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Dec. 19--The sweep of influenza cases across the country and the lack of vaccine to meet the demands of a worried public are reminders that, as with so many things, timing is everything.
If international health officials had discovered the Fujian strain of influenza a little earlier or if manufacturers had been able to speed up production, perhaps there would have been time enough to make a vaccine that was both the right type and the right quantity.
That's not the case now.
"No one was aware of the Fujian strain until it was too late," explained Rhonda Smith, a spokeswoman for the U.S. Centers for Disease Control and Prevention.
About three-quarters of the flu cases reported nationwide this flu season come from the Fujian strain, with the remainder from the very similar Panama type. The Panama strain is one of three viruses in the vaccine produced this year. The Fujian is not.
According to the CDC, animal studies indicate that because the two strains are so similar, the current vaccine will do a lot to lessen the severity of a Fujian flu even if it doesn't prevent it.
By Wednesday, Allegheny County had recorded 171 confirmed cases, setting a record within four weeks of the flu season's start. Thirty more cases were reported yesterday. Only a small portion of all flu cases are reported.
The state Department of Health has determined that the 45 specimens it has tested so far are either Fujian or Panama straoms but has had to send the samples to the CDC for further testing. The county cases are either Fujian, Panama or New Caledonia -- all called Type A influenza -- and have also been sent to the CDC for testing.
"I'm sure they're swamped down there," said state Department of Health spokesman Richard McGarvey. "If our lab can't do it, 45 to 49 of the other states can't do it either."
The process of developing flu vaccine begins before the previous season is over. With the coordination of the World Health Organization, experts watch for virus strains as they crop up around the globe.
In February, health workers found a new influenza variant that was causing illness in Australia and the southern hemisphere around the time that the vaccine strains are typically chosen, said Barbara Loe Fisher, president of the National Vaccine Information Center and a member of the FDA flu vaccine advisory committee.
The New Caledonia and Type B Hong Kong were chosen, but the experts decided to hold off on picking the third and final vaccine strain for a few weeks.
"Everybody was trying to isolate and produce this Fujian strain and they weren't able to do it," Fisher said. "They defaulted to A Panama."
Health officials should have informed the public that because of troubles in producing the Fujian vaccine, this year's shots were not going to offer protection against all the variations that were expected to hit, she said.
By the early spring, vaccine manufacturers received seed strains from federal authorities and started growing large amounts of the viruses in chicken eggs. The viruses were killed and processed into vaccines that can be safely administered to humans.
The time-consuming operation is geared to make as many as 80 million doses to be given to people in September and October.
A spokesman said that this year vaccine-maker Aventis Pasteur made 35 percent more doses than had been ordered. In a typical year, it discards about 10 to 15 percent of its supply. But this season even the extra production was not enough to meet demand.
The CDC has given Aventis a sample of a Fujian-like strain called A-Wyoming to study in case it was needed for a vaccine next year. But no attempts will be made to create a vaccine this year without the government's direction.
Dr. Lee Harrison, an infectious disease expert at the University of Pittsburgh, said health officials might have had a greater sense of urgency in producing a Fujian vaccine if the vaccine that was mded didn't offer at least partial protection.
What worries Harrison is what happens when a totally novel flu strain appears.
The current practice of picking flu vaccine strains is about as good as it is going to get, he said. What's needed are improved methods that will decrease production time.
"What we've seen so far is what seems to be a relatively early and severe flu season with a variant strain," Harrison said. "We've seen some panic, we've seen exhaustion of our flu vaccine stocks and we've seen that there's very little surge capacity among the flu vaccine manufacturers."
Improving surge capacity -- the ability to quickly generate more vaccine -- will be critical if another flu pandemic hits, which some experts say is imminent.
So, as Harrison put it, "We need new approaches to be able to respond to flu."
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