HEADLINE: Swine flu resembles feared 1918 flu, study finds

SUMMARY: Like the 1918-19 Spanish flu that killed millions, the novel H1N1 strain is more likely to cause pneumonia than regular flu viruses because it has a greater ability to infect the lungs, researchers reported this week.  Animal testing confirmed other studies that have shown the new swine flu strain spreads more easily beyond the upper respiratory tract to go deep into the lungs.

STORY LINK: http://www.msnbc.msn.com/id/31889365/ns/health-swine_flu/

HEADLINE: WHO says healthcare workers should get first H1N1 shots

SUMMARY: Governments should put healthcare workers first in line for pandemic H1N1 vaccine when it becomes available in order to keep their health systems functioning, the World Health Organization recommended. Next in line for vaccine would be groups that are most vulnerable to severe H1N1 infections, such as pregnant women, people with chronic health problems and young adults. At the same time, the WHO reported that manufacturers growing the candidate vaccine viruses are getting relatively poor yields and it may take longer to fulfill their existing contracts.

STORY LINK: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jul1309who.html

ANALYSIS: As the H1N1 influenza virus continues to spread around the globe this week, multiple news stories have drawn attention to ongoing research, planning factors and efforts to produce an effective vaccine.  From a preparedness perspective, these are interrelated matters.  A University of Wisconsin-led study has shown the current swine-origin H1N1 strain able to penetrate deeper and replicate in the lungs more readily than recent seasonal influenzas.  This is significant because the ability to travel and survive deep in the lungs was a characteristic of the deadly 1918-19 pandemic.  While there is still no way to predict how virulent the H1N1 strain will become by autumn, this discovery points to the potential that it can evolve to a more serious health threat.

The seriousness of this possibility is increased by low yields in flu antigens used to manufacture an H1N1 vaccine – a quarter to half the amount normally produced for seasonal flu vaccines.  Public health officials and manufacturers indicate it may be January before current orders for some 900 million doses are fulfilled, well behind the start of the flu season.  Still unsure is whether it will take one or two immunizations to achieve immunity; the greater number effectively cutting the vaccine supply in half.  WHO-affiliated laboratories are working to produce additional vaccine viruses that can produce greater antigen yield, but it is impossible to predict if this will be successful.

The continuing – and predictable – uncertainty drives the need for pragmatic planning and prioritization of limited resources, including vaccine supply.  The WHO has recommended healthcare workers get the first H1N1 shots, to maintain the effectiveness of the care delivery system.  While this may seem intuitively obvious, the planning factors are more involved than they would appear.  “Healthcare workers” can be instinctively defined as physicians, nurses and technicians.  However, the health system relies on administrative support, housekeeping, security, truck drivers to deliver supplies, and a host of other non-clinical team members.  Detailed planning as to who is likely to be available during a crisis, limited staffing models, and internal prioritizations must be conducted in advance. Firestorm’s Predict. Plan. Perform. model is apt, even though the future of the virus is unforeseeable.  By anticipating a repeat of the dire circumstances of 1918-19 – when one half of the world population was infected and as many as 100 million may have died – plans to address the pandemic’s impact can be developed; anything less severe will be addressed by that preparation. 

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