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Severe Flu Strain Exposes Medicine Shortages, Threat of Pandemic

Posted - Nov. 28, 2003 at 11:20 a.m.



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A severe and early outbreak of flu is striking now in Texas, Colorado, Scotland and England, and top flu experts are warning that the world has too few anti-flu medicines on hand if a global super outbreak of influenza, called a pandemic, hits in the future.

Senior influenza researchers are urging world health authorities to start using genetic modification to make vaccines -- a still untested process -- and begin stockpiling anti-flu medicines.

"The world will be in deep trouble if the impending influenza pandemic strikes this week, this month, or even this year," influenza researchers Dr. Richard Webby and Dr. Robert Webster of St. Jude's Children's Research Hospital in Memphis write in today's issue of the journal Science.

The worst isn't here -- yet.

"What we're experiencing now is a bad flu season, not a pandemic," said Dr. Bruce Gellin, director of the National Vaccine Program Office and a senior official at the U.S. Department of Health and Human Services. "It's a reminder to all of us how significant a disease influenza is and therefore a reason we have to do all that we can to prepare for a pandemic."

The flu striking Texas, Colorado and the United Kingdom now is a strain called Fujian. It is a modification of a particularly serious type of flu, called H3N2, which has been inflicting human beings for more than 35 years.

This nasty version has the potential to double the normal 35,000 annual U.S. flu deaths, researchers say. Four children died in Denver this week, and one in seven doctors visits in Texas are for flu symptoms.

"We will probably see more excess deaths this year than we saw in the 1968 (Hong Kong flu) pandemic," said Dr. W. Paul Glezen, director of the Influenza Research Center at the Baylor College of Medicine in flu-struck Houston. "We have to expect this year that we'll see (U.S.) mortality in the range of 65,000 to 70,000, which is high."

As bad as Fujian is, however, experts fear something worse -- the passage to human beings of an entirely new strain that would spread more quickly and with deadlier effect because people don't have immunity. Such strains are now running rampant in birds and pigs.

Earlier this year, newer strains hit small pockets of the world, putting flu experts on alert. In February, a family in Hong Kong was struck with the bird flu H5N1 and one person died. In March, a poultry flu, H7N7, hit the Netherlands, infecting dozens of people and killing a veterinarian.

Luckily, the strains didn't spread, but "a lot of alarm bells are going off," Webby said, because these variations have grown dramatically in birds and pigs in the past 12 months.

National Vaccine Program director Gellin compared the growing bird and pig strains to "sparks in a dry forest." Sometimes they cause forest fires and sometimes they don't, he said in an interview. Either way, he added, the world has to be ready if they do.

But the world is nowhere near ready, St. Jude's researcher Webster told reporters in a news conference.

The current method of making flu vaccines -- using chicken eggs to grow two virus strains, hoping for a hybrid of the two strains to use in the vaccine -- would take too long in the midst of a fast-moving pandemic, Webster said. Plus, some flu strains -- including the current Fujian and the feared new bird flu strains -- don't grow well in eggs.

So Webster and fellow researcher Webby are pushing for a new technique to grow the seed stock for future flu vaccines. It is a genetic modification method called reverse genetics and has never been used before on flu vaccines. This method could shave months from a process that now can take eight months.

There are potential pitfalls with patent issues and European objections to the concept of genetically modified vaccines, said University of Michigan epidemiology professor Dr. Arnold Monto, director of that school's Bioterrorism Preparedness Initiative. But, he said, the idea makes sense.

The National Institute of Allergy and Infectious Diseases is working on this technique for unusual flu strains, like the Asian bird flu, said NIAIAD influenza program officer Dr. Linda Lambert. Safety tests on a vaccine derived by reverse genetics will start in the fall of 2004, she said. If a pandemic breaks out earlier, the U.S. government could have something ready within months, she said.

Even that speeded up process won't be fast enough in a pandemic, Monto said -- leaving medical professionals to rely largely on four anti-viral medications to both try to prevent the illness and to combat the virus in people who have fallen ill.

Those medications are in short supply even under today's conditions, researchers say. A pandemic would present a major supply problem.

In Fort Worth, one hospital with a young flu victim in the intensive care unit had only two pills of the anti-viral Tamiflu available, said Dr. Scott Harper, an infectious disease physician specializing in flu at the Centers for Disease Control and Prevention in Atlanta.

"We have shortages right now with ordinary use," said Baylor's Glezen. "If we had a pandemic we'd have a riot with people trying to get these drugs."

Monto said the U.S. government should stockpile the anti-flu medicines just as it does Cipro and other medicines to counter bioterrorism. He noted that all the anti-flu medicines are made outside of the United States. In the event of a pandemic, other countries might hoard the supplies, leaving America without much.

Health and Human Services' Gellin said his agency is discussing the idea of stockpiling anti-flu medicines. But he said no decision has been made on whether to do so.

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Copyright ©2003 State College Centre Daily Times. All Rights Reserved.

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