Cold & Flu


Swine flu may hospitalize 1.8 million patients in the U.S. this year, filling intensive care units to capacity and causing “severe disruptions” during a fall resurgence, scientific advisers to the White House warned.

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Swine flu, also known as H1N1, may infect as much as half of the population and kill 30,000 to 90,000 people, double the deaths caused by the typical seasonal flu, according to the planning scenario issued yesterday by the President’s Council of Advisers on Science and Technology. Intensive care units in hospitals, some of which use 80 percent of their space in normal operation, may need every bed for flu cases, the report said.

The virus has sickened more than 1 million people in the U.S., and infections may increase this month as pupils return to school, according to the Centers for Disease Control and Prevention in Atlanta. If swine flu patients fill too many beds, hospitals may be forced to put off elective surgeries such as heart bypass or hernia operations, said James Bentley with the American Hospital Association.
“If you have 1.8 million hospital admissions across six months, that’s a whole lot different than if you have it across six weeks,” said Bentley, a senior vice-president of the Washington-based association, which represents 5,000 hospitals.
The scenario projections were “developed from models put together for planning purposes only,” said Tom Skinner, a spokesman for the CDC, at a briefing in Atlanta today. “At the end of the day, we simply don’t know what this upcoming flu season is going to look like. It could be severe, it could be mild, we just don’t know.”

Past Pandemics
The models were based on past pandemics, and the CDC is working on new projections based on the latest data gathered from swine flu patients, Skinner said. Those estimates should be available “soon,” he said, without further specifying.
President Barack Obama was urged by his scientific advisory council to speed vaccine production as the best way to ease the burden on the health care system. Initial doses should be accelerated to mid-September to provide shots for as many as 40 million people, the panel said in a report released yesterday. Members also recommended Obama name a senior member of the White House staff, preferably the homeland security adviser, to take responsibility for decision-making on the pandemic.
“This isn’t the flu that we’re used to,” said Kathleen Sebelius, U.S. health and human services secretary. “The 2009 H1N1 virus will cause a more serious threat this fall. We won’t know until we’re in the middle of the flu season how serious the threat is, but because it’s a new strain, it’s likely to infect more people than usual.”

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Clinical Trials
Data from clinical trials to assess the safety and effectiveness of swine flu vaccines will start to become available in mid-September, health officials reported Aug. 21. Full results from the two-dose trials won’t be available until mid-October.
“We are making every preparation effort assuming a safe and effective vaccine will be available in mid-October,” Sebelius said today at the CDC’s Atlanta offices.

H1N1 has already reached more than 170 countries and territories in the four months since being identified, the Geneva-based World Health Organizationsaid. Swine flu causes similar symptoms as seasonal strains. It has so far resulted in worse than normal flu seasons, with increased hospitalizations and cases of severe illness, the WHO said in an Aug. 12 release.
New Zealand and Australia, in the midst of their normal flu seasons, have reported intensive care units taxed to capacity by swine flu patients. The experience provides clues to what the U.S., Europe and Japan may see when the H1N1 virus returns.


President’s Advisers
The president’s advisory council describes as a “plausible scenario,” that 30 percent to 50 percent of the U.S. population will be infected in the fall and winter. As many as 300,000 patients may be treated in hospital intensive care units, filling 50 percent to 100 percent of the available beds, and 30,000 to 90,000 people may die, the group’s report said.

“This is a planning scenario, not a prediction,” according to the report. “But the scenario illustrates that an H1N1 resurgence could cause serious disruption of social and medical capacities in our country in the coming months.”
Peter Gross, chief medical officer at Hackensack University Medical Center in New Jersey, said if the group’s scenario comes true, “I think every hospital in America is going to be in a crunch. We’ll be hard pressed to deal with those predictions,” he said.

‘Overblown’ Estimates
The estimates seem “overblown,” Gross said, given that swine-flu outbreaks in 1968 and 1957 failed to cause as many deaths, even with medical technology and disease surveillance less advanced than today.
“Influenza, you can make all the predictions you want, but it’s more difficult than predicting the weather,” Gross said yesterday in a telephone interview, after the advisory report was made public. “If influenza was a stock, I wouldn’t touch it.”
The 775-bed hospital is planning for an outbreak, upping its order of flu medications and discussing where to put patients if the worst occurs, Gross said.

The President’s Council of Advisers on Science and Technology is chaired byJohn Holdren, the director of the White House Office of Science and Technology, Eric Lander, the head of the Broad Institute of Massachusetts Institute of Technology and Harvard University in Cambridge, Massachusetts, and Harold Varmus, the chief executive officer of Memorial Sloan-Kettering Cancer Center in New York.
The 21-member group of scientists and engineers, created by Congress in 1976, advises the president on policy involving scientific matters.

New Estimates
Seasonal flu usually kills about 36,000 Americans, Skinner said. Swine flu causes more severe illness needing hospitalization among younger people than seasonal flu, while leaving people 65 and older relatively unscathed, saidMike Shaw of the CDC.
The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.
“We don’t know whether the number of severe illnesses will be much greater, but we do know that it’s a new virus and therefore people are very vulnerable,” said Anne Schuchat, director of the CDC’s Center for Immunization and Respiratory Diseases, in an interview yesterday.


Disease Burden
About 100 million people in the U.S. get the annual flu shot, Schuchat said. Pregnant women, who have “a disturbingly high burden of disease” from swine flu, only get vaccinated for seasonal flu about 15 percent of the time. Pregnant women are a top priority for vaccinations, she said.
Seasonal flu usually kills about 36,000 Americans. Swine flu causes more severe illness needing hospitalization among younger people than seasonal flu, while leaving people 65 and older relatively unscathed, said Mike Shaw, associate director of laboratory science at the CDC’s flu division.
The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.
“People who get infected with this strain happen to be the healthiest members of our society,” said Shaw in a presentation yesterday at the agency.
The H1N1 strain is genetically related to the 1918 Spanish Flu that killed an estimated 50 million people. Variations of the Spanish Flu circulated widely until about 1957, when they were pushed aside by other flu strains. People whose first exposure to a flu virus was one of those Spanish Flu relatives may have greater immunity to the current pandemic, Shaw said.


* Text by Tom Randall and Alex Nussbaum, August 25, 2009

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Fast treatment manufactured from flu survivors’ antibodies could pave the way to more effectively thwarting pandemics

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A new method for swiftly producing proteins to fight infections could mean the difference between life and death during future pandemics. Researchers report in Nature today that they have perfected a way to manufacture monoclonal antibodies capable of destroying diseases such the avian flu, which have the ability to swap genes with human flu varieties and jump from birds to people.

Their research is a dramatic advance, because it marks the first time that scientists were able to rapidly generate the disease-killing proteins, according to study co-author Patrick Wilson, an immunologist at the Oklahoma Medical Research Foundation (OMRF) in Oklahoma City. He says that researchers could one day spare scores of lives and nip potential epidemics in the bud by whipping up a treatment within a month from natural antibodies that survivors developed against the threatening disease.

Until now, he says, it took as long as three months to produce enough monoclonal antibodies to protect huge populations, because the immune system only pumps out small quantities in response to infections.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the new work a “significant advance,” noting in a statement that it “opens the way to producing [monoclonal antibodies] that potentially could be used diagnostically or therapeutically” for the flu as well as other infectious diseases such as hepatitis C and the human immunodeficiency virus (HIV), which can lead to full-blown AIDS.

The new technique, pioneered by Wilson and fellow researchers at the Emory University School of Medicine in Atlanta, saves time by using antibodies produced by so-called B cells (white blood cells that produce and then ferry them to infection sites to battle invading germs) in response to vaccines instead of to actual infections.

According to Wilson, monoclonal antibodies from (deliberately infected) animals were routinely used in the first half of the 20th century to try to treat diphtheria (an upper-respiratory illness that killed roughly 15,000 people annually in the early 1920s until a vaccine was formulated against it in 1924) and tetanus (a potentially fatal infection also known as lockjaw, because one of the muscles it destroys is in the jaw). There were, however, compatibility issues: The human immune system in most cases viewed the animal antibodies as alien and rejected them—or lacked the ammunition to destroy them, thereby making patients sicker.

To avoid these problems, researchers have been trying to perfect and speed up procedures for extracting monoclonal antibodies from humans, replicating them in a lab, and then injecting them into victims suffering from the diseases they were formed to fight. The key to collecting these antibodies has been to remove B cells that bear them from survivors of, say, a particular flu strain—or alternatively, someone who has been vaccinated against the flu (because the flu vaccine contains a weakened version of the virus).

Until now, scientist have run into problems trying to recreate large enough quantities quickly enough to spare lives. Wilson says the process traditionally has taken so long that by the time enough new B cells were generated, the flu strain targeted already had mutated into a form no longer vulnerable to the captured crop of antibodies.

In the new method, the researchers isolated B cells from humans who had been vaccinated against—and therefore had built up specific antibodies to—the seasonal flu. But instead of prodding extracted B cells to proliferate, Wilson says, the teams simply plucked the antibody-producing genes from them and inserted those into existing B-cell lines, thereby increasing their protein output.

The type of B cells that the scientists tapped for the coveted proteins are known as antibody-secreting plasma cells (ASCs). ASCs are among the first-line defenders that the immune system sends out when it detects an infection (including weakened vaccine versions). These cells are tasked with scoping out potential danger and signaling the backup germ fighters required to knock out invading armies. ASCs are short-lived, because they serve more as scouts than as combat soldiers.

The teams found that up to 80 percent of the ASCs that they isolated during their peak (seven days after vaccination) contained monoclonal antibodies to the flu strain they had injected.

“The reason this is so exciting is that the same kind of B cell could be present in people [who] have primary infections,” says Wilson, noting that researchers thus far have only showed this works with antibodies created in response to vaccines. The team now plans to test the method on people infected with the flu or another virus.

Antonio Lanzavecchia, director of the Institute for Research in Biomedicine in Bellinzona, Switzerland, stresses that the effectiveness of Wilson’s technique depends on the relatively short time span during which ASCs are active.

Lanzavecchia believes that his own research is more promising: He has harvested antibodies against both severe acute respiratory syndrome (SARS) and avian flu using so-called memory B cells, which are immune cells that store antibodies from all vaccines and previously beaten viruses—and remain in the blood permanently.

“If you have a spontaneous disease, you have only a short window of time where you can get [ASCs],” he says, “so targeting memory B cells [from someone who has beaten the illness] may be an advantage.”

The problem is, Wilson says, that a person has relatively few memory B cells—”on the order of one in thousands”—making the process of extracting antibodies from them a time-consuming task, because they first must be located.

“We are making new antibodies that [are potentially more effective because they] are binding to very specific strains of a virus,” he says. He adds that the new technique might also be employed to pin down the flu strain someone has by testing the effectiveness of extracted antibodies against it.

Wilson says that the new technique could become widely available in a few years if it is proved safe and effective during human clinical trials.

By Nikhil Swaminathan

The two winter respiratory illnesses may look alike, but pay attention to tell them apart

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How many times have you dismissed sniffles as “just a cold,” and carried on with a stuffed nose and sinuses assuming that the symptoms would eventually run their course, perhaps a bit more quickly with a few doses of Mom’s homemade chicken soup?

Influenza is another story. The common cold eventually fizzles, but the flu may be deadly. Some 200,000 people in the U.S. are hospitalized and 36,000 die each year from flu complications — and that pales in comparison to the flu pandemic of 1918 that claimed between 20 and 100 million lives. The best defense against it: a vaccine. Yet barely 30 percent of 4,000 U.S. adults surveyed said they’d been inoculated this season, despite a record supply of flu shots, according to a new RAND Corp. survey. (GlaxoSmithKline, which makes flu vaccine, helped pay for the survey.)

So what is the difference between a cold and the flu – and how can you be sure which one you have?

We asked Jonathan Field, director of the allergy and asthma clinic at N.Y.U. Langone Medical Center/Bellevue Hospital in New York. Following is an edited transcript of our interview with him.

What causes the flu? How is it different from a cold?

The flu is a viral infection caused by the influenza virus, a respiratory virus. The common cold is also a viral infection caused by the adenovirus or coronavirus and there are many, many subsets with a lot of variability. That’s why it’s said there’s no cure for the common cold [and] there’s no real vaccine. The flu is known to be from influenza and is preventable with vaccination.

Colds tend to produce runny nose, congestion, sore throat. Influenza is more pronounced in that it infects the lungs, the joints and causes pneumonia, respiratory failure and even death. It tends to infect the intestinal tract more in kids, with diarrhea and vomiting. Because of the relative immaturity of the gut, they may absorb more virus and that wreaks more havoc on the intestines. Flu causes epidemics and pandemics with the potential for mortality, whereas the common cold is a nuisance for us.

How can someone who’s feeling ill distinguish between cold and flu, or an allergy?

Flu typically starts in early November and can go until March. The peak time is now — November to January. Allergy is typical in spring or fall, and cold more so in winter.

The body can respond in only so many ways, but there are things you can use to differentiate. Allergic symptoms are similar to those of a cold, but [result from] your immune system responding to something benign. Usually there’s no fever, and there’s an allergic manifestation of itch in the back of the throat or the ears. It’s unlikely with allergy to have body aches. With a cold, there’s sometimes a low-grade fever.

You can tell the difference by the length and severity of the illness and whether you’ve had a similar experience in the past. Both colds and flu usually last the same seven to 10 days, but flu can go three to four weeks; the flu virus may not still be there, but you have symptoms long after it’s left. Allergy can last weeks or months.

Are the treatments for these illnesses different?

For any of these things, if it affects the nose or sinus, just rinsing with saline that gets the mucus and virus out is a first-line defense. It’s not the most pleasant thing to do, but it works very well. There are classes of medicines that can help the flu — Tamiflu and Relenza — antivirals that block viruses’ ability to reproduce and shorten the length and severity of the illness. But they have to be taken within 48 hours or the cat is proverbially out if the bag [because by then] the virus has done the most of its reproduction. For a cold or flu, rest and use decongestants and antihistamines, ibuprofen, acetaminophen, chicken soup and fluids.

Zinc supposedly helps the body’s natural defenses work to their natural capacity and decrease the severity and length of a cold. Cells need zinc as a catalyst in their protective processes, so if you supply them with zinc, it helps them work more efficiently. You should also withhold iron supplements. Viruses use iron as part of their reproductive cycle, so depriving them of it blocks their dissemination.

The majority of these infections are not bacterial and do not require [nor will they respond to] antibiotics. My rule of thumb is that a viral infection should go away in seven to 10 days. If symptoms persist after that, you’d consider if it’s bacteria like Strep or Haemophilus influenzae. Those bacteria cause illnesses that are longer lasting.

Is that treatment approach the same for kids?

In general, the same rules apply: Most children will have six to eight colds a year in their first three years of life, and most are viral. It’s very easy to test for strep and for that you should have a [positive] culture [before treating with antibiotics].

Are the strategies for avoiding cold and flu different?

Avoidance is very similar: Strict hand washing, not sharing drinking cups or utensils, and avoiding direct contact with people who are sneezing. As long as someone has a fever, they have the possibility to transmit infection. After they’ve had no fever for 24 hours, they’re not infectious.

The U.S. Centers for Disease Control and Prevention (CDC) now recommends that just about everyone get the flu shot: kids 6 months to 19 years of age, pregnant women, people 50 and up, and people of any age with compromised immune systems. Is the shot beneficial to anyone who gets it?

Unless you have a contraindication, there’s no reason not to get it. Contraindications would include egg allergy (because the vaccine is grown from egg products), any vaccines within a last week or two, and active illness at the time of your vaccine.

By Jordan Lite