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When flu flies the coop: a pandemic threatens

Science News, Sept 10, 2005 by Ben Harder

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The World Health Organization (WHO) and some national governments have stockpiled oseltamivir, which could be used to prevent infections or to treat people already sick with flu.

"A mobile stockpile of Tamiflu that could be moved anywhere on the planet rapidly is the way to go," Longini says. On the basis of their study's results, he and his colleagues say in the Aug. 12 Science, "the current WHO stockpile of 120,000 courses could possibly be sufficient to contain a pandemic if the stockpile were deployed at the source of the emerging strain within two to three weeks of detection."

Successful containment would depend on many factors, however, and the model could be overly optimistic, the researchers acknowledge.

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The other modeling analysis, conducted by Neil M. Ferguson of Imperial College London and his colleagues, predicts in an upcoming Nature that "a stockpile of 3 million courses of antiviral drugs should be sufficient." That study treated Thailand as the epicenter of the epidemic.

This analysis assumed that an effective vaccine wouldn't be widely available by the time a pandemic begins. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, in Bethesda, Md. announced on Aug. 6 that government scientists had found an experimental vaccine against H5N1 that seems effective. The investigators observed a strong immune response in people who received two shots of vaccine, but its efficacy in preventing disease isn't known because no volunteer was exposed to the actual pathogen.

Secretary of Health and Human Services Michael O. Leavitt said in July that the United States will stockpile enough vaccine for 20 million people and antiviral medicine for 20 million more.

But, according to Fauci, the government has purchased only enough H5N1 vaccine, from French manufacturer Sanofi-Pasteur, to inoculate 450,000 people at the dose used in the recent test. Acquiring more vaccine will take months, because few facilities are capable of mass-producing it.

Furthermore, the pandemic strain will almost certainly not correspond precisely to the strain that the Sanofi-Pasteur vaccine targets. That will limit the vaccine's effectiveness.

The existing vaccine could still shield some inoculated people and, among those who get infected despite the shot, the treatment could reduce the severity of the disease and the rate at which they spread flu to others. "Even if it didn't completely protect people, it would still [make other] measures more effective," says Halloran.

If the transmissibility of the virus is sufficiently high, however, or if the preventive pharmaceuticals can't be deployed in time, a local outbreak could expand like a wildfire. In that ease, Halloran's and Ferguson's models indicate, social procedures such as canceling schools and dismissing office workers could be of particular importance.

But those actions are socially and economically disruptive, and they offer no guarantee of choking the pandemic, Halloran says. If people decide not to leave home to get food, she says, even pizza deliverers could become vehicles for spreading influenza.

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When flu flies the coop: a pandemic threatens

Science News, Sept 10, 2005 by Ben Harder

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