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As Vaccine Development Kicks Off, Caution Urged

A man learns how to use a vaccine injection gun during the swine fluinflu outbreak of 1976 i

A man learns how to use a vaccine injection gun during the swine flu outbreak of 1976. CDC/Phil/Corbis hide caption

toggle caption CDC/Phil/Corbis
A man learns how to use a vaccine injection gun during the swine fluinflu outbreak of 1976

A man learns how to use a vaccine injection gun during the swine flu outbreak of 1976.

CDC/Phil/Corbis

Treatment Options

  

In most cases, the swine flu can be treated and prevented using the same anti-viral drugs that fight the seasonal influenza strains.

  

— The CDC recommends using the capsule Tamiflu (oseltamivir phosphate) or the inhaled drug Relenza (zanamivir). These antiviral drugs can also help prevent flu infections.

  

— These prescription drugs fight the flu by keeping the virus from reproducing in your body. The drugs aren't an instant cure, but they can make the illness milder and make the sick person feel better faster. They may also prevent serious flu complications.

  

— For treatment, anti-viral drugs should be started within 24 to 48 hours of symptoms to be effective.

  

Symptoms And Spreading

  

— Swine flu symptoms are similar to those of the regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.

  

— Swine flu can spread from person to person, mainly by exposure to coughing or sneezing. People may become infected by touching something with flu virus on it and then touching their mouth or nose, so it's important to throw away used tissues, wash dishes and laundry thoroughly and keep sick people away from others until they are well. And, someone who has the flu is contagious even before he or she starts having symptoms.

  

Source: Centers for Disease Control and Prevention

Song Kyung-Seok-Pool/Getty

The last time the nation raced to contain an outbreak of swine flu, the result was a controversial — and ultimately flawed — national immunization program.

That 1976 outbreak, which began with the death of a military recruit at Fort Dix, N.J., was believed to have been the first major incidence of swine flu in humans since the 1918-19 pandemic. Known as the "Spanish" flu, the 1918 strain killed more than 50 million people.

And though the virus making the rounds today is not genetically identical to the earlier strains, researchers already have abundantly more information about the latest iteration than they did when they faced down swine flu 33 years ago.

The new virus has already shown its ability to be transmitted human to human — not just animal to human.

Delivering Treatment

The new flu in many cases can be effectively treated with antiviral drugs that serve as both a preventative and a treatment. Federal health officials for several years now have been stockpiling those prescription drugs, produced under the brand names Tamiflu, a capsule, and Relenza, which is inhaled.

These antivirals are effective — but are not an instant cure. They work best if taken within two days of the onset of symptoms and, in general, can make symptoms milder.

Fast-Tracking A Vaccine

At an international level, researchers are ramping up plans to develop a vaccine designed, if needed, to contain a potential pandemic.

An already formulated seasonal flu vaccine would not protect against the new strain, health officials have determined. That means a new vaccine has to be developed that would, if used, either be added as an element to the current formulation or administered separately.

"A new component will be required," says Harvey Fineberg, president of the Institute of Medicine.

"We are fortunate now to have isolates of the virus, and it will be possible to develop seed strains that will help produce a vaccine," says Fineberg, former dean of Harvard's School of Public Health. In 1978, Fineberg, at the Carter administration's request, co-authored a report that analyzed the nation's response to the swine flu outbreak.

Flawed Immunization

Testing the safety of the vaccine will be a key component. With the 1976 outbreak, the government inoculated 45 million people before shutting down the program after more than 500 people developed the rare Guillain-Barre syndrome, a form of paralysis that can be fatal. More than $400 million was spent on the vaccination effort and resulting damages to people who developed the syndrome and their families.

In the end, 25 people died from Guillain-Barre. About 200 cases of swine flu were recorded, and only one resulted in death: the Fort Dix Army recruit.

Among its other findings, Fineberg's report — "The Epidemic That Never Was" — asserted that while preparations in the face of an epidemic are urgent, actions should depend on solid findings.

In contrast to 1976, health officials now appear to be moving more deliberately, seeking to avoid spreading panic and jumping into a flawed immunization program.

President Obama on Monday morning cautioned against alarm, and public health action is in a bit of a holding pattern, says Dr. Greg Poland, professor of medicine and infectious diseases at the Mayo Clinic in Rochester, Minn.

What would push health officials toward ordering massive batches of a new vaccine, Poland says, would be the severity of illnesses. Currently, patients in the U.S. have reported relatively mild symptoms.

Evidence of very widespread human-to-human transmission would also increase the urgency behind vaccine development.

"We're semi-teetering on that," Poland says.

'An Insurance Policy'

It could take four to six months to develop and test a vaccine, and then another four months to produce it.

"But you don't want to jump the gun and cause panic or expense that's unnecessary," he says. "At the same time, you need an insurance policy."

The insurance policy, he says, includes monitoring, moving stockpiles of antiviral drugs to where they're needed, beginning a vaccine development process and more monitoring.

Right now, however, it's not clear whether the outbreak will fizzle or whether it's the beginning of something that could become a pandemic, he says. And researchers are debating why the outbreak has been so much more severe in Mexico. Genetics, nutritional status and chronic respiratory irritation due to pollution are among factors being discussed.

The World Health Organization raised its pandemic alert level Monday to Phase IV, which signals sustained human-to-human spread of the virus. Phase VI means the outbreak has reached pandemic level.

Recent international outbreaks of the avian flu and SARS (Severe Acute Respiratory Syndrome) have helped prepare the international public health community to respond to the latest health scare, Poland says.

But despite strides made in recognizing and doing battle with such viruses, the process by which vaccines are developed has remained locked in the 1940s and '50s: Vaccine researchers still take the virus from a mammal and adapt it to grow in chicken eggs.

"The virus might have to be mutated to do that, and it might grow poorly so you don't have a high yield," says Poland, who is among those advocating for more research developing new technology to produce vaccines quickly and safely.

An Early Warning

Right now, however, the focus is on the immediate health concern, and both Poland and Fineberg advocate an urgent but measured response, particularly given the country's last swine flu experience.

"This is a very early stage," Fineberg says. "The main task at hand is collecting accurate and more complete information."

"The flu is very unpredictable when it begins, and in how it takes off," he says. "The key now is to do everything in preparation and to get all of our necessary elements lined up over the summer."

It's an early warning — in time for the fall, when flu season typically begins in earnest.

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