Today the British medical journal The Lancet, which published the 1998 study by Andrew Wakefield implying autism was linked to vaccinations, fully retracted the study in the wake of increasing allegations of misconduct against the lead author.
The 1998 paper, based on a small sample of 12 children, implied a connection between an autism-like disorder and a triple vaccine for measles, mumps and rubella [AFP]. Despite the small sample size, and a commentary published by The Lancet encouraging caution in interpreting the results, the Wakefield paper became one of the chief sources cited by the modern anti-vaccination movement. His assertion caused one of the biggest medical rows in a generation and led to a big fall in the number of vaccinations, prompting a worrying rise in cases of measles [Reuters].
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As swine flu is now prevalent in 41 states, doctors are getting plenty of chances to study the workings of the disease. They now know that in severely ill patients, intense inflammation in the lungs prevents oxygen from being tranfered to the blood stream. Says physician Robert Fowler: “Most patients are still able to take breaths, but these breaths are ineffective” [Science News]. That oxygen deprivation can cause widespread organ damage.
The speed with which swine flu patients can go downhill marks the H1N1 virus as strikingly different from the seasonal flu virus, doctors say. “In severe cases, patients generally begin to deteriorate around three to five days after symptom onset. Deterioration is rapid, with many patients progressing to respiratory failure within 24 hours, requiring immediate admission to an intensive care unit” [Reuters], says World Health Organization doctor Nikki Shindo.
Doctors say that severely ill patients should promptly be put on breathing machines and given antiviral drugs like Tamiflu. In cases where patients’ respiratory systems have already crashed, some doctors are trying a treatment called extracorporeal membrane oxygenation, in which blood is extracted from each patient and passed through a machine that adds oxygen [Science News].
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Sigh. Less than three weeks after health officials convened a press conference in Thailand to announce a rare piece of good news in the hunt for an HIV vaccine, some scientists are asking whether the results were overstated.
The large clinical trial of the vaccine was a modest success, but it was plenty exciting for HIV vaccine researchers who have been waiting for years for any sign of progress. The U.S. Army and Thai researchers who collaborated on the trial found that the vaccine lowered the risk of infection by about 31% — a “modest benefit,” they said, but one that was statistically significant, suggesting the finding was not a fluke [The Wall Street Journal, blog]. But the press conference did not trumpet another analysis of the data, which included only those volunteers who carefully followed the experiment’s rules and got the full regimen of six shots at the right times. This second analysis showed a 26 percent rate of protection, and a much higher chance that the benefit was a fluke.
Some scientists say both analyses should have been revealed during the September announcement, and claim that the way the press conference was handled further undermines the research. “The press conference was not a scholarly, rigorously honest presentation,” said one leading HIV/AIDS investigator, who like others asked that his name not be used. “It doesn’t meet the standards that have been set for other trials, and it doesn’t fully present the borderline results. It’s wrong” [ScienceInsider].
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Swine flu vaccines have arrived! Or more accurately, limited amounts of the first available vaccine, a nasal spray, have been delivered to distribution points around the country, and several states began vaccinating health care workers and young children on Monday. It’s not a moment too soon: The Centers for Disease Control and Prevention have announced that flu is now widespread in most of the United States. The infections are “overwhelmingly” pandemic H1N1 influenza, commonly known as swine flu. The flu season generally lasts well into May, so many months of uncertainties lie ahead [Los Angeles Times].
CDC director Thomas Frieden says that so far, vaccine “demand is outstripping supply, but we expect that fairly soon supply will be outstripping demand.” … Over the next two to three weeks, tens of millions of additional doses will become available [Los Angeles Times]. The injectable form of the vaccine will be ready for distribution next week.
Now that the vaccines have been successfully hustled off the assembly lines, the next daunting challenge for public health officials is convincing people to go get vaccinated. Myths and worries about the vaccine have spread on talk radio and anti-vaccine Web sites [The New York Times], with even celebrities like Bill Maher unhelpfully chiming in via Twitter. At a Tuesday press conference, Frieden strongly refuted one of the most commonly voiced concerns: that in rushing the vaccine through production, it wasn’t properly tested for safety.
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As the nation prepares for a massive vaccination campaign to protect the most vulnerable people from the swine flu virus, scientists are preparing to combat public fears over the vaccine. Scientists worry that the public (or at least the activists who are convinced, against all scientific evidence, that vaccines cause autism and other diseases) will misinterpret coincidental deaths as side effects of the vaccine.
As soon as swine flu vaccinations start next month, some people getting them will drop dead of heart attacks or strokes, some children will have seizures and some pregnant women will miscarry…. “There are about 2,400 miscarriages a day in the U.S…. You’ll see things that would have happened anyway. But the vaccine doesn’t cause miscarriages. It also doesn’t cause auto accidents, but they happen” [The New York Times], says Jay Butler of the Centers for Disease Control and Prevention.
The CDC is particularly focused on convincing pregnant women of the vaccine’s safety. A recent study in The Lancet reported strikingly high rates of death and of complications like pneumonia in pregnant women with H1N1 influenza. Pregnancy meant a fourfold risk of hospitalization, sometimes with a tragic outcome [The New York Times]. Experts note that pregnant women often avoid medications out of fear of harming the fetus, but say that these women should be among the first to get vaccinated for swine flu, and should swiftly start antiviral medications if they come down with the virus. To date, the virus has killed 28 pregnant women in the United States.
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Now that the first vaccines against swine flu are about to become available, scientists are busy working out the details of how the vaccines can best be administered. Researchers already knew that a single dose was sufficient to protect adults, and they’ve now found that one shot works for teenagers and children over the age of 10. But young children who have never had the flu or a flu shot, however, need two doses, they said…. Children 6 months to 9 years old received some protection from one shot, but not enough, so health officials will recommend that they get two shots 21 days apart [The New York Times].
At least 6 million doses of vaccine will be available the first week of October, federal health officials announced today, and this first batch is in the form of a nasal spray called FluMist. The intranasal vaccine has not been approved for children younger than 2, adults older than 49 or pregnant women, so it may go primarily to healthcare providers [Los Angeles Times]. Injectable vaccines should make it to doctors’ offices a week or two later.
New York State has taken the drastic step of requiring that all hospital, home health and hospice workers get the swine flu vaccine. Experts say the mandatory vaccination will protect not just the workers, but also their patients. But some workers are upset by the edict. Health workers’ union official Joel Shufro says the unions do not oppose vaccination “but we oppose a mandatory program,” he said. “This is: ‘You don’t get the shot, you’re fired’” [The New York Times].
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Two HIV vaccines on trial in Thailand have shown some limited success in protecting people from the virus that causes AIDS. And in the hard-fought world of HIV research, that qualifies as a major breakthrough. Says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: “For more than 20 years now, vaccine trials have essentially been failures…. Now it’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions” [The New York Times].
The Thailand trial studied two vaccines that had already proven ineffective on their own. But people who received both vaccines were 31 percent less likely to get HIV, compared to people who received a placebo. This partial protection is a good step, but it’s also a puzzle to scientists who don’t understand why the vaccines only worked for some people.
In the trial, more than 8,000 volunteers received the vaccines, and an equal number received placebos. After three years, 51 people from the vaccinated group had been infected, compared to 74 people in the placebo group. While the numbers are small, researchers say they’re statistically significant.
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The big news in swine flu this week: Vaccines from four drugmakers have been approved for use in the United States, and with the companies’ production lines cranking there will be plenty to go around. Clinical trials have also shown that a single shot is enough to create a strong immune response, which means stockpiles will go twice as far as they would have if two shots were necessary. Said U.S. Health Secretary Kathleen Sebelius: “There will be vaccines for everyone.” … The first doses should be available within the next four weeks, according to the FDA [Reuters].
But as flu season is already ramping up, some people are wondering what they can do to protect themselves until the vaccine is available. One enterprising reporter decided to find out what her daily routine would be like if she wore a paper jumpsuit, mask, goggles, and gloves provided by a company called Flu Armor. But experts are reminding the public that face masks, which became a symbol of the initial outbreak in Mexico last spring, are really designed to stop the spread of droplets from the person wearing the mask, not to protect the wearer from viruses [Los Angeles Times].
The most effective preventive measure is also a simple one: wash your hands with soap often, or use an alcohol-based hand sanitizer. Experts note that hand-to-face contact has a surprising impact on health. Germs can enter the body through breaks in the skin or through the membranes of the eyes, mouth and nose [The New York Times].
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Let’s start with the good news: Clinical trials of the swine flu vaccines currently under production are showing that a single shot may be enough to protect a person against the H1N1 virus, rather than the series of two shots that was thought to be necessary. That means the vaccine supplies rolling off the pharmaceutical companies’ assembly lines will cover twice as many people. Experts say it should be possible to vaccinate — well before the flu’s expected midwinter peak — all the 159 million people that the Centers for Disease Control and Prevention estimate are in the high-risk groups: pregnant women, people under 24 years old or caring for infants, people with high-risk medical conditions and health-care workers [The New York Times].
In China, vaccinations are already underway, still Chinese health official Liang Wannian says the virus may well sicken tens of millions in the coming months. “The situation we face is not optimistic,” Liang said, noting that the virus had been found in all of China’s 31 provinces and regions [AFP]. While most cases won’t be severe, Liang says the sick could overwhelm the country’s hospitals and clinics.
While Chinese officials have said that vaccinations would start with high-risk groups, they also disclosed that people participating in the festivities of National Day on October 1st, which marks the 60th anniversary of the founding of communist China, will be at the front of the line. There are at least 200,000 official participants, plus thousands of security police. According to the BBC’s China analyst, Shirong Chen, they have been pushed to the front of the queue not just because it is a huge public event that carries national pride, but because all the top leaders and dignitaries will be in Beijing. The authorities cannot afford the political risk of any infection there [BBC News]. However, this prioritizing may leave less vaccine available for children, pregnant women, and health care workers.
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Over the past four years, a controversy has erupted over whether to routinely give girls the new vaccine against the human papillomavirus (HPV), a sexually transmitted virus that can cause genital warts and cervical cancer. Now we can have the debate all over again–but this time, with boys. An advisory panel of the Food and Drug Administration has recommended that the vaccine be made available for boys as well. While boys are obviously not at risk for cervical cancer, HPV can give them genital warts and, in very rare cases, can lead to anal or penile cancer.
The pharmaceutical giant Merck makes the first HPV vaccine available in the United States, Gardasil, which is considered most effective when given to young people who aren’t yet sexually active and therefore haven’t yet encountered the virus. But analyst Tim Anderson says that the regime of three shots over six months may deter some customers. “You are asking a healthy teen to come to the doctor three times in six months,” Mr. Anderson said…. “Pretty much no healthy teen would ever do that, let alone to come back and get a shot” [The New York Times]. It may be a particularly hard sell because most cases of genital warts clear up naturally, and because anal and penile cancers are so rare–each year they’re diagnosed in about 2,100 and 1,300 American men respectively.
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Image: flickr / lu_lu
Although researchers searching for an HIV vaccine have been down the path of optimism and disappointment many times before, a new finding has nevertheless brought fresh hope to the flagging effort. Researchers have discovered two antibodies that can effectively fight back most strains of the HIV virus, and say they’ll now try to make a vaccine that can teach the human body to produce these antibodies.
The weapons in question are called broadly neutralising antibodies…. These are antibodies that deactivate a wide range of HIV strains—which is particularly important for an effective vaccine, because HIV is so variable [The Economist]. Researchers found the two new antibodies after screening blood samples from 1,800 people around the world who were infected with HIV but hadn’t yet developed AIDS; the two antibodies both came from an African donor. Of these two potent antibodies, one neutralized 127 of 162 HIV strains and the other neutralized 119.
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The week began with the news that Colombian president Alvaro Uribe had come down with swine flu while meeting with other South American leaders in Argentina. But Uribe is making a full recovery, and experts note that cases of the H1N1 flu are starting to taper off along with the influenza season in the Southern Hemisphere…. “All countries report that after mid-July, disease activity in most parts of the country decreased,” [Reuters], according to a U.S. government report.
Meanwhile, schoolchildren and college students across the Northern Hemisphere are heading back to school, and health officials are bracing for swine flu, round two. It’s already cropping up where conditions are right. Just as the football season is getting under way, Duke, Texas Christian and Alabama have reported cases of swine flu or of players experiencing flulike symptoms…. The strain tends to spread most quickly among young adults, who have not built an immunity to flu strains. Because the athletes share dorm rooms, cafeterias and sometimes unsanitary locker rooms, “it’s kind of an ideal situation for the flu,” said Artealia Gilliard, a spokeswoman for the Centers for Disease Control and Prevention [The New York Times]. Outbreaks were also reported at some colleges where women are attending sorority rush events before the start of classes.
Colleges have put a number of contingency plans in place to deal with outbreaks, including swine flu buses to spirit away the sick to infirmaries and drive-up vaccination clinics that will open as soon as vaccines are available, probably in early October. City education departments are also kicking their preventive machinery into high gear. On Tuesday, New York Mayor Michael Bloomberg announced that all primary school-age children in New York City will be offered free vaccines for seasonal and H1N1 flu this year [Reuters]. School officials in New York and elsewhere have said that they’re reluctant to close schools, as they did in the spring during the pandemic’s onset, because it disrupts parents’ work schedules and does little to halt the spread of the virus.
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Another day, another swine flu story: Amidst all the chatter, it can be hard to find the most reliable sources and relevant info. To keep you informed of the latest intelligence, 80beats will round up the news each week.
On Monday, the President’s Council of Advisors on Science and Technology issued an alarming report spelling out a “plausible scenario” for how the swine flu pandemic will play out during the coming flu season. The report estimated that the H1N1 virus could hospitalize 1.8 million Americans, potentially clogging emergency rooms and intensive care wards, and could kill up to 90,000 people in the United States. In a typical year, the seasonal flu virus kills about 35,000 Americans.
But on Tuesday, some public health officials walked back the report’s conclusions. One expert who helped prepare the report said that the numbers were probably on the high side, given that some weeks had passed since the calculations were finished in early August. “As more data has come out of the Southern Hemisphere, where it seems to be fading, it looks as if it’s going to be somewhat milder,” said the expert, Marc Lipsitch…. “If we were betting on the most likely number, I’d say it’s not 90,000 deaths; it’s lower” [The New York Times].
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The genome of an HIV virus is a truly twisted thing, but now for the first time researchers have traced its every fold and contour. By mapping its entire structure, they hope to gain a greater understanding of how the virus operates, and potentially accelerate the development of drug treatments [BBC News]. Usually geneticists focus on the sequence of genes that comprise an organism’s genome, but recent evidence suggests that the structure can also play a role in how it functions.
Like many other viruses, the HIV genome consists of single-strand RNA, rather than the double-stranded DNA found in most animals. Though scientists have identified HIV’s genes and their order, just one-fifth of its genome has been described in precise spatial detail. That’s important because genomes don’t look anything like the neatly linear, bar code-like pictures returned by basic sequencing techniques. In reality, genomes are arranged in intricate, three-dimensional loops and whorls. And just as a list of machines isn’t very useful without a description of their arrangement on a factory floor, structure matters [Wired.com].
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Clinical trials began in the Australia this week on a vaccine to thwart a possible flu epidemic of the virus that has so far killed more than 700 people worldwide. Similar trials will soon begin in the United States in the hopes of producing a vaccine in time for flu season.
Two separate seven-month trials to test a possible swine flu vaccine in Australia began on Monday and Wednesday; the studies have 300 and 240 subjects, respectively. Because it’s winter in the Southern Hemisphere, and therefore flu season, Australian authorities said it was important to test vaccines there as soon as possible. “[The Southern Hemisphere] is where the problem is right now,” Nikolai Petrovsky [director of one of the manufacturers of the vaccines in the trial] told the Associated Press. “The demand was here yesterday. We’re right in the middle of a surge of swine flu cases where perhaps the United States won’t have to worry about it as much until their flu season hits in six months” [AP].
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