Months before the world was introduced to the swine flu, the S.C. Department of Health and Environmental Control commissioned a task force to take a look at the state’s preparedness plan for a severe influenza pandemic.

“We found (we) had more work to do, DHEC does, particularly in dealing with scarcity of medical resources in a pandemic,” said Dr. Phil Schneider, an emeritus bioethics professor at CCU and co-chair of the SC Pandemic Influenza Ethics Task Force.

“There’s no point in putting treatment into a patient who will not benefit from it. Tough thing to say, but that’s what we’re going to be faced with in a full-fledged pandemic,” Schneider said.

A key component of battling influenza is ventilators. As of June, there were 1,284 ventilators in hospitals across the state, according to the task force.

How those would be rationed during a severe pandemic where tens of thousands could possibly benefit from a ventilator is an “ethical” choice, and one where the task force is weighing in.

“The doctors will have to decide who the sickest people are and who are the people who have the best chance to survive,” Schneider said.

To determine who will receive critical care, specifically ventilators, the task force recommends hospitals implement the Sequential Organ Failure Assessment (SOFA) System, which rates a patient’s mortality risk.

Through a series of testing, the patient will be given a score between 0-24. The higher the score, generally higher than 11, the closer one is to death and less likely they’ll receive critical care, Schneider said.

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Adding such a chemical adjuvant to the vaccine could help stretch limited supplies by making a single dose more potent, researchers believe. That’s important in the United States, where public health officials are expecting about 45 million doses of vaccine by mid-October – far fewer than the 120 million doses that had been expected.

“An adjuvant potentially allows us to use less vaccine, so we can spread the vaccine supply among a larger number of people,” said Dr. Corry Dekker, lead investigator of the Stanford study and medical director of the Stanford-Lucile Packard Children’s Hospital Vaccine Program.

Adjuvants have been used for years in flu vaccines in Europe and in several childhood vaccines in the United States. But they’ve never been added to the seasonal flu vaccine in the United States.

That’s partly because they’ve never been needed, vaccine experts said. The United States almost always has plenty of seasonal flu vaccine to give everyone who wants it, and the vaccine has been fairly effective with most people.

“People have not felt pressed to develop better vaccines,” said David Lewis, a Stanford infectious disease expert who is not involved with Dekker’s study. “But that’s not to say you couldn’t do better by adding an adjuvant.”

Because most people have no immunity to the swine flu – a form of influenza Type A, subtype H1N1 – researchers have assumed they would need two vaccine doses to gain immunity. An adjuvant might mean people only need one dose, or that they can get smaller dosages.

It’s not clear how adjuvants help boost the immune response to a vaccine. Scientists think adjuvants may stimulate different parts of the immune system and make them more responsive to the antigen in a vaccine.

The Stanford clinical trial, which is sponsored by the National Institutes for Health, is the first to test the swine flu vaccine in the Bay Area.

Stanford will be recruiting participants for the trial during the next two weeks. Researchers hope to begin screening participants the week after Labor Day and start immunizing people the week of Sept. 14.

About 130 people will be enrolled in the study. Participants will receive two doses of vaccine, spaced three weeks apart. They will be divided into groups based on age, the size of the vaccine dose and whether or not they get a vaccine with the adjuvant. It’s a double-blind study, so neither participants nor researchers will know how much vaccine subjects receive or whether they are given an adjuvant.

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They can’t, however, prepare for a host of unknowns, including when and how a vaccine will be available and administered or the timing and severity of a possible pandemic.

The Green Bay School District has a 50-plus page pandemic plan designed to prepare officials as much as possible.

“I feel good about the things I can control,” said Barbara Dorff, director of student services for the Green Bay School District. “The things I don’t feel good about are the fact that they don’t have vaccine ready yet, and they’re not really sure when it should be ready. … We just don’t have all the answers yet.”

Other questions include how much vaccine will be available and how and where it will be distributed, said Judy Friederichs, director of the Brown County Health Department.

via School districts prep for swine flu pandemic | greenbaypressgazette.com | Green Bay Press-Gazette.

For now, governments have resisted closing schools preemptively, judging that the virus has not yet reached the scale where such a move would be beneficial. But they have been circulating contingency plans for schools and companies — an approach broadly supported by health experts.

Simon Cauchemez, an epidemiologist at Imperial College London, said that evidence from the spread of the virus in past months in the southern hemisphere, where it has been winter and where he said the disease had been mild in most cases, showed that there was no reason to shut schools ahead of time.

“I think the view is that we don’t want this kind of intervention unless your health system really cannot cope,” he said, referring to school closures.

Localities should wait and see whether health care systems in specific areas were able to handle the volume of swine flu cases, he said. If the volume of cases began rising to unmanageable levels, only then might it be sound policy to shut schools, he said.

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