Japan to vaccinate medical workers for bird flu

[Sally Furniss]

Japan to vaccinate medical workers for bird flu
15 Apr 2008 09:11:57 GMT
<!-- 15 Apr 2008 09:11:57 GMT ## for search indexer, do not remove --> Source: Reuters

<!-- AN5.0 article title end --> <script language="JavaScript" src="http://www.alertnet.org/bin/js/article.js"></script> <input value="13" name="CurrentSize" id="CurrentSize" type="hidden"> <!-- Japan to vaccinate medical workers for bird flu --> <!-- Reuters --> TOKYO, April 15 (Reuters) - Japan plans to vaccinate 6,000 medical workers and quarantine officers with stockpiled bird flu vaccines to check their effectiveness and possible side-effects, the health ministry said on Tuesday. The plan, which follows suggestions made by some lawmakers and experts that vaccinations take place before a feared flu pandemic, will be submitted to a panel of experts for approval on Wednesday, an official said. If approved, vaccination will take place before the end of the fiscal year in March 2009, and mark the first case in the world in which the vaccines -- based on strains of the H5N1 virus from China and Indonesia -- have been given to such a large group of people prior to a possible pandemic. Japan has stockpiled vaccines for 10 million people using strains of the H5N1 virus from China, Indonesia and Vietnam. So far the government's stance has been to use them only after a breakout. If the first vaccination is deemed effective, the ministry will consider vaccinating an additional 10 million people, mainly those involved in maintaining social infrastructure such as gas and electricity networks, the official said. While it is impossible to predict what strain of the virus could trigger a pandemic, the main suspect is the H5N1 bird flu virus that has killed more than 200 globally. The government estimates that in a case of a pandemic, a quarter of the population could be infected with the virus and that up to 640,000 people would die. The stockpiled vaccines have already been approved in Japan and have been produced by the Research Foundation for Microbial Diseases of Osaka University and the Kitasato Institute, the ministry said. There have been 238 human deaths globally from the H5N1 strain since 2003, with Vietnam and Indonesia accounting for most fatalities, the WHO said. (Reporting by Yoko Kubota; Editing by Alex Richardson)

http://www.alertnet.org/thenews/newsdesk/T221016.htm

[tropical]

Re: Japan to vaccinate medical workers for bird flu

A step forward.

I'm shure that the vaccine was carefuly builded when the health sector would be the first to got it.

The oposite situation compared with the seasonal flu shots, where in many countries, many health workers don't want to use the vaccine.

[HenryN]

Japan to vaccinate medical workers against bird flu

Japan to vaccinate medical workers against bird flu

41 minutes ago
TOKYO (AFP) ? Japan is to vaccinate thousands of medical workers and officials against bird flu to prepare for a possible pandemic, a health ministry official said Wednesday.
The ministry will vaccinate about 6,400 people by next March and plans eventually to expand the programme to about 10 million people including police and military officers, the official said on condition of anonymity.
"I believe it would be the world's first plan to vaccinate thousands of people" for a possible outbreak of a new type of flu, he said.
Japan has stockpiles of so-called pre-pandemic vaccines for 20 million people.
The official said the government will study the effectiveness and side effects of the vaccines, which are expected to be given to volunteers.
"Once the effectiveness and safety of the vaccines are known, the government will consider expanding it to a scale of some 10 million people," he said.
The H5N1 strain has killed more than 230 people worldwide since late 2003.
Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.
Health minister Yoichi Masuzoe on Tuesday proposed using part of the government's stockpiled vaccines on workers at hospitals or quarantine, customs and immigration offices.
The plan was backed Wednesday by a government-appointed panel of experts.
"If we obtain good results over its effectiveness and safety, we want to consider vaccinating (an additional) 10 million people who are in medical occupations" or other key jobs such as at utilities, Masuzoe said.
The ministry panel also approved plans to increase the vaccine stockpile and to try to shorten to six months the period needed to produce an effective vaccine if a pandemic occurs. It currently takes 18 months.
Japan saw several outbreaks of the deadly H5N1 strain in early 2007, leading authorities to kill tens of thousands of chickens as a precaution, but it has reported no human deaths.

http://afp.google.com/article/ALeqM5i4SeyPnzgI3iLDmzziKZAOVNqubA

[HenryN]

Re: Japan to vaccinate medical workers against bird flu

Japan vaccinates bird flu workers

Japan is to become the first country in the world to vaccinate thousands of officials against bird flu.
Six thousand health workers and other staff will be inoculated over the next few months, and the programme might be extended to cover millions more.
Although bird flu has caused 240 deaths since 1993, none has been in Japan.
But there are fears that an outbreak elsewhere in Asia could spread quickly in Japan, which has some of the world's most densely-populated areas.
Bird flu is currently relatively difficult for humans to catch, but health authorities fear it could mutate into a form that is much more easily spread among humans, which could cause a pandemic.
Sensible or over-sensitive?
Japan has already stockpiled 20 million doses of so-called "pre-pandemic" bird flu vaccine for use after a major outbreak.

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The vaccine has been made using the deadly H5N1 strain of the disease collected in Vietnam and Indonesia.
Japanese Health Minister Yoichi Masuzoe made the proposal for vaccination on Tuesday, and it was backed by a government-appointed panel of experts on Wednesday.
The plan is to initially use 6,400 doses of vaccine to inoculate doctors, quarantine inspectors and other health and immigration officials.
If successful, the government aims to expand the programme to others.
"If we obtain good results over its effectiveness and safety, we want to consider vaccinating (an additional) 10 million people who are in medical occupations" or other key jobs such as at utilities, Mr Masuzoe told reporters.
By taking this action, Japan is taking bird flu precautions to levels not seen anywhere else in the world, according to the BBC correspondent in Tokyo, Chris Hogg.
Japan is probably the only Asian country which has the resources to do this.
But is this sensible or an over-reaction to the threat posed by bird flu?
The World Health Organization does not sound convinced that it would improve the chances of Japan weathering a major bird flu outbreak, our correspondent says.
WHO spokesman Gregory Hartl told the Associated Press that the planned vaccinations were "a big roll of the dice". "Obviously, the Japanese think there's some benefit to be had from this, and we are not going to prevent an individual country from using their resources," he added.

Story from BBC NEWS:

http://news.bbc.co.uk/go/pr/fr/-/2/hi/asia-pacific/7349904.stm

[kent nickell]

Re: Japan to vaccinate medical workers for bird flu

Good luck, this sort of program has proved difficult in the past... (not to mention it seems that they are using a questionable strain of the virus) (I think the largest attempt of this nature would be the US in 1976, see below)


Japan to vaccinate medical workers against bird flu


TOKYO (AFP) ? Japan is to vaccinate thousands of medical workers and officials against bird flu to prepare for a possible pandemic, a health ministry official said Wednesday.
The ministry will vaccinate about 6,400 people by next March and plans eventually to expand the programme to about 10 million people including police and military officers, the official said on condition of anonymity.
"I believe it would be the world's first plan to vaccinate thousands of people" for a possible outbreak of a new type of flu, he said.
Japan has stockpiles of so-called pre-pandemic vaccines for 20 million people.
The official said the government will study the effectiveness and side effects of the vaccines, which are expected to be given to volunteers.
"Once the effectiveness and safety of the vaccines are known, the government will consider expanding it to a scale of some 10 million people," he said.
The H5N1 strain has killed more than 230 people worldwide since late 2003.
Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.
Health minister Yoichi Masuzoe on Tuesday proposed using part of the government's stockpiled vaccines on workers at hospitals or quarantine, customs and immigration offices.
The plan was backed Wednesday by a government-appointed panel of experts.
"If we obtain good results over its effectiveness and safety, we want to consider vaccinating (an additional) 10 million people who are in medical occupations" or other key jobs such as at utilities, Masuzoe said.
The ministry panel also approved plans to increase the vaccine stockpile and to try to shorten to six months the period needed to produce an effective vaccine if a pandemic occurs. It currently takes 18 months.
Japan saw several outbreaks of the deadly H5N1 strain in early 2007, leading authorities to kill tens of thousands of chickens as a precaution, but it has reported no human deaths.

http://afp.google.com/article/ALeqM5...mzziKZAOVNqubA

-------------

Here are some excerpts from Are We Ready? Public Health Since 9/11 by David Rosner and Gerald Markowitz (2006)


Joseph Henderson suggests that smallpox became a primary focus since it appears as the only disease on CDC's Catergory A list that is preventable with a vaccine...

Gene Matthews basically supported the view that smallpox had to be taken off the table, 'my view was that CDC could not afford to assume that this is not a real threat'. It is these kinds of low-risk, high-consequence issues that drive people in government crazy.

.... Maintaining confidence in health agencies becomes all the more important because Matthews and other federal officals consider an attack a question not of if but of when.

Jeffrey Koplan is a bit more specific in assessing the problems for public health infrastructure resulting from an increasing focus on bioterrorism: "We are a public health agency, not a part of the military. We had a culture where it was easy to have interchanges among scientists and we realized the need to reach out to the coummunity. The bioterrorism concerns were real but were at odds with the ways of public health's doing things. By its very nature bioterrorism has close ties to law enforcement and the military. Public health does not have close ties to these intstitutions but rather seeks ties to community groups."

While the possible breakdown in public trust threatens public health services, Hardy argues that there are also real benefits to the new attention to the influence of the military on public health bureaucracies. "The biggest problem in public health is how leaders respond in times of crisis. I have helped develop a national preparedness leadership initiative with the Kennedy School and the School of Public Health at Harvard... for forty officials in pulblic health, emergency preparedness, and senior staffers in Congress. We have not had leaders bold enough to take the right moves at the right time. This is the weakest link in the chain."

The ideological disagreements about the best focus for public health play out in the relationship between public health officials and the Department of Homeland Security. While Ed Thompson argues that this relationship "is developing," George Hardy sees "good and bad things in the establishment of the DHS - one of the really good things is that Homeland Security is really eager to learn about public helath - what it does and how to include it in their thinking. Hence public health is much more integrated into the state response apparatus than ever before"

from the Conclusion What Lessons Have We Learned from the book Are We Ready? Public Health Since 9/11 by David Rosner and Gerald Markowitz (2006)

Much of the success of the public health response to 9/11 in New York City had less to do with formal emergency planning or conscious preparation than with the presence of an existing infrasturcture of health services, laboratories, and personnel. Though many officials outside the city praised New York's ability to take action during the crisis, and some personalized its success by attributing it to the political leadership, in fact the work was done by bureaucracies that nothing and no one could have mobilized had they not already been there.

Another message that comes through loud and clear is that failure to communicate honestly about uncertainty is a big mistake. The issuance of pronouncements that obviously are not supported by everyday observations will in the end backfire, as the public officials making such claims are certain to lose the public's trust and goodwill and ultimatley their authority.

Finally, when national threats are present, clear lines of federal and other authority need to be established. Local authority need not be usurped, but decisive leaders who control resources and make decisions with good personal and situational intelligence are required in times of crises.

---------------

Here are some interesting excerpts from State of Immunity, The Politics of Vaccination in Tweintieth-Century America , 2006, by James Colgrove..

Smallpox

It was thus against a a backdrop of confusion among the public, sharp disagreements among health professionals, bioterrorism experts, and politicians about risks, benefits, and precautionary action, and the buildup to an increasingly likely war with Iraq that President George W. Bush announced a comprehensive plan to protect the nation from smallpox in mid December 2002. While admitting that his administration had 'no information that a smallpox attack is imminent,' Bush outlined an ambitious three-phase plan. In the first phase, about half a million health care workers and emergency personnel were to be vaccinated within thirty days. Thereupon a broader effort would commence, targeting some 10 million health care workers. Finally, in late spring or early summer, the vaccine would be made available to any adult for whom it was not medically contraindicated.

In recommending such a large-scale operation, the administration had, in an unprecedented move, overruled the advice of the federal Advisory Committee on Immunization Practices.


Former CDC director William Foege was among many who publicly criticized the scope of the plan. Foege's years of experience on the front lines of the global smallpox eradication program in the 1970s gave him special credibility on this issue, which he drew upon when he argued in a Washington Post op-ed column that ring vaccination, not blanketing the general population, was the wisest course of action. Ring vaccination had been effective, he wrote, even in a place like India, with its high population density, millions on trains at any one time and many people without actual addresses. For anyone not involved in that effort, ring vaccination seemed--and probably still seems-- counterintuitive. But in India we went from the highest incidence of smallpox recorded in decades in May 1974 to zero in May 1975... Compare this with the record of mass vaccination programs, which had been tried in India for more than 150 years without success . The key to fighting smallpox proved to be not background immunity but diligence in finding and vaccinating every possible contact of every patient.

Because of the administration's failure to win the support of frontline health care providers around the country, the program never met the goal laid out in phase one, much less progressed to the second or third stages. Out of the half a million health care workers targeted to receive the vaccine in the first phase, less that ten percent--approximately 40,000 people nationwide--were vaccinated

Anthrax

Another vaccine dispute emerged from the US military. In December 1997, US Defense Secretary William Cohen announced a plan to vaccinate all 2.4 million members of the military against anthrax, a highly lethal bacterial infection. It was the first time that the military had attempted to immunize all active and reserve members against a potential biological weapon, and reflected a growing concern that countries hostile to the United States were developing a variety of agents that could be used for chemical warfare. The vaccine--administered in six injections over the course of eighteen months--was known to cause minor side effects such as pain and swelling at the infection site, headache, and fever, but rumors soon began to circulate among service members that it could cause sterility and paralysis. Many soldiers refused the shots and, in so doing, faced a variety of disciplinary actions, including court-martial,. The resistance was fueled in part by widespread mistrust of the military's past responses to soldiers' health problems, including its failure to be forthcoming about issues such as Agent Orange and Gulf War Syndrome. By eary 2000, some three hundred fifty service members had refused the shots, and an unknown number had left the service rather than be forced to undergo them. The problems with morale and refusal attracted the attention of some members of Congress, who called on the Pentagon to suspend the program in light of concerns about the vaccine's safety and efficacy.

Swine Flu

In 1976, the CDC had to deal with one of the most difficult crises in its history: forestalling a feared epidemic of swine flu.

In January 1976, an army cadet at Fort Dix in New Jersey died of the flu. A culture of the virus revealed that the strain was closely related to the one that had caused the worldwide influenza pandemic in 1918 that had killed at least 20 million people. Alarmed officials at the CDC considered mounting a mass campaign to protect every American from the possible reemergence of the deadly strain. In April, David Sencer, the CDC's director, recommended that a mass vaccination program go forward and President Gerald Ford announced it to the country.

In a survey in New York City in mid November, more than half the respondents said they had not been vaccinated and did not intend to be, citing as reasons that the vaccine was unnecessary, that they were afraid of it, or that their physician had recommended against it.

By mid December more than fifty cases of Guillain-Barre Syndrome had been reported, the majority of cases had received the vaccine within the previous month. On December 16, 1976, the program was suspended, never to resume. Some 40 million people had received the vaccine. Although this was the largest number of people ever vaccinated in a single mass campaign, it was less than one-fifth of the national target population.

[tropical]

Re: Japan to vaccinate medical workers for bird flu

"Ring vaccination had been effective, he wrote, even in a place like India, with its high population density, millions on trains at any one time and many people without actual addresses. For anyone not involved in that effort, ring vaccination seemed--and probably still seems-- counterintuitive. But in India we went from the highest incidence of smallpox recorded in decades in May 1974 to zero in May 1975... Compare this with the record of mass vaccination programs"

Indeed, and congratulations to the anti-scourge team.

But, some places (countries) must started a mass-vaccination as a measure in some imported illness situations.

The problem is: is this Japan effort an vacc. exp., or an needed effort because of some near term supposed h2h bf escalation in their region.

[kent nickell]

Re: Japan to vaccinate medical workers for bird flu

Yes, it is a dilemma... I also don't think ring vaccination would be the best way to go for influenza unless we did manage to get a clearer picture of phase 4-5 possilby through more incremental changes in the virus...

[Treyfish]

Re: Japan to vaccinate medical workers for bird flu

6,000 may be given bird flu vaccination<!--// headline_end //--><!--// byline_start //-->
The Yomiuri Shimbun
<!--// byline_end //--><!--// article_start //--><!-- google_ad_region_start=region1 -->The Health, Labor and Welfare Ministry announced a plan Tuesday to inoculate 6,000 medical practitioners and quarantine officers with flu vaccine by the end of this fiscal year as a preemptive measure against the possible outbreak of a new type of avian influenza.
The decision to vaccinate the front-line workers, aimed at confirming the safety and effectiveness of the vaccine, looks set to be officially approved by a panel of experts Wednesday.
Although many countries have vaccine stocks, none have yet started vaccinating against a new type of flu that has developed from avian influenza. Japan will be the first country in the world to try to vaccinate against it.
(<!--// date_start //-->Apr. 16, 2008<!--// date_end //-->) http://www.yomiuri.co.jp/dy/national...16TDY02308.htm
<!-- google_ad_region_end=region1 --><!--// article_end //-->

[HenryN]

Re: Japan to vaccinate medical workers for bird flu

Vaccinations for new flu strains eyed for public

<!--// headline_end //--><!--// byline_start //-->The Yomiuri Shimbun
<!--// byline_end //--><!--// article_start //--><!-- google_ad_region_start=region1 -->The Health, Labor and Welfare Ministry on Wednesday began a feasibility study on inoculating the general public with avian influenza vaccine to prepare for the possible outbreak of a new strain of pandemic flu, sources said.
Under the ministry's current plan, the vaccinations for 10 million people engaged in occupations maintaining social functions, such as police officers and those working for water and electric utilities, will start in fiscal 2009.
Hoping to eliminate concern over a possible epidemic, the ministry also will discuss whether to include the general public in the vaccination plan.
The ministry currently stockpiles sufficient avian flu vaccine concentrate solution for 20 million people and has already indicated that it would increase the amount of the stock.
However, expanding the vaccination to the public at large could cause social confusion over possible side-effects.
The ministry, therefore, will discuss the target population and timing of vaccinations, among other issues, after examining the safety of the inoculation, according to the sources.
Even people who have been vaccinated will likely develop symptoms in the event of an outbreak of a new type of influenza from any source, avian or otherwise.
Taking these factors into consideration, the ministry plans to inoculate 6,000 people who wished to receive flu vaccinations by the end of March next year. Falling into this category are doctors and quarantine officers who will most likely come into contact with patients.
The vaccination will be administered on a clinical test basis as a preemptive measure against the possible outbreak of a new type of flu.
If the vaccination proves to be effective, the ministry plans to expand the program to 10 million people in preparation for an epidemic.
Switzerland also is considering conducting a preemptive vaccination for the general public, but has yet to introduce it.
(<!--// date_start //-->Apr. 17, 2008<!--// date_end //-->)

http://www.yomiuri.co.jp/dy/national/20080417TDY02301.htm

<!-- google_ad_region_end=region1 --><!--// article_end //-->

[HenryN]

Re: Japan to vaccinate medical workers for bird flu

Commentary

http://www.recombinomics.com/News/04180803/H5N1_Pre_Pandemic_Japan.html

[kent nickell]

Re: Japan to vaccinate medical workers for bird flu

Thanks Henry for the insightful commentary (as usual)... I thought your comments on the poultry vs the human problems with H5N1 vaccine were interesting. It does seem like it could be a good time to work on human herd immunity for this persistent virus. I also like the idea of a trivalent H5N1 vaccine..

The way that you have shown whereby the same polymorphism can appear on different genetic backgrounds is also disturbing. If this happened with the code for easy transmissibility (whatever that is) we could be looking at more than one pandemic virus possibly producing a wave type effect. And we may not have a leisurely course from phase 3-4-5-6....

[HenryN]

Re: Japan to vaccinate medical workers for bird flu

Thanks Henry for the insightful commentary (as usual)... I thought your comments on the poultry vs the human problems with H5N1 vaccine were interesting. It does seem like it could be a good time to work on human herd immunity for this persistent virus. I also like the idea of a trivalent H5N1 vaccine..

The way that you have shown whereby the same polymorphism can appear on different genetic backgrounds is also disturbing. If this happened with the code for easy transmissibility (whatever that is) we could be looking at more than one pandemic virus possibly producing a wave type effect. And we may not have a leisurely course from phase 3-4-5-6....

Yes, the ability of polymorphisms to jump from one genetic background to another is a major concern (although not well appreciated by those designing targets).

The latest on Amantidine resistance is another example. All clade 1 isolates were Amantadie resistant in 2004/2005. The level was markedly lower for clade 2 and initially, there was no reported resistance in clade 2.2 (Qinghai strain). The first report was in China in 2006 in Shantou. However, there are now reports in Israel and Saudi Arabia and two very different genetic backgrounds. The isolate in Israel is like Egypt, while Saudi Arabia is like WEST Africa. Of course there may be much more resistance because full sequences from isolates in Egypt (or many countries in Europe) have not been released. However, the limited number of known resistant M2 sequences are on different genetic backgrounds.

H5N1 can evolve quite rapidly, especially when being pushed, and chasing (and pushing) H5N1 evolution during a pandemic can be hazardous to the world's health (and H5N1 can make 1918 look like a walk in the park).

[Sally Furniss]

Re: Japan to vaccinate medical workers for bird flu

Japan Ministry of Health plans to hold before the end of 2008, 6 thousand vaccinations

Associated Press

National health-care workers to protect against possible epidemic of avian influenza, transmits Associated Press, referring to a report from the Health Ministry of Japan.


Program vaccination against bird flu should be approved by the government on 16 April this year.


In the Japanese Ministry of Health plans also include the vaccination of an additional 10 million people, including government officials and law enforcement officers, if the above measures prove their safety and effectiveness.

http://translate.google.com/translate?u=http%3A%2F%2Ftop.rbc.ru%2Fsociety%2F15%2F04%2F2008%2F157593.shtml&langpair=ru%7Cen&hl=en&ie=UTF8

[AlaskaDenise]

Re: Japan to vaccinate medical workers for bird flu

Commentary

http://www.recombinomics.com/News/04...mic_Japan.html

Commentary

H5N1 Pre-pandemic Vaccine Plans in Japan

Recombinomics Commentary 15:33
April 18, 2008

Japan has already stockpiled 20 million doses of so-called "pre-pandemic" bird flu vaccine for use after a major outbreak.

The plan is to initially use 6,400 doses of vaccine to inoculate doctors, quarantine inspectors and other health and immigration officials.

If successful, the government aims to expand the programme to others.

"If we obtain good results over its effectiveness and safety, we want to consider vaccinating (an additional) 10 million people who are in medical occupations" or other key jobs such as at utilities, Mr Masuzoe told reporters.

The above comments describe Japan?s plans to implement a pre-pandemic vaccination strategy. Although many countries have pandemic vaccines in clinical trials, most have announced plans to stockpile such vaccines, instead of using the vaccine in a strategy targeted at preventing a pandemic or immunizing first responders.

Japan?s decision is not a surprise. Although they have only confirmed one H5N1 outbreak, neighboring South Korea has now reported H5N1 outbreaks in 3 of the last 5 seasons. These outbreaks have been linked to wild birds and there is little doubt that the H5N1 in South Korea is also in Japan.

Recent vaccine results for poultry has had mixed results. One of the more alarming developments has been in Egypt, where H5N1 has been isolated from vaccinated stocks. The sequence of the HA from these isolates had a large number of non-synonymous changes, which were likely involved in the immunological escape. The recent H5N1 from Israel had the same series of changes, raising concerns about rapid H5N1 evolution, which may be linked to mismatched vaccines. However, the mis-matches are more of a concern for poultry vaccination programs, because H5N1 can be efficiently transmitted from bird to bird, especially in domestic poultry. In addition, the Israeli isolate, like the recent isolate from Saudi Arabia, was amantadine resistant. Moreover, wild bird isolates from Astrakhan were oseltamivir (Tamiflu) resistant, suggesting that anti-viral may have limited utility in controlling a rapidly expanding pandemic.

Similarly, creating a useful vaccine after the pandemic has gained momentum is also unlikely to be effective. H5N1 diversity has grown markedly in the past few years. There are now four distinct sub-clades linked to human cases, and there is further diversity within the sub-clade. Thus, H5N1 could evolve rapidly during vaccine generation, reducing vaccine effectiveness. This effectiveness would be further compromised because the target population is immunologically naive and would likely require booster shots.

Thus, plans to create a vaccine after a pandemic has begun are unlikely to be successful.

In contrast, a pre-pandemic vaccine would primer the target population and may protect from an H5N1 that is not efficiently transmitted. Thus, the vaccine could delay the start of a pandemic. Moreover, vaccine costs are minimal, as seen in the trivalent vaccine to treat seasonal flu. That vaccine contains three different viruses and is available at nominal cost. Due to the rapid evolution of H5N1, a trivalent H5N1 vaccine may be an approach that would produce cross reactive immunity.

The likelihood of a H5N1 pandemic remains high. The current versions of H5N1 emerged out of China in late 2003/2004. The movement of H5N1 into long range migratory birds has produced an major geographical expansion, and the clade 2.2 strain has been reported in over 50 countries in the past few days. Moreover, receptor binding domain changes have been associated with clusters in multiple countries in the Middle East, and these clusters have maintained a high case fatality rate. Recent data on receptor binding domain changes suggest one or two changes could produce an efficiently transmitted H5N1, which when linked to the current high case fatality, would have catastrophic consequences.

Germany and Switzerland are also considering implementation of a pre-pandemic vaccine, as are Vietnam and Indonesia. It is likely that such a concept will spread in the upcoming months, as the persistence of H5N1 increases, along with its genetic diversity.


.

[mixin]

Re: Japan to vaccinate medical workers for bird flu

For now, they have decided to limit the number, pending successful testing:

The health ministry is considering inoculating about 1.5 million doctors and other medical professionals with pre-pandemic flu vaccines in a planned expansion of advance vaccinations to better prepare for a possible outbreak of new types of influenza, ministry sources said Sunday.

http://www.japantoday.com/category/national/view/15-mil-medical-professionals-eyed-for-expanded-flu-vaccinations