two shots for each person and is monitoring the clinical trials, according to a Department of Health spokeswoman who declined to be named in line with government policy.

Age Groups

More data from the studies will be coming in mid-October about how effective the vaccine is in different age groups, Martin said in an interview.

“This is not just in the European region,” Martin said. “We’re all dipping into the same pool of vaccine.”

CSL, based in Melbourne, said it plans to donate the vaccine to developing nations in Asia and the South Pacific and is discussing a pilot program with the WHO to start by providing as many as 100,000 doses. Paris-based Sanofi, London-based Glaxo, and Basel, Switzerland-based Novartis are among the other companies making the vaccine.

As many as 2 billion people, or 30 percent of the world’s population, may become infected by the new virus as it spreads globally, according to the Geneva-based WHO. While fewer than 0.5 percent of sufferers may need hospitalization, those who do may require critical care for up to three weeks, overwhelming intensive-care units.

Concern that vaccine bought by governments might not get used by their people may make countries more inclined to share supplies with poorer nations, said Marie-Paule Kieny, director of the WHO’s Initiative for Vaccine Research.

“Some countries may take a more altruistic view now,” she said. “We will see this fear of not being able to use all of it and concern of public money being spent unwisely, and you may now start to see generosity mushrooming.”

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Well, it was an interesting weekend.  It all started Friday afternoon, as the day was winding down.  I got a call from my daughter, Mailin, who teaches fifth grade at a local private school.  She was suddenly feeling quite ill after an otherwise uneventful day, and had gone to the school clinic.  Her temperature: a hair under 102 degrees F.

What should she do, she asked?  I told her to immediately go home and go to bed.  I then called my wife and told her to get a box of Tamiflu from our strategic reserve and place it in her room and to start her on Tamiflu immediately.

When our daughter got home, she actually misread the directions and took two Tamiflu capsules (this may factor in later in the story), and went straight to bed.  My wife prepared chicken soup and gave a heaping portion to her, along with two Advils.  She complained of headache; a very sore throat; body aches; she had suddenly acquired a nasty-sounding cough; and she was in extreme fatigue.

I, of course, sprung into immediate action, and went straight to the football stadium to call the Lincoln High football game (a 28-3 win over Daytona Beach Spruce Creek).  On the way home, I stopped at Wal-Mart and bought out their remaining supply of N-95 respirators along with an extra box of disposable gloves.  When I returned home, my wife and I "masked up," donned gloves and entered her bedroom, now referred to as her "bubble."  My wife took her temperature while I pulled "solid surface detail," cleansing every possible solid surface she had touched in her bathroom and bedroom with Clorox wipes.  Her fever had reduced to just over 101 degrees F.

I also suggested to my wife, who is a recent chemotherapy patient, that she should start on Relenza immediately as a preventative.

The following morning, her fever had returned, registering nearly 102 degrees F again.  We immediately "masked and gloved up" and repeated the previous evening's work.  Since she had taken twice the normal dose of Tamiflu the day before, she had not had any Tamiflu since around 4PM Friday.  So my wife gave her the first Tamiflu of the new day, while I cleaned and cleaned and cleaned some more.

Now I am reminded of what Jesus Christ said about being a prophet in one's own country.  To paraphrase, being a "flu expert" in one's own household means getting a second opinion.  So my wife called our family doctor and left a message.  Soon enough, a call came from one of the nurses on duty.  My wife Marta relayed all the symptoms.  Additionally, she conveyed the results of a phone call received that morning from another teacher at the school.  A child in Mailin's class had tested positive for swine flu.  Marta also disclosed that we had placed our daughter on Tamiflu.

Yes, the nurse said, that fits the bill for swine flu.  Keep Mailin on the antiviral.  Also, she instructed us to both go on Tamiflu as a preventative.  Marta hung up the phone and looked at me.  I, of course, being the loving husband I am, took every opportunity to remind her that the doctors completely agreed with my diagnosis and treatment.  She, in turn, refused to go on Relenza but did start on Tamiflu, one capsule a day -- the same dosage I had recommended.

Now Relenza is an interesting medication.  I knew it used an inhaler but had never worked the damn thing before.  I always thought it worked like an asthma inhaler.  Wrong!  Theory is one thing; practice is another.  Fortunately, Glaxo has a full-color, photo-filled set of instructions so complete that even a middle-aged dude who hates to read the manual can follow along.  Pull off the blue cover to the mouthpiece.  OK.  Now pull out the mouthpiece until it clicks.  Now pinch the little doobers and withdraw the full apparatus.  WTF!  Now open the cylinder that came with the inhaler and withdraw the disk with the four little bubbles on it, looking like the bottom of the UFO from The Invaders.  Place the disk into the slot, bubbles down.  Now close it all back up.

But wait, as the late Billy Mays would say, there's more!  Now lift up this lever and lift it until it is completely perpendicular to the inhaler.  KEEP EVERYTHING LEVEL or you'll spill the medicine!  Okay, okay!  Now return the lever to its original position and exhale as much as you can!  Now INHALE DEEPLY while keeping the inhaler level, but DON'T COVER THOSE LITTLE HOLES ON EITHER SIDE OF THE MOUTHPIECE!  Okay, okay!  Now hold your breath and let the medicine get deep into your lungs!

I held my breath and kept the air in my lungs as long as I could, taking care not to cough and expunge all that medicine.  All this reminded me of some questionable activity I engaged in way back in my youth, when holding stuff in the lungs was de rigeur,if you catch my drift.  Then I had to exhale and pulled out the mouthpiece, which turned the disk one quarter turn, prepping the next dose of Relenza.  I lifted the lever, puncturing the next blister, and re-inhaled.

That afternoon, our daughter ate some more, and in the evening, her fever had stabilized.  She took her evening Tamiflu and stayed in bed.

Sunday, we repeated the exercise.  She began feeling somewhat better and was very thirsty.  Today, she is doing much, much better.   She asked, When can I come out of my bubble! Once we know she is fever-free for 24 hours without the assistance of fever-reducing medications, she should be able to return to her teaching duties.

I have been doing this Relenza regimen for three days now, two puffs a day.  My wife is still on Tamiflu and I credit her with making a sound decision.  The  inhaler for Relenza is a bit of a bother! 

Here are some takeaways from my experience:

First, having a private stockpile of Tamiflu is very beneficial.  Not everyone can have as sympathetic a doctor as I, but having the stuff on hand meant she did not have to wait an extra minute for antivirals to be purchased.  That, in my opinion, was a huge advantage.  Otherwise, she would have had to wait until a prescription was called in.  And what if the local pharmacy had been sold out of Tamiflu?  We would have been forced to do what Australian mothers did last year; namely, drive across their cities in a vain search for antivirals.

And with my daughter's cough, there was no bloody way she was going to be able to take Relenza deep enough into her lungs.  No way.

Second, being well-versed in the symptoms of influenza was absolutely important.  Knowing when to pull the trigger was based on sound diagnosis and making quick decisions.

Third, Tamiflu is an amazing substance!  We know a family whose child's temperature reached 105 degrees F. until it began to subside.  Contrast this with the shortened fever cycle experienced by our daughter.  I am all about Tamiflu!  I agree with the late Graeme Laver that it should be an over-the-counter medicine today.  My daughter (she is 26) has had zero side effects.  Neither has my wife. And neither have I with Relenza, save for some issues with lung capacity. ;-)

Fourth, you can't find enough solid surfaces to clean.  Light switches, door handles, sink knobs, toilet flushers, toilet seats, and on and on and on.  But you've got to hit them all, to make sure you nailed the virus.

Fifth, we are still monitoring our daughter's cough.  If it gets worse, or doesn't get better very soon, off to the doctor she will go.  As we all know, pneumonia -- both bacterial and viral -- is a persistent side effect of this flu (or any flu, really).  So we are very sensitive to that cough and what it could still turn into.  That is also, quite frankly, why she did not return to work today. That, and the desire to ensure completely fever-free behavior for 24 straight hours.

Sixth, it is absolutely amazing how quickly this virus hits.  The day before, she was fine and full of vigor.  This reminded me that she had been shedding virus for at least a day or two prior to the onset of symptoms, and meant my wife and I had both come into contact with the virus.  We won't know if our ages or the antivirals (or both) might have warded off this virus, but ordinarily both of us should have been stricken with the flu by now.  The fact that three days have passed (even more when you factor in the incubation period) and we are not feeling sick is testament to quick preventative use of antivirals.

Seventh, I cannot help but wonder if "doubling up" accidentally on the initial dosage of Tamiflu was beneficial.  We having double the amount of antivirals a huge kick, like doubling the first dose of antibiotics? 

All in all, it was a unique chance to put theory to practice and to apparently come out of it none the worse for wear.

So how was your weekend?

The newspapers are positively aglow with the recent studies which seem to indicate the H1N1/2009, (aka swine flu) vaccine can confer immunity with one shot, and after only ten days. And justifiably so!  For the news is good.

Previously, scientists and researchers postulated that it would take two jabs, spaced three weeks apart, in order to deliver enough attenuated inert virus  to confer immunity to swine flu.

So this study, on the surface, is decidedly good news.  The ramifications of this are nothing short of spectacular.  First, it means the entire seed virus-to-vaccine chain performed surprisingly well and was also surprisingly nimble.  As you recall, initial seed virus stock was very slow to grow, and the CDC and WHO had to whip up a faster-growing batch of seed virus stock to send to vaccine manufacturers.

Second, there had to be enough eggs, and those eggs had to be free of cross-contamination.  So as Earl Butz, late of this earth and the Ford Administration famously said, the roosters of America did their duty.

It also means very little virus "drifted" during manufacturing, and it speaks volumes about the research and quality control that the vaccine industry has undertaken since the debacle of 2004-05's flu season.  For more information and a superb primer on vaccine manufacture, read the book "A Warning Shot: Influenza and the 2004 Flu Vaccine,"by Timothy Brookes and the staff at Johns Hopkins. 

The US government ordered 195 million doses of the new H1N1/2009 monovalent vaccine.  The calculus performed was that most Americans would need two jabs, as I said earlier.  Now if these initial test results hold firm, it means we will now have double the available vaccine than we thought we had a month ago.

The projected available vaccine doses equals 62% of the American population.  I dare say that if we were to vaccinate everyone in the high-risk groups, plus virtually all school-age children under 25, we stand a very good chance of reaching the Holy Grail of Herd Immunity. Herd Immunity is when enough people are vaccinated against a virus, that virus can no longer gain a beachhead in a community.  It fails to achieve the critical mass necessary to sustain human-to-human transmission.  Herd Immunity means the virus cannot infect enough hosts in a chain, and the chain breaks.  Think a viral chain mail/email scheme that breaks due to unwilling participants.

Same thing:  The virus' chain of transmission is broken when enough people are vaccinated, predominantly the young.  It is the young -- schoolchildren and college students -- who pass this virus (and all flus) on to their family members and then on to the community at large.  You break that chain, you break the pandemic.

So the Quest for Herd Immunity against a pandemic virus is within the reach of Americans.  It decidedly does not mean the same for persons within developing nations, however.  And I would not be the least bit surprised if persons such as Supari of Indonesia and others begin clamoring for vaccines, since everyone thought it would take two jabs anyway. It might be appropriate for the favored nations to siphon off some of their vaccine to the WHO for use in developing nations. 

Even if we were to siphon off some vaccine, the goal of herd immunity against H1N1/2009 could be within reach.  Let us hope that the final test reports confirm the initial speculation.  We could use some good news now!

CIDRAP stands for the Center for Infectious Disease Research and Policy at the University of Minnesota.  Its director is the world-famous Dr. Michael Osterholm.  Dr. Osterholm advises everyone from the White House to Oprah on infectious disease.  Dr. Mike is also an expert on bioterrorism and has advised DHS many times on lethal bio-engineered pathogens.  He wrote a book, Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe. I should point out that Dr. Osterholm wrote this a year before the anthrax attacks of October, 2001.

The upcoming summit is titled "Keeping the World Working During the H1N1 Pandemic -- protecting employee health, critical operations and customer relations."  Its focus is on those final steps that corporations, businesses and governments need to take to ensure they do not implode when the second and third waves of H1N1 traverse the globe.

Brazil has just passed the United States in the number of confirmed deaths due to H1N1(2009)V Skyhook swine flu. Or whatever the Heck we are supposed to call it these days.

Anyway, the number down there is 557, compared to 522 in this nation. This is a race we do not need to win. Argentina is third, with 439 deaths.

The bad news within the bad news is that South America leads the world not just in the sheer numbers of swine flu deaths, but in overall mortality.This is further reinforcement of the blog I wrote a few weeks ago, talking about just how hard South America got hit with H1N1v.

Here's the AFP story:

Brazil tops global swine flu toll with 557 deaths: officials

(AFP) – 17 hours ago

SAO PAULO — Brazil now has 557 swine flu deaths, making it the country with the highest number of fatalities in the world from the disease, according to figures announced by the health ministry Wednesday.

The toll puts it ahead of the latest count from the United States, which as of August 20 had 522 swine flu deaths, according to the US Centers for Disease Control and Prevention.

Brazil's health ministry said in a statement the government was freeing up one billion dollars to buy 73 million doses of a new vaccine being developed against swine flu, as well as Tamiflu stocks, hospital equipment and diagnostic gear.

It added that the infection rate appeared to be diminishing in the country, which is about to exit the southern hemisphere winter at the end of this month.

The ministry stressed that, as a ratio of its population of 190 million, Brazil's mortality rate from the virus ranked 7th in the world.

Argentina, Chile, Costa Rica, Uruguay, Australia and Paraguay all had higher rates on that basis, it said, referring to data from the European Center for Disease Prevention and Control.

The United States, which has a population of 300 million, came 13th on the list.

The Americas is the worst-hit region in the world in terms of swine flu deaths, accounting for more than 90 percent of the global count given by the World Health Organization.

After Brazil and the United States, Argentina is the country to suffer the most, with at least 439 swine flu deaths.