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4 May 2009

http://www.startribune.com/lifestyle/health/44203912.html?page=1&c=y


 


Quest for flu vaccine has its own perils



National Museum of Heath and Medicine, Armed Forces Institute of Pathology, Associated Press file


This 1918 photograph shows influenza victims crowded into an emergency hospital at Fort Riley, Kan. That year’s Spanish flu pandemic killed tens of millions worldwide.



Using lessons from history, health officials seek a balance between acting prematurely and being ready.





 




"Is it going to fizzle out, or are we watching history unfold?"


That question hovers over world health officials as they move to the next steps in battling the outbreak. They are pressing ahead with plans to develop a vaccine -- yet history shows that process itself can be fraught with risk.


In effect, health officials are walking a high wire. If they act prematurely, they risk repeating the mistakes of the swine flu scare of 1976, when a massive vaccination program killed more people than the flu virus itself.


If they wait too long, they fear the specter of the catastrophic 1918 Spanish flu.


"The first wave of disease also came in the spring," Poland said in an interview last week, "then sort of fizzled out over the summer. Then, in early fall, it came roaring in with a vengeance." The world wasn't prepared, and that global pandemic killed tens of millions of people.


Viruses are unpredictable because they mutate easily, said Poland, who chairs a committee on pandemic influenza that advises the Secretary of Defense. So a flu virus can turn less dangerous -- or more deadly -- with little warning.


In 1976, federal officials feared the worst when 13 soldiers at Fort Dix, N.J., contracted swine flu and one died. Top health officials warned that a pandemic might be brewing just as in 1918, and President Gerald Ford announced a plan to vaccinate "every man, woman and child" in the United States.


The virus, as it turns out, never spread through the population. But several hundred vaccinated people developed a paralyzing nerve disorder called Guillain-Barré syndrome. Most recovered, but dozens died. The vaccine program was abruptly halted after more than 40 million people were immunized.




It was, says Poland, a cautionary tale that no one has forgotten. "Everybody's very queasy about this because of the '76 swine flu episode," he said.


This time, the strategy is more balanced, says Michael Osterholm, a University of Minnesota pandemic expert and government adviser.


"I'm convinced that the lessons of '76 have been well learned," he said. This time, he said, authorities want to have vaccine ready to go if it's needed for a second wave. "There will be no administration of this vaccine for this [virus] if there's not widespread disease spreading out there."


For some, though, the prospect of a new swine flu vaccine has little appeal.


Merlaine Taylor of Grand Rapids, Minn., hasn't had a flu shot in 22 years, since she developed Guillain-Barré syndrome. Although her case was not connected to a vaccine, her doctor advised her to avoid flu shots as a precaution. "Once you've had Guillan-Barré, you don't care to have it again," said Taylor, who was temporarily paralyzed and on life support before recovering.


As to a new vaccine, she said, "I'd rather have the swine flu."


Get flu vaccine? 'Oh my God, no.'


Mary Beth Dolan, who had Guillan-Barré in the early 1970s, feels much the same. Asked about a new swine flu vaccine, Dolan, who grew up in Minneapolis and now lives in Maine, said: "I would never take it. Oh my God, no."


Developing the vaccine itself, which will take four to six months, will present a series of challenges -- including ensuring its safety.


"Any time there's a new solution, there will be a new unintended side effect," said Dr. Bill Nersesian, chief medical officer of Fairview Physician Associates, who headed the swine flu program in Maine in 1976 as state epidemiologist.


He said he hopes that experience will prompt vaccine developers to look more diligently for side effects this time.


That's not to say that Nersesian will be first in line for a vaccination this time around, if the new flu strain stays relatively mild. "Based on that profile, I'm not ready to run out and get a swine flu vaccine for myself," he said.




But Dr. Kristin Nichol, an infectious disease expert at the Minneapolis Veterans Affairs Medical Center, says there's no time to waste.


"We need to get wheels turning now if we want a vaccine available," she said.


Nichol noted that no one in the population is immune to this new strain, and "since 1976, we've had a phenomenal track record of safety with influenza vaccines."


Poland cautions that history is a flawed lens for viewing new outbreaks. The new flu strain has some parallels with the killer 1918 pandemic but also with the 1957 Asian flu pandemic, which was no more deadly than a normal flu season. "You don't know which way things are going to go," he said. "What we know so far suggests we're doing the right thing."


Osterholm, of the University of Minnesota, agrees. "When people ask me when will we know if we're out of the woods," he said, "I say, 'call me in a year.'"


Staff writer Josephine Marcotty and University of Minnesota journalism student Kate Levinson, on assignment for the Star Tribune, contributed to this report. Maura Lerner • 612-673-7384



It was, says Poland, a cautionary tale that no one has forgotten. "Everybody's very queasy about this because of the '76 swine flu episode," he said.


This time, the strategy is more balanced, says Michael Osterholm, a University of Minnesota pandemic expert and government adviser.


"I'm convinced that the lessons of '76 have been well learned," he said. This time, he said, authorities want to have vaccine ready to go if it's needed for a second wave. "There will be no administration of this vaccine for this [virus] if there's not widespread disease spreading out there."


For some, though, the prospect of a new swine flu vaccine has little appeal.


Merlaine Taylor of Grand Rapids, Minn., hasn't had a flu shot in 22 years, since she developed Guillain-Barré syndrome. Although her case was not connected to a vaccine, her doctor advised her to avoid flu shots as a precaution. "Once you've had Guillan-Barré, you don't care to have it again," said Taylor, who was temporarily paralyzed and on life support before recovering.


As to a new vaccine, she said, "I'd rather have the swine flu."


Get flu vaccine? 'Oh my God, no.'


Mary Beth Dolan, who had Guillan-Barré in the early 1970s, feels much the same. Asked about a new swine flu vaccine, Dolan, who grew up in Minneapolis and now lives in Maine, said: "I would never take it. Oh my God, no."


Developing the vaccine itself, which will take four to six months, will present a series of challenges -- including ensuring its safety.


"Any time there's a new solution, there will be a new unintended side effect," said Dr. Bill Nersesian, chief medical officer of Fairview Physician Associates, who headed the swine flu program in Maine in 1976 as state epidemiologist.


He said he hopes that experience will prompt vaccine developers to look more diligently for side effects this time.


That's not to say that Nersesian will be first in line for a vaccination this time around, if the new flu strain stays relatively mild. "Based on that profile, I'm not ready to run out and get a swine flu vaccine for myself," he said.




But Dr. Kristin Nichol, an infectious disease expert at the Minneapolis Veterans Affairs Medical Center, says there's no time to waste.


"We need to get wheels turning now if we want a vaccine available," she said.


Nichol noted that no one in the population is immune to this new strain, and "since 1976, we've had a phenomenal track record of safety with influenza vaccines."


Poland cautions that history is a flawed lens for viewing new outbreaks. The new flu strain has some parallels with the killer 1918 pandemic but also with the 1957 Asian flu pandemic, which was no more deadly than a normal flu season. "You don't know which way things are going to go," he said. "What we know so far suggests we're doing the right thing."


Osterholm, of the University of Minnesota, agrees. "When people ask me when will we know if we're out of the woods," he said, "I say, 'call me in a year.'"


Staff writer Josephine Marcotty and University of Minnesota journalism student Kate Levinson, on assignment for the Star Tribune, contributed to this report. Maura Lerner • 612-673-7384



It was, says Poland, a cautionary tale that no one has forgotten. "Everybody's very queasy about this because of the '76 swine flu episode," he said.


This time, the strategy is more balanced, says Michael Osterholm, a University of Minnesota pandemic expert and government adviser.


"I'm convinced that the lessons of '76 have been well learned," he said. This time, he said, authorities want to have vaccine ready to go if it's needed for a second wave. "There will be no administration of this vaccine for this [virus] if there's not widespread disease spreading out there."


For some, though, the prospect of a new swine flu vaccine has little appeal.


Merlaine Taylor of Grand Rapids, Minn., hasn't had a flu shot in 22 years, since she developed Guillain-Barré syndrome. Although her case was not connected to a vaccine, her doctor advised her to avoid flu shots as a precaution. "Once you've had Guillan-Barré, you don't care to have it again," said Taylor, who was temporarily paralyzed and on life support before recovering.


As to a new vaccine, she said, "I'd rather have the swine flu."


Get flu vaccine? 'Oh my God, no.'


Mary Beth Dolan, who had Guillan-Barré in the early 1970s, feels much the same. Asked about a new swine flu vaccine, Dolan, who grew up in Minneapolis and now lives in Maine, said: "I would never take it. Oh my God, no."


Developing the vaccine itself, which will take four to six months, will present a series of challenges -- including ensuring its safety.


"Any time there's a new solution, there will be a new unintended side effect," said Dr. Bill Nersesian, chief medical officer of Fairview Physician Associates, who headed the swine flu program in Maine in 1976 as state epidemiologist.


He said he hopes that experience will prompt vaccine developers to look more diligently for side effects this time.


That's not to say that Nersesian will be first in line for a vaccination this time around, if the new flu strain stays relatively mild. "Based on that profile, I'm not ready to run out and get a swine flu vaccine for myself," he said.




But Dr. Kristin Nichol, an infectious disease expert at the Minneapolis Veterans Affairs Medical Center, says there's no time to waste.


"We need to get wheels turning now if we want a vaccine available," she said.


Nichol noted that no one in the population is immune to this new strain, and "since 1976, we've had a phenomenal track record of safety with influenza vaccines."


Poland cautions that history is a flawed lens for viewing new outbreaks. The new flu strain has some parallels with the killer 1918 pandemic but also with the 1957 Asian flu pandemic, which was no more deadly than a normal flu season. "You don't know which way things are going to go," he said. "What we know so far suggests we're doing the right thing."


Osterholm, of the University of Minnesota, agrees. "When people ask me when will we know if we're out of the woods," he said, "I say, 'call me in a year.'"


Staff writer Josephine Marcotty and University of Minnesota journalism student Kate Levinson, on assignment for the Star Tribune, contributed to this report. Maura Lerner • 612-673-7384


Flu spreads but deaths stay low

No new deaths in Mexico as global caseload grows. A5



 






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