Adjuvants: Concerns temper the promise of the vaccine technology

In recent months, two major vaccine manufacturing power-houses (GSK and Sanofi-Pasteur) have announced results of clinical trials of pre-pandemic H5N1 vaccine using adjuvant, an antigen-sparing technology that may exponentially increase the manufacturing capacity of vaccine - particularly critical in a pandemic situation. In light of use of adjuvants, the WHO ramped up its forecast of available vaccine courses from a few hundred million to 4.5 billion (2 billion short of the projected global need, assuming mechanisms are in place to distribute the vaccine to everyone).

"(Adjuvants are chemicals that are incorporated in some vaccines to improve response to the vaccines' active ingredient. Adjuvants make it possible to reduce the dose of antigen in a vaccine without dampening the immune response.)"

Adjuvant presents obstacles though - some immunologic and others regulatory. The tradeoff of a possibly less safe vaccine may be acceptable in a pandemic - and regulatory hurdles (a particular problem in the US) are likely to be bypassed or sped up in a pandemic. Even so, concern remains.

"While adjuvants hold the greatest promise for dose-sparing, they also provoke trepidation because they are by definition immune-system activators. While many have been tested over the years, few have entered the market, because they proved too reactogenic to be acceptable to consumers or safe. Only one set of adjuvants, aluminum salts or alum (aluminum hydroxide, aluminum phosphate, and potassium aluminum sulfate), is licensed in the United States. Aluminum adjuvants and MF59, an oil-in-water emulsion that contains squalene (an oil found in some fish oils), are licensed in Europe."

"I have heard a lot of people say they expect problems with adjuvanted vaccines," said Hedwig Kresse, an associate analyst for infectious diseases with the British-based market analysts Datamonitor. "It is a technology that definitely has some potential, but there are a lot of issues that need to be addressed first".

Full story: http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct3007panvax4.html

Pandemic hysteria leads to overstocking of Tamiflu

During the height of hysteria about the possibility of a pandemic flu, New Zealanders began placing orders en masse for the best known defense against a possible pandemic: Tamiflu. Many other nations experienced similar reactions.

"Between 12 and 18 months ago, people had rushed to place orders for Tamiflu, saying they would wait up to six months for the drug to arrive. However, interest in bird flu seems to have waned "

Now, many pharmacy shelves are overstocked with the drug, as many of those rushing to place orders last year no longer want it.

"Pharmacy Guild of New Zealand president Steve Wise said ironically about a year ago you could not get Tamiflu "for love nor money", but there was now a surplus."

New Zealand doesn't expect to be able to exhaust its current stocks through treatment of seasonal flu. The current stocks expire in 2010, and the over-purchasing of the drug has raised concerns that much of the stocks will simply go to waste.

Full story: http://www.stuff.co.nz/4253690a11.html

Indonesian Boy Tests Positive for H5N1

A three-year-old Indonesian boy has tested positive for H5N1. The boy is from the same neighborhood in Tangerang, a city west of the capital of Jakarta, as the five-year-old girl who died of bird flu last week. Her death was the 89th fatality in Indonesia due to the virus. Fortunately, the boy has only experienced mild flu symptoms and is receiving treatment at Sulianti Saroso hospital in Jakarta.

"Indonesia, which has now had 111 confirmed cases of the disease in humans, has suffered more fatalities than any other country.
Excluding the latest case, there have been 204 deaths and 332 cases globally since 2003, according to World Health Organization data. "

Story from Reuters AlertNet: http://www.alertnet.org/thenews/newsdesk/JAK14415.htm

Burmese junta bans news on H5N1

Censorship boards of the Burmese junta have banned news broadcasts within the nation regarding a new outbreak of H5N1 in Burma, an outbreak confirmed by journalists on October 20.

"The latest H5N1 bird flu outbreak was reported to the OIE-World Organization for Animals on October 24 by the regime's Livestock Breeding and Veterinary Department, according to the OIE Web site. The Burmese report sent to the OIE said the bird flu outbreak killed 400 chickens and ducks. The authorities reportedly killed 33,459 fowl to try to contain the virus."

This is the first reported outbreak among foul since July.

Full story: http://www.irrawaddy.org/article.php?art_id=9138

Another Outbreak in Vietnam

More than 290 ducks were found dead at a small farm in the central province of Quang Tri, Vietnam that tested positive for H5N1. The dead ducks were part of a flock of 600 5-day-old ducklings that had not been vaccinated. The rest of the flock was culled to prevent further spread of the disease, the farm was disinfected, a ban has been placed on poultry transport from the farm, and poultry at neighboring farms have been vaccinated. Earlier in October there was an outbreak reported in the Mekong Delta province of Tra Vinh which was the first in Vietnam in more than two months.

"Vietnam's aggressive poultry vaccination program has been seen as key to controlling the disease in birds and deny it opportunity to jump to humans.
So far this year, Vietnam has vaccinated 62.6 million birds, including 39.4 million ducks and 23.2 million ducks."

http://www.bangkokpost.com/breaking_news/breakingnews.php?id=122965

H5N1 may become endemic in parts of Europe

After German scientists discovered the H5N1 virus in dead domestic ducks, experts are recommending that Europe prepare for future outbreaks of avian influenza. If it persists in wild waterfowl throughout the year, Europe could become the third continent where the H5N1 strain is endemic. "It could well be that there is more virus circulation in Europe than currently assumed," said Food and Agriculture Organization (FAO) senior animal health officer Jan Slingenbergh.

"FAO veterinary experts said they were particularly concerned about the Black Sea area where a high concentration of chickens, ducks and geese is comparable with virus-entrenched Asia.
Experts urged the European countries to boost their H5N1 monitoring and surveillance schemes in all regions with big duck and geese production."

"We are not saying that the virus is widely spread in European countries, in fact most of the countries are currently virus-free. But undetected localised virus spots in countries with significant waterfowl may pose a continuous risk."

Full story at: http://uk.reuters.com/article/topNews/idUKL2510016520071025

89th Death in Indonesia

The Ministry of Health has reported the 89th death in Indonesia, a four year old girl from Tangerang.

http://www.depkes.go.id/en/2410an.htm

Reuters reports that poultry had died in the girl's neighborhood a week before -

"The four-year-old girl died on Monday after being admitted to hospital two days earlier, health ministry spokeswoman Lili Sulistyowati said by telephone. The girl, who had been suffering from fever, died after being transferred to Persahabatan hospital in Jakarta.

Officials were still investigating the case, but four chickens had previously died in the girl's neighbourhood, another official at the ministry's bird flu centre said.

Contact with sick fowl is the most common way for humans to contract the deadly H5N1 strain of the virus.

Bird flu is endemic in bird populations in most parts of Indonesia, where millions of backyard chickens live in close proximity with humans.

Indonesia, which has now had 110 confirmed cases of the disease in humans, has suffered more fatalities than any other country."

http://www.alertnet.org/thenews/newsdesk/L23739948.htm