Scientists have found that people infected with H1N1 swine flu have an extraordinary immune response, producing antibodies that are protective against a variety of flu strains.
The discovery has provided clues to how to make a universal vaccine. Some of the antibodies produced were protective against core elements critical for the virus to function but which don’t change as much as other regions of the virus.
Swine flu
If these can be replicated in a vaccine it could put an end to the yearly scramble to predict each winter’s flu strains and rapidly mass-produce a vaccine.
The researchers analysed antibodies from nine patients who had swine flu in 2009-10. Five were effective against all the seasonal H1N1 strains of flu from the past decade, the devastating “Spanish flu” from 1918 and the potentially lethal H5N1 avian flu.
“The result is something like the Holy Grail for flu-vaccine research. It demonstrates how to make a single vaccine that could potentially provide immunity to all influenza,” said Patrick Wilson, of the University of Chicago, an author of the study published in the Journal of Experimental Medicine.
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The death toll from this winter’s flu outbreak is continuing to rise as a row erupts over who should manage the vaccination campaign in the future.
Latest figures show 254 people in the UK have died – up from 112 last week.
But overall flu activity appears to be going down.
It comes after Professor David Salisbury, the government’s head of immunisation, suggested ministers should take charge of the flu jabs programme from GPs.
But doctors rejected the suggestion, saying it could make matters worse.
Of those who have died, 195 were infected with the H1N1 swine flu virus.
Four in five were among people from an “at risk” group – but many had not received their jab this season.
Experts said the majority of newly-confirmed deaths probably took place over a six-week period, rather than in the last seven days, as there has been a backlog in the recording process over the Christmas and New Year holiday period.
Overall, the latest figures, published by the Health Protection Agency, indicate that flu activity across the UK is now past its peak.
In the past week the number of GP consultations in England has fallen to 66.5 per 100,000 – down from 108.4 per 100,000 the previous week. The rest of the UK also reported falls.
Meanwhile, the number of patients in intensive care has fallen – they are now half what they were at the peak.
Professor John Watson, head of the respiratory diseases department at the HPA, said: “Our latest flu report suggests levels of flu are declining across the UK, but nonetheless flu is still circulating in the community and the message remains that people in an at-risk group should get the seasonal flu vaccine – it’s not too late to protect yourself from flu this season.”
‘Pretty compelling’
Professor Salisbury revealed his desire to see central government take control of ordering and supplying flu vaccination in an interview with the BBC News website.
He said there was a “pretty compelling” case for the move after the problems this winter.
GPs ran out of seasonal flu jabs earlier this month, forcing ministers to turn to stockpiles of the old swine flu vaccine – which does not offer protection against all the strains of flu circulating this winter.
Most vaccines, including the entire childhood immunisation programme, are ordered by the Department of Health for the whole of the UK.
The system used means all vaccines that are sent out to GPs can be tracked and the government knows how many doses are left in the system.
Flu is one of the few exceptions, with GPs in England ordering jabs direct from manufacturers and similar systems operating elsewhere in the UK.
Prof Salisbury, who is leading a review into the issue, said this was a “historic hangover” that now needed looking at.
Professor Salisbury said: “Certainly this winter we have seen an unsatisfactory position. That is a situation that we don’t want to see happen again.
“We compare that with the routine childhood immunisation programme where we have not had to suspend part of the programme because of shortage of vaccine for at least a decade. This argues that we do need to look very carefully at whether flu vaccine supply can be done on a more dependable basis.”
He suggested as an interim measure the government could purchase an emergency stockpile next year.
However, he has yet to open talks with doctors. He said he would be doing that in the near future before making final recommendations to ministers.
But the suggestion has caused some surprise coming just a day after the government unveiled a bill paving the way for GPs to be given more power – they will get control of much of the NHS budget from 2013.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs’ committee, said: “I don’t think a wholesale change like this would work. The flu programme is complex and intense as we have a lot of people coming for immunisation at once.
“That does not happen with childhood vaccines and so I am not sure a central system could cope with the volume of vaccine GPs need almost all at once.
“What we need is for an emergency stock to be held, perhaps regionally, in case doctors do run out.”
Sixty-two people died with flu in the UK in the past week, bringing the total to 112 since October, figures reveal.
However, the Health Protection Agency (HPA) said the rise could be due to delayed reporting, with many of the deaths occurring before Christmas.
Most of those who died had swine flu. The majority were aged between 15 and 64, but nine children under 14 died.
An HPA spokesman said the number of people seeing their GP for flu-like illness was beginning to plateau.
Of the 81 deaths where data is available, 63 people were in risk groups for flu.
And of the 47 for whom vaccine status is known, 40 had not had this season’s flu jab.
Since October, 95 deaths have been linked to swine flu and 12 to the influenza B virus, with the rest unclassified.
Cases not soaring
Professor Sally Davies, Interim Chief Medical Officer for England told the BBC that, while it may look as if deaths had soared in the last week, in actual fact the rise had been “steady”.
The HPA reports only verified deaths, so while it appears as though the number dying from flu had doubled in the past week, the figure seems larger because of the time it takes to confirm the cause of death.
Professor Davies was reluctant to say the outbreak had peaked, but added: “I hope we’ll have good news, maybe not next week because of schools going back, but the week after.”
And she appealed to parents of children with underlying health conditions to have their children vaccinated.
“Their parents must take them to have the vaccination as soon as they can.”
Last week it was announced that jabs left over from the swine flu pandemic would be made available after some GP’s practices reported a shortage of this year’s vaccine.
More than 200,000 doses have been ordered.
Professor David Salisbury, director of immunisations at the Department of Health, said: “No one should be turned away because of a shortage of vaccine. There is no reason to turn away at-risk patients.”
Bacterial infections
The HPA said though that the figures only represented a proportion of those who had died from flu, or from complications such as pneumonia.
However, deaths are far fewer than the 500 seen during the swine flu pandemic in 2009.
The number of people in critical care beds in England has fallen from 783 last week to 661.
Professor John Watson, head of respiratory diseases at the HPA, said: “Our latest flu report suggests levels of people seeing their doctor for flu-like illness is beginning to plateau but this may be skewed by the recent holiday period.
“Flu is still circulating in the community and the message remains that those people in an at-risk group should have their seasonal flu vaccine as soon as possible as this is the best way to protect themselves from flu this winter.”
At-risk groups who are advised to have the jab include pregnant women, the elderly and those with other underlying conditions such as heart problems, diabetes, lung, liver or renal diseases and those who have weakened immune systems.
The HPA added that it had seen a “modest” increase in bacterial infections such as pneumococcal and meningococcal disease, which might be linked to flu, and that it was advising doctors to remain vigilant for them.
Professor Watson added: “The severity of these conditions means that prompt identification and treatment are essential.”
Professor John Oxford, a virologist at Barts and the Royal London, suggested the outbreak might be “past the worst”.
But he told the BBC it was important for government and experts like himself to learn lessons.
“It was much bigger than we thought. We should think much more seriously about vaccinating the under-fours.”
THE death toll in the flu outbreak has more than doubled in a week to 112, it was revealed yesterday.
That is 62 more than the total of 50 deaths since October reported last week.
Among the victims are six children under five and nine aged five to 14. The last seven days have seen 21 deaths, more than in any previous week. Figures from Christmas and New Year have also been taken fully into account for the first time as people return to work.
The worst may not yet be over, the Shadow Health Secretary John Healey warned last night. “The big jump in deaths and high numbers seriously ill in hospital suggest we’re still not through the worst of this flu outbreak.”
Of the 112 dead since October, 95 had swine flu, five had flu type B, and 12 have not had the flu type confirmed. Of 81 cases where information was available, 63 were in risk groups and had other health problems.
High-profile deaths include that of three-year-old Lana Ameen, who died of swine flu on Boxing Day and whose parents have urged the Government to vaccinate the under-fives.
Professor Dame Sally Davies, the Government’s interim chief medical officer, yesterday said any death was a tragedy for the family.
“As a paediatrician I’ve seen deaths like this and they are horribly painful for the family concerned and the family lives with it forever. I want to offer my condolences to all families who have lost a loved one.”
Professor Davies said she hoped the figures would show, in retrospect, the beginning of a downturn.
“Although we are still experiencing deaths, they are not out of line with seasonal flu.”
The Health Protection Agency said the number of people seeing their GP was beginning to plateau and the number in critical care in England has fallen from 783 last week to 661.
Among those patients in critical care, 18 are under five and another eight are aged five to 15.
It emerged yesterday that one-year-old Jessica Davies has become one of the youngest swine flu victims.
Parents Lindsay and Athol Davies, of Hartlepool, took her to the doctor’s three times before she was tested for the H1N1 virus. She has since been prescribed Tamiflu in the hope that her condition will improve.
Lindsay, 25, said: “I would just like to warn other parents to keep going back to their doctor if they think their child has swine flu. If it wasn’t for a doctor at the hospital suggesting Jessica was tested then she wouldn’t have been diagnosed and that to me is very worrying.”
The Department of Health insisted independent expert advice was “absolutely clear” that children under five who do not have risk factors should not be vaccinated.
But increasing public alarm at the scale of the outbreak has prompted a surge in people demanding the jab from their doctor.
As supplies ran low yesterday – with Boots revealing its stores have “very limited” stocks – the Government was forced to make the Pandemrix jab left over from the 2009 swine flu pandemic available.
Professor David Salisbury, director of immunisation, said: “There really is no reason for anyone to be turned away on the basis that there is no vaccine available or not being sent out.”
Professor Salisbury also defended the Government’s position on not vaccinating healthy under-fives, saying a study had shown that 63 per cent of children under five in London had immunity against swine flu.
He also questioned how many people would die from other illnesses if resources were diverted to something else at short notice, such as vaccinating healthy children.
A devastated husband yesterday urged everyone to get the flu jab after his wife became one of the victims. Mother-of-two Katrina Mullen, 41, of Scarborough, North Yorkshire, died in hospital at the weekend. She had underlying health problems.
Her husband Jason said: “You just don’t think it will happen to you, but it can, and I really hope this will make people more aware.”
Mother-of-three Tracy Watkins, 47, died from swine flu just one day after complaining she felt “rough”, her husband Richard revealed yesterday. Journalist Tracy, of Over Norton, Oxfordshire, was given antibiotics by her GP for a chest infection. But hours later she was rushed to hospital with breathing problems and was pronounced dead next morning.
‘Where can I get my children vaccinated? They are not in the “at risk” group and the chemists that have been offering vaccinations won’t vaccinate under 18′s.’
Only those in at-risk groups are eligible for flu jabs from their GP. Pharmacies will give the jab to healthy adults for around £13-15, if they have stocks remaining, but most will not give flu jabs to children as this requires extra training. You could get the vaccine from a private GP or clinic. I have read a report of parents being charged nearly £80 by a clinic for giving a vaccine to a young child.
Hannah, from Skipton, in North Yorkshire, writes:
‘My Three-year-old daughter had the swine flu vaccine last year when it was available to all under-fives (she has no underlying health problems). Will last year’s vaccine protect her from this season’s outbreak?’
No-one knows for certain what level or duration of protection is provided by last year’s pandemic H1N1 vaccine. Flu strains undergo minute changes over the years – something known as “antigenic drift” which is why the vaccine is tweaked every season. That’s why those in at-risk groups are offered a new jab every autumn.
Having said all that, the H1N1 swine flu virus does not seem to have altered very much since it hit the headlines in Mexico in early 2009. So being vaccinated last year is likely to offer a good level of continuing protection. But it will not guarantee it. The flu vaccine is not 100% effective. Of 34 deaths for which we have information this winter, one person had received the monovalent (single strain) pandemic H1N1 vaccine last year.
Wendy in Burton-Upon-Trent, Staffordshire, writes:
‘In our case both my husband, a diabetic, and myself, 20 weeks pregnant are obviously in “at risk” groups. Although I have two prescriptions from my GP for the influenza vaccine I have to source it myself as they have no stocks and haven’t since December. During the last fortnight I have tried many, many places to source the vaccine without success – now it has peaked should I just give up?’
This situation should have changed. Yesterday, the head of immunisation at the Department of Health, Professor David Salisbury, said there was no reason why anyone in an at-risk group should be turned away.
This is because the government has now opened its stockpile of H1N1 pandemic vaccine. There are nearly 13 million doses available. As of yesterday, 400 orders had been submitted and nearly 200,000 doses of vaccine dispatched. So it is worth contacting your GP again to check if they have doses available. If they don’t, ask them politely to order some – the Department of Health says it is not charging GPs for the jabs.
If you are in an at-risk group, you should not simply hope for the best. We cannot be sure when the outbreak will peak and it is likely to have a long “tail” – flu viruses will continue to circulate for many weeks to come. So it is best to be protected.
Sue, from the Midlands, asks:
‘Why are older people, around my age of 62 not becoming infected with swine flu in the same numbers as younger people? Is it because we have immunity from succumbing to earlier flu epidemics and how similar to H1N1 would these earlier strains have to be for you to build up resistance to the current H1N1?’
The H1N1 virus – or swine flu – is similar to a strain that was circulating between 1918-1957. This was replaced by another strain of flu with a different genetic make-up (H2N2) during the pandemic of 1957. So people born before 1957 seem to have developed some level of immunity from the current swine flu strain.
Having said that, it is no guarantee that elderly people won’t fall ill. There have been 16 flu-related deaths among the 65+ age group this winter, out of a population of around 10 million. That number will be an underestimate because it will simply include those who have been tested for flu. Some of the deaths are likely to have been due to other strains of flu that are circulating. So annual immunisation for all older people is a wise move.
Andrew, from Newcastle, asks:
‘How do this year’s flu death figures compare with each of the last five years? Are they steady, increasing or decreasing?’
The first year of H1N1 swine flu- up to April 2010 – saw nearly 500 confirmed deaths throughout the UK. In each case the person who died tested positive for the virus. But there will have been more deaths where the virus will not have been identified. Since October there have been 112 confirmed deaths from flu.
2009 was the first year that flu deaths were collected in such a precise manner. In previous years the Office for National Statistics worked out the excess of deaths over the winter period during a flu outbreak and compared them to similar periods where there was no flu about. This resulted in a rough estimate of 8,000 flu-related deaths each winter, with 20,000 or more deaths during epidemics. In 1989-90 there are estimates that flu was responsible for 25,000 deaths. But we can’t directly compare this winter’s figures with years gone by.
Most of the deaths prior to April 2009 were among the frail elderly. The difference, since the advent of swine flu, is that the virus mostly affects those under 65 with people in middle age accounting for the biggest proportion of serious illness. But other flu stains are circulating – H3N2 and Flu B – and these can also cause serious illness especially among the elderly.
The mother of a three-year-old swine flu victim has called for the vaccination of all children, not just those considered by doctors to be “at risk”.
Gemma Ameen and her husband, Zana, switched off their daughter Lana’s life support two days after she apparently caught a cold on Christmas Eve.
The couple, a nurse and a doctor, initially took Lana to a hospital in Stockport, Cheshire, where she
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was diagnosed with an infection and sent home.
Later the same day, she was taken back to Stepping Hill Hospital after suffering multiple fits. Mr and Mrs Ameen claimed she then had to be revived three times over a three-hour period as they said a junior doctor refused to call a specialist consultant.
Lana was eventually transferred to Alder Hey Hospital in Liverpool where she died on Boxing Day.
Mrs Ameen has issued a photograph of her daughter in intensive care in a bid to reverse NHS policy on who is eligible for the seasonal flu vaccine that combats the H1N1 virus.
The UK Department of Health insisted independent expert advice was “absolutely clear” that children who did not have risk factors should not be vaccinated.
The advice had been reviewed recently and the Joint Committee on Vaccination and Immunisation had not changed its recommendation, it said.
But Mrs Ameen, 28, said: “It’s heartless really. It definitely needs looking at again with another review.
“Rather than just taking facts and figures, they need to start thinking about people’s lives.
“It’s not about whether they thought Lana should have been eligible. Obviously she was, because she died from it. I think all children should be vaccinated and anyone else who is prepared to pay for it.”
Mrs Ameen, who is 12 weeks pregnant, said she had tried to get a vaccine for her daughter from their family GP but was unable to receive the jab because Lana had no underlying health problems at the time.
Both she and her husband, who is being comforted by relatives in his homeland of Kurdistan, have received the seasonal flu protection.
The family are from Birmingham and Mrs Ameen had been visiting her mother, Janet, at her home in Stockport at the time her daughter fell ill.
The nurse has now launched a website campaign, Lana’s Cause, with the objective “to make the swine flu vaccine available to everybody”.
On it, she has written: “Lana was on a day-to-day basis a very healthy, bright and bubbly little girl who had no underlying health issues.
“She was taken to Alder Hey Hospital in Liverpool.