Giuseppe
Emeritus
TheStar.com - The war to beat the flu bug
The war to beat the flu bug
Dec 06, 2008 04:30 AM
Diana Zlomislic - Living Reporter
A hospital volunteer at Toronto's Mount Sinai walks briskly down the hall of its main lobby. She has come from the fridge; the right pocket of her lab coat bulging with a brand new cocktail to fight flu. Clustered inside a transparent wrapper are 25 syringes, each filled with half a millilitre of vaccine.
The volunteer, known to staff and patients as "Grandma Moses," is chief wrangler at the makeshift flu clinic where four long tables covered in thin, plastic film butt against the wall in the main lobby, about 20 steps past the coffee hut. One of the six nurses on site carefully fishes the package from Grandma's pocket and puts it on ice. If the vaccine's temperature dips below 2C or above 8C, it's good as garbage.
As well as retrieving medical supplies, Grandma Moses is also scouting the halls, encouraging staff and visitors to get immunized. After 18 years, she has perfected her pitch, delivered with a slight Australian lilt that says: Listen, I know what I'm talking about.
"This is a hospital," she says. "If you don't have something coming in, we'll give you something on your way out."
One visitor, in a striped dress shirt and slacks, takes a seat and waits for a nurse's instructions. Clearly, he did not wake up this morning with inoculation on his mind. His sleeves are not wide enough to roll past the elbow.
He removes his shirt, revealing a bare, hairy chest and the blush of diffidence. A nurse measures three fingers down from the outer edge of his shoulder bone, then presses the superfine, inch-long needle into his arm. He gets a small, round bandage to cover the prick site and a baby KitKat.
The visitor buttons his shirt, zips his jacket and leaves. Immunized, yes, but protected? Maybe not.
The 10 to 15 droplets of vaccine injected into this man's left deltoid muscle represent the work of thousands of researchers worldwide who have been monitoring influenza activity and identifying new strains for the past year. Even so, it's a crapshoot. We'll know in a few weeks how well this year's formula works.
Why is such an ambitious enterprise, bringing together the world's best minds using the latest technology, unable to guarantee success?
Part of the answer is the cunning nature of the flu bug and its ability to evade eradication. The other part is the deadline. The massive pharmacological machinery needed to produce the vaccine by late summer/early fall requires a cut-off time.
Globally, more than 100 research centres work year-round monitoring influenza activity and identifying new strains. Four of them are supercentres ? collecting, analyzing and testing data from neighbouring regions.
The World Health Organization empowers these four centres ? in London, Atlanta, Tokyo and Melbourne ? to select three strains, from a pool of thousands, to use in the annual vaccine recipe. The group gathers in Geneva every February for the announcement.
Sometimes they don't get it right.
Last year, the vaccine failed to match the strains that actually circulated. One of the strains scientists wanted to include in the mix simply wouldn't grow well enough in eggs to mass-produce.
"There's a cut-off time," explains Dr. Tim Booth, director of the viral disease division at National Microbiology Laboratory in Winnipeg. "If you don't have a strain that's suitable for production by that time, they just need to use the previous year's."
By the end of last year's flu season, scientists were reporting a significant amount of "drift" in two of the three strains. When a virus drifts, it literally changes shape, making it difficult for our bodies to spot and produce enough antibodies to fight it.
A vaccine is only as good as the enemy it knows to attack. When the virus changes, so must the vaccine.
While there's no great indicator of how many people die of flu every year, most doctors agree that immunization is our best chance at protecting not just ourselves but each other.
"Often, if you look at health statistics, death certificates for example, it won't list flu as the cause of death," says Michael Shaw, who works in the influenza division at Atlanta's Centers for Disease Control and Prevention, "but the flu is what set up the situation that allowed the secondary infection to take hold."
''And that's something I think a lot of people don't appreciate. It's often flu that weakens the patient enough for these secondary infections to come in and cause complications. By expanding the population that you're recommending to be vaccinated, you're trying to establish a sort of herd immunity so that you protect others by just blocking its transmission."
And if you do get sick? Booth advises people to avoid self-diagnosing.
While you may be sneezing and coughing and shivering, only a doctor can know for sure whether you have the flu. There's actually a test for it.
"One of the reasons why flu vaccine can get a bad rap," he says, "is all these other things like adenovirus, rhinovirus, coronavirus ? they all cause influenza-like symptoms."
For millennia, the virus mystified humankind. Two thousand years ago, the historian Livy described a flu-like disease that ravaged the Roman army and its rivals one autumn ? "a calamity almost heavy enough to turn them from all thoughts of war."
In fact, not until the invention of the electron microscope in the 1930s did scientists have a clear idea of what they were dealing with.
The technology didn't come soon enough for the 50 million people around the world ? a moderate estimate, epidemiologists say ? who died from complications of 1918's Spanish Flu.
In The Great Influenza, author John Barry references a mathematical concept called "reversion to the mean." In other words, after something really bad happens, we can expect something less bad to follow. Maybe even something good.
In the decade that followed the Spanish Flu and World War I, for scientists studying the flu epidemic, something good came ? in the form of a ferret.
The bigger-than-a-rat, smaller-than-a-cat, half-domesticated member of the weasel family has been part of vaccine testing since the 1930s, when a doctor in a London lab noticed the animal sneezing after one of his colleagues took time off to recover from the flu.
The animals had originally been used in tests for canine distemper.
"Generally, we use ferrets because they're susceptible to flu almost exactly like humans are," Shaw says.
"They're given a little squirt up the nose and they get the flu. They sneeze, they get fever, they lose their appetite and they recover. And you look at the antibodies they've developed because of that infection."
By looking at how that antibody reacts with the previous vaccine, we can get an idea of how much it might have changed. It's that data that go into the deliberations in Geneva.
"Much of the CDC's Canadian data come from Booth's lab in Winnipeg, which gathers and analyzes flu strains from 31 sites across the country. Last year, it analyzed about 1,400 flu strains.
"In any one year, there are usually only four or five types of flu circulating," says Booth."We know thousands of people get flu every year. You only need to survey a portion of those. We feel between 1,000 and 2,000 flu strains from various parts of the country gives us a representative picture."
The lab sent about 100 of those samples to the CDC. The strains are couriered in polyethylene cryovials ? about half the size of a lipstick tube.
"These things will withstand freezing," Booth says."That's the idea. You can put them straight into liquid nitrogen and they won't crack or shatter.
"Our data go into this huge pot and then the CDC consults extensively on what's going to be in the next vaccine."
Two drug companies are responsible for supplying flu vaccine to the Canadian public market.
Sanofi Pasteur, which produces Vaxigrip in France, holds 25 per cent of the federal contract while GlaxoSmithKline, which makes Fluviral in Montreal, holds the rest.
The drug companies are required to complete efficiency tests on healthy human volunteers for government approval before the vaccine goes to market, but the results are classified.
"It's so confidential, they won't tell us," Booth says of the test results.
Because of that, his lab is in the process of testing the efficiency of this season's recipe.
"We're taking 500 people kind of randomly ? a cross-section of the population across the country ? who get the vaccine," Booth explains. "Blood samples are taken before the flu shot is administered and again two weeks later after the vaccine kicks in. We measure the amount of antibody those people have. That gives us an idea of how good the vaccine is."The answers will come too late to be useful this year but they could be invaluable next season. Meanwhile, Toronto Public Health is more than halfway through its immunization program for the season. Last year, 33,000 Torontonians waited in line at a mall, a civic centre or supermarket to get their flu shot.
So far this season, 25,000 have been vaccinated with just 12 more clinics until the program ends on Jan. 8.
So, what does all this mean to Grandma Moses and the man she recruited for a flu shot at Mount Sinai?
She should keep up the good work and he was wise to pay her heed, flu experts say. There's every reason to think that, this year, the vaccine will work.
To find a vaccination clinic near you, visit toronto.ca/health/flu/.
<cite cite="http://www.thestar.com/article/547330">TheStar.com | Illnesses & Issues | The war to beat the flu bug</cite>Dec 06, 2008 04:30 AM
Diana Zlomislic - Living Reporter
A hospital volunteer at Toronto's Mount Sinai walks briskly down the hall of its main lobby. She has come from the fridge; the right pocket of her lab coat bulging with a brand new cocktail to fight flu. Clustered inside a transparent wrapper are 25 syringes, each filled with half a millilitre of vaccine.
The volunteer, known to staff and patients as "Grandma Moses," is chief wrangler at the makeshift flu clinic where four long tables covered in thin, plastic film butt against the wall in the main lobby, about 20 steps past the coffee hut. One of the six nurses on site carefully fishes the package from Grandma's pocket and puts it on ice. If the vaccine's temperature dips below 2C or above 8C, it's good as garbage.
As well as retrieving medical supplies, Grandma Moses is also scouting the halls, encouraging staff and visitors to get immunized. After 18 years, she has perfected her pitch, delivered with a slight Australian lilt that says: Listen, I know what I'm talking about.
"This is a hospital," she says. "If you don't have something coming in, we'll give you something on your way out."
One visitor, in a striped dress shirt and slacks, takes a seat and waits for a nurse's instructions. Clearly, he did not wake up this morning with inoculation on his mind. His sleeves are not wide enough to roll past the elbow.
He removes his shirt, revealing a bare, hairy chest and the blush of diffidence. A nurse measures three fingers down from the outer edge of his shoulder bone, then presses the superfine, inch-long needle into his arm. He gets a small, round bandage to cover the prick site and a baby KitKat.
The visitor buttons his shirt, zips his jacket and leaves. Immunized, yes, but protected? Maybe not.
The 10 to 15 droplets of vaccine injected into this man's left deltoid muscle represent the work of thousands of researchers worldwide who have been monitoring influenza activity and identifying new strains for the past year. Even so, it's a crapshoot. We'll know in a few weeks how well this year's formula works.
Why is such an ambitious enterprise, bringing together the world's best minds using the latest technology, unable to guarantee success?
Part of the answer is the cunning nature of the flu bug and its ability to evade eradication. The other part is the deadline. The massive pharmacological machinery needed to produce the vaccine by late summer/early fall requires a cut-off time.
Globally, more than 100 research centres work year-round monitoring influenza activity and identifying new strains. Four of them are supercentres ? collecting, analyzing and testing data from neighbouring regions.
The World Health Organization empowers these four centres ? in London, Atlanta, Tokyo and Melbourne ? to select three strains, from a pool of thousands, to use in the annual vaccine recipe. The group gathers in Geneva every February for the announcement.
Sometimes they don't get it right.
Last year, the vaccine failed to match the strains that actually circulated. One of the strains scientists wanted to include in the mix simply wouldn't grow well enough in eggs to mass-produce.
"There's a cut-off time," explains Dr. Tim Booth, director of the viral disease division at National Microbiology Laboratory in Winnipeg. "If you don't have a strain that's suitable for production by that time, they just need to use the previous year's."
By the end of last year's flu season, scientists were reporting a significant amount of "drift" in two of the three strains. When a virus drifts, it literally changes shape, making it difficult for our bodies to spot and produce enough antibodies to fight it.
A vaccine is only as good as the enemy it knows to attack. When the virus changes, so must the vaccine.
While there's no great indicator of how many people die of flu every year, most doctors agree that immunization is our best chance at protecting not just ourselves but each other.
"Often, if you look at health statistics, death certificates for example, it won't list flu as the cause of death," says Michael Shaw, who works in the influenza division at Atlanta's Centers for Disease Control and Prevention, "but the flu is what set up the situation that allowed the secondary infection to take hold."
''And that's something I think a lot of people don't appreciate. It's often flu that weakens the patient enough for these secondary infections to come in and cause complications. By expanding the population that you're recommending to be vaccinated, you're trying to establish a sort of herd immunity so that you protect others by just blocking its transmission."
And if you do get sick? Booth advises people to avoid self-diagnosing.
While you may be sneezing and coughing and shivering, only a doctor can know for sure whether you have the flu. There's actually a test for it.
"One of the reasons why flu vaccine can get a bad rap," he says, "is all these other things like adenovirus, rhinovirus, coronavirus ? they all cause influenza-like symptoms."
For millennia, the virus mystified humankind. Two thousand years ago, the historian Livy described a flu-like disease that ravaged the Roman army and its rivals one autumn ? "a calamity almost heavy enough to turn them from all thoughts of war."
In fact, not until the invention of the electron microscope in the 1930s did scientists have a clear idea of what they were dealing with.
The technology didn't come soon enough for the 50 million people around the world ? a moderate estimate, epidemiologists say ? who died from complications of 1918's Spanish Flu.
In The Great Influenza, author John Barry references a mathematical concept called "reversion to the mean." In other words, after something really bad happens, we can expect something less bad to follow. Maybe even something good.
In the decade that followed the Spanish Flu and World War I, for scientists studying the flu epidemic, something good came ? in the form of a ferret.
The bigger-than-a-rat, smaller-than-a-cat, half-domesticated member of the weasel family has been part of vaccine testing since the 1930s, when a doctor in a London lab noticed the animal sneezing after one of his colleagues took time off to recover from the flu.
The animals had originally been used in tests for canine distemper.
"Generally, we use ferrets because they're susceptible to flu almost exactly like humans are," Shaw says.
"They're given a little squirt up the nose and they get the flu. They sneeze, they get fever, they lose their appetite and they recover. And you look at the antibodies they've developed because of that infection."
By looking at how that antibody reacts with the previous vaccine, we can get an idea of how much it might have changed. It's that data that go into the deliberations in Geneva.
"Much of the CDC's Canadian data come from Booth's lab in Winnipeg, which gathers and analyzes flu strains from 31 sites across the country. Last year, it analyzed about 1,400 flu strains.
"In any one year, there are usually only four or five types of flu circulating," says Booth."We know thousands of people get flu every year. You only need to survey a portion of those. We feel between 1,000 and 2,000 flu strains from various parts of the country gives us a representative picture."
The lab sent about 100 of those samples to the CDC. The strains are couriered in polyethylene cryovials ? about half the size of a lipstick tube.
"These things will withstand freezing," Booth says."That's the idea. You can put them straight into liquid nitrogen and they won't crack or shatter.
"Our data go into this huge pot and then the CDC consults extensively on what's going to be in the next vaccine."
Two drug companies are responsible for supplying flu vaccine to the Canadian public market.
Sanofi Pasteur, which produces Vaxigrip in France, holds 25 per cent of the federal contract while GlaxoSmithKline, which makes Fluviral in Montreal, holds the rest.
The drug companies are required to complete efficiency tests on healthy human volunteers for government approval before the vaccine goes to market, but the results are classified.
"It's so confidential, they won't tell us," Booth says of the test results.
Because of that, his lab is in the process of testing the efficiency of this season's recipe.
"We're taking 500 people kind of randomly ? a cross-section of the population across the country ? who get the vaccine," Booth explains. "Blood samples are taken before the flu shot is administered and again two weeks later after the vaccine kicks in. We measure the amount of antibody those people have. That gives us an idea of how good the vaccine is."The answers will come too late to be useful this year but they could be invaluable next season. Meanwhile, Toronto Public Health is more than halfway through its immunization program for the season. Last year, 33,000 Torontonians waited in line at a mall, a civic centre or supermarket to get their flu shot.
So far this season, 25,000 have been vaccinated with just 12 more clinics until the program ends on Jan. 8.
So, what does all this mean to Grandma Moses and the man she recruited for a flu shot at Mount Sinai?
She should keep up the good work and he was wise to pay her heed, flu experts say. There's every reason to think that, this year, the vaccine will work.
To find a vaccination clinic near you, visit toronto.ca/health/flu/.