As another year comes to a close we’d like to look back at the fascinating research breakthroughs and inspiring patient stories from 2011. ScienceLife ran 168 posts this year, and while we wish we could highlight all of them, here are a handful of our favorites from each month.

January

Patrick Wilson found out that the H1N1 virus could end up helping us fight all types of flu. Stephen Pruett-Jones studied how some male birds mimic the sounds of predators to pick up the ladies (with an audio clip). We interviewed David Gozal about his study on the link between childhood obesity and lack of sleep, and took a look at NCAA regulations mandating sickle cell testing for athletes.

February

Harold Pollack gave a lecture on why violent crime in urban, minority communities should be considered a public health epidemic. Siri Atma Greeley studied the actual medical benefit of widespread genetic testing. Stacy Lindau wanted to know why so few women get help for sexual problems after surviving cancer. We talked to Bana Jabri about the causes of celiac disease, and Sliman Bensmaïa showed us how the brain processes the basic elements of touch very much like it handles visual information.

March

Sola Olopade educated women in Nigeria about using clean-burning stoves to prevent indoor pollution. Stefano Allesina and Jonathan Levine looked at how rock-paper-scissors helps explain evolution. Joshua Miller went to Yellowstone Park to see what stories the ghostly bones of animals can tell, and Scott Eggener questioned the wisdom of indiscriminate prostate cancer screening.

Photo by Gerald Waddell

Andrea King studied the wide range of responses to drinking alcohol, and why it can be fun for some people and a bummer for others. Cheryl Reed took a ride in a helicopter with our UCAN nurses. Kamal Sharma looked at the genes that control animals’ gait, and Ningqi Hou studied how urban environments can dictate how much exercise people get.

May

Daniel McGehee looked at the long-term effects of nicotine on the brain. Habibul Ahsan went to Bangladesh to study the health impacts of accidental exposure to arsenic in drinking water. The brain’s overlooked supporting cells got their due at a conference on neuroscience, and we remembered a landmark discovery about a once popular drug taken during pregnancy that we now know can cause cancer.

June

As we headed into summer, Diana Lauderdale used Google to track MRSA. We learned about an extraordinary transplant where a man received a new heart, liver AND kidney. Daniel Geynisman gave us the rundown on whether or not cell phones are killing us (they’re not, as long as you don’t use them in the car), and some UChicago undergrads studied what happens to gorillas on the birth control pill.

July

We spoke to Donald Jensen and Andrew Aronsohn about the new outlook for patients with hepatitis C. Igor Schneider made a time machine to find the genetic switch for limb development. Farr Curlin led a study about the benefits of addressing spiritual needs alongside medical care, and Adam Cifu looked at the phenomenon of scientific study reversals.

August

Stefano Allesina dug into the long, shady history of nepotism in academia in Italy. John Schneider talked about his work addressing sexual health and stigma in India. Michael Becker discovered a new treatment for the Royal Disease, and we had the rare chance to name check a Spiderman villain in a post.

September

Martha McClintock and Suzanne Conzen studied the connection between social isolation, stress and breast cancer. Gallego Romero traveled to India to search for the origins of lactose intolerance. Stephanie Dulawa developed a mouse model for OCD, and Paul Vezina looked at a different kind of obsession, compulsive gambling.

October

Arshiya Baig started a pilot project to help people learn about life with diabetes through pictures. Manyuan Long found that some of the youngest genes are in the brain. Jens Ludwig and Stacy Lindau published a landmark study about the connection between neighborhood poverty and health, and Issam Awad studied a rare brain disease that soon could be treated with a drug instead of surgery.

November

Cathy Pfister and Tim Wootton figured out how to use seashells to track climate change over the years. Lianne Kurina found a link between loneliness and sleep quality. Shantanu Nundy, Monica Peek and Marshall Chin developed a program to send text message reminders to people with diabetes, and Pan Chen looked at the links between childhood abuse and aggressive behavior in adults.

December

Inbal Ben-Ami Bartal, Jean Decety and Peggy Mason discovered that rats can show empathy for their fellow rats in distress. Maciej Lesniak performed a scary but amazing brain surgery on a patient who was awake. Cathryn Nagler searched for the source of food allergies within our bodies, while Stafano Guandalini uncovered the challenges in educating doctors about one of those allergies, celiac disease.

Whew. Hope you were able to click through at least a few of those. We look forward to another great year of research in 2012. We’re taking a break next week, but we’ll be back on January 5. Happy holidays!

The 2009 H1N1 pandemic, better known as the season of swine flu, was not like other flu seasons of recent vintage. A typical seasonal strain of influenza is most deadly at the extremities of age, with the highest mortality rates in the very young and very old. One of the reasons why experts were concerned about the 2009 flu was that it went off-script, killing mostly people in their twenties and thirties. Influenza researchers speculated on why the normally vulnerable elderly appeared to have the advantage against this particular pandemic. But it wasn’t until a recent study by University of Chicago and Stanford scientists looking at the failure of flu vaccines in older adults that the source of this advantage revealed itself.

In a typical season, senior citizens are among the priority groups for receiving the flu vaccine, due to their increased risk of severe symptoms. Yet the success rate of the standard influenza vaccine is reduced in those above 65 years of age, falling from 90 percent efficacy to as low as 17 percent. Most have attributed this decline to a general principle called “immunosenescence,” the weakening of a person’s immune system as they grow older. Since vaccines work by stimulating the production of antibodies against an inactivated flu strain to protect against the real virus, is the deficiency in the aged a matter of antibody quantity, quality, or both?

A multi-institutional team led by co-first authors Meghan Sullivan of UChicago and Sanae Sasaki of Stanford developed a new assay to test this question for a recent article in The Journal of Clinical Investigation. Two groups of volunteers - one aged 18-30, one aged 70-100 - received the seasonal flu vaccine in the winter of 2007-08, and researchers took blood samples from them seven days later, when vaccine-induced antibody production is at its peak. Scientists could then measure the number of antibody-secreting cells, called plasmablasts, and antibodies circulating in the blood of the volunteers. They could also run experiments testing how well those immune defenses bind different strains of influenza, the first step in fighting off a virus.

Their first experiments replicated the clinical data - even in a test tube, younger volunteers (or at least their antibodies) are much more likely to respond to the influenza strains included in the vaccine than samples from older subjects. Subsequent experiments revealed that the immune systems of elderly subjects were at a numerical disadvantage, with significantly fewer plasmablasts observed in serum compared to the samples from their younger counterparts.

“It had been appreciated before that there are fewer immune cells in older people, but this is the first time showing that fewer antibody secreting cells are raised in response to vaccination,” said Sullivan, a graduate student in the laboratory of Patrick Wilson (and a contributor to ScienceLife).

But surprisingly, that was where the immune deficits in older patients started and ended. Though there were fewer plasmablasts in older subjects, each produced the same number of antibodies as those of the young. What’s more, when the antibodies from young and old were compared for their ability to bind the viral strains targeted by the vaccine, they were nearly identical. So the failure rate of vaccines in elderly can be explained by the lower quantity of antibody “factories,” rather than a defect in the quality of the antibodies themselves.

“We would think that antibody activity would be decreased in older people, but in fact the ability to bind is basically identical,” Sullivan said. “The antibody secreting cells are the weak point; elderly people are just not making enough.”

Amid the media storm surrounding the rapid spread of swine flu in 2009, the research team used the same samples to test another idea. One theory for why senior citizens were protected against that particular H1N1 strain was that they may have been exposed to a similar influenza that circulated before 1950. With their blood samples, the researchers could compare how the antibodies of their old and young subjects responded to the 2009 H1N1, which neither group had been vaccinated against two years prior. In this competition, the senior citizens were the surprise winners - antibodies from older subjects (especially those older than 78) were more responsive to the H1N1 virus than those from younger volunteers.

The result suggests something off an immune system trade-off in the elderly. Though they may have a harder time producing sufficient antibodies to fight off the flu, the antibodies they do produce are able to attack a more diverse range of influenza strains.

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Photo by Bruce Powell

Yesterday wasn’t just St. Patrick’s Day for fourth-year medical students around the country - it was also Match Day, the tense and celebratory day when aspiring doctors learn the residency program where they will spend their next 3-7 years. At the Pritzker School of Medicine, green-clad students and supporters absolutely packed the hospital’s Billings Auditorium for the big event Thursday morning, cheering their peers as they were called one by one at random to collect their match envelope. In a local tradition, it literally pays to go last, as students throw into an informal prize pot for whoever has to wait and squirm the longest to pick up their envelope (second-to-last gets a Hershey bar as consolation). In the video below, you can see some of that process - including the outcry when the last envelopes are miscounted - followed by the amazing tension-release of the countdown and unison envelope opening.

The numbers from the day are just as exciting as the video. At Pritzker (recently ranked #12 among medical schools by US News and World Report), 110 students were matched in 24 specialties at 46 institutions, including 23 students who will stay with us here at the Medical Center. The most popular specialties for Pritzker students were internal medicine (25% of the class), general surgery (11%), and pediatrics (11%). Nationally, trends continued to shift for the second consecutive year toward primary care specialties such as internal medicine, family medicine, and pediatrics, according to the National Residency Matching Program, a step in the right direction to meet some of the increased demand for primary care doctors expected in the wake of health care reform. MedPageToday’s Kristina Fiore breaks down the numbers.

Podcast 0.3: Transplants, Rock-Paper-Scissors Ecology, and More

We have settled on a name for our young research podcast: Bench to Bedside. However, we are still keeping the training wheels on as we work out the technical kinks and explore the best ways to deliver audio versions of our latest research and medical stories. Please enjoy the third installment of our podcast, featuring a recent coast-to-coast kidney transplant chain that involved the Medical Center, how Rock-Paper-Scissors can explain biodiversity, the fight against indoor air pollution in Nigeria, and the new numbers on the eating disorders epidemic in the United States. As always, we would love to hear feedback on what we’re doing right and wrong at robert.mitchum@uchospitals.edu or dianna.douglas@uchospitals.edu.

Bench to Bedside Episode #0.3 by robmitchum

Elsewhere…

Some people keep ant farms, some people keep multiple flasks of bacteria growing for 13 years (and counting) to study evolution. Ed Yong writes about experiments from Michigan State University that show “tortoise” bacteria can beat out “hare” bacteria over the long run. (And if you’re a science communicator of any sort, do listen to Ed and Carl Zimmer’s “Death to Obfuscation” session from January’s Science Online meeting)

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Two years ago, fear about the the novel H1N1 flu strain spread far more quickly than the virus itself, fueled by equal parts scientific concern about its resemblance to the deadly 1918 flu and media hysteria. In those early days, with a vaccine still months away, scientists were working quickly to develop protections and treatments for the flu for those at high risk of infection and serious illness. As a Chicago Tribune reporter covering the impending pandemic, one of the flu experts I spoke to about these efforts was Patrick Wilson, assistant professor of medicine at the University of Chicago. Wilson, in collaboration with scientists from the CDC and Emory University, was looking at the antibodies produced by the first people exposed to H1N1, to see if they could be used as emergency “vaccines” for health care workers that would be exposed to infected patients.

Though the worldwide pandemic did not measure up to initial concerns, it remained a dangerous and virulent flu, infecting 60 million and hospitalizing more than 250,000 in the United States alone. And while it was not urgently needed, Wilson’s research on the antibodies for H1N1 continued, in order to learn about how the body defended itself against this viral invader. As published this week in the Journal of Experimental Medicine, that project led to a surprising conclusion: the antibodies produced to fight the 2009 H1N1 virus were not only successful in warding off that virus, but might be protective against many different types of influenza - including the historically nasty 1918 strain.

“The result is something like the Holy Grail for flu-vaccine research,” Wilson said. “It demonstrates how to make a single vaccine that could potentially provide immunity to all influenza. The surprise was that such a very different influenza strain, as opposed to the most common strains, could lead us to something so widely applicable.”

When the body reacts to an influenza virus, or any other infectious disease, it creates antibodies that target a specific segment of the invading virus or bacteria to kill or neutralize it. But because influenza viruses are constantly mutating into new forms, antibodies your immune system generated for previous seasons’ strains may not be protective against new strains. Hence, the need for a yearly flu shot, which contains inactivated forms of the viruses that scientists predict will become common in the next season. The vaccine spurs the production of antibodies against those strains, offering protection against infection.

For Wilson and his collaborators, the original idea was to take antibodies from patients exposed to H1N1 in its earliest days and use them to either protect others from infection or treat those who had already been infected. Initial experiments on the antibodies’ power of recognition proved successful - as predicted, many of the antibodies harvested from the white blood cells of H1N1 patients were able to bind the flu strain in an assay. But then, a surprise: when tested with seasonal flu strains from previous years, the antibodies could bind those viruses as well. Researchers threw the last 10 years of seasonal flu, the deadly 1918 virus, and even a dangerous but rare H5N1 avian flu at the antibodies and found they could neutralize them all.

Attacking a virus in a dish is one thing, but the big test would be whether these antibodies could fight infections in the body. Mice were given the antibodies before receiving a dose of the 2009 H1N1 strain, and were found to be protected against the virus as if given a vaccine. When mice were dosed with H1N1 first, then given antibodies as much as 3 days later, the antibodies successfully fought off the infection; by day 12, the antibody-treated mice were free of virus, while the unfortunate control mice all perished by day 7 or 8. The antibodies went on to reign victorious over influenza in further experiments with seasonal flu, the 1918 flu, and avian flu.

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When the novel H1N1 flu virus began to appear in North America and Europe in Spring 2009, it contained some worryingly familiar signs to flu experts. The new strain appeared suddenly in a season when flu typically declines, spread at a rapid pace, and seemed to disproportionately affect the young more than the old. The last influenza to display those features was the notorious 1918 flu, which killed as many as 100 million people around the world before burning out a year later.

“It was the most devastating infectious diseases episode in world history,” said Michael David, Instructor of Medicine at the University of Chicago Medical Center. “In numbers, it was probably 10 to 100 times more severe in terms of the absolute number of people killed than were killed in The Black Death.”

Of course, last year’s H1N1 pandemic was nowhere near as deadly, causing only an estimated 12,500 deaths in the United States despite approximately 60 million infections. The low mortality among elderly populations from H1N1 may have actually made the 2009-10 flu season less deadly than usual, as the Centers for Disease Control and Prevention estimate a yearly average of roughly 36,000 influenza deaths. But comparing 1918 to 2009 still reveals interesting similarities, David said in his October 14 talk at the Department of Pediatric Grand Rounds.

In the spring, when the virus first showed up on public health radar as a novel strain with all the right ingredients for a pandemic (jumped from animal to human, easily transmissable), the worst case scenario of 1918 couldn’t be ruled out. Like the 2009 strain, the 1918 influenza also made a relatively modest appearance in the spring, David said - graphs of the pandemic’s death rate revealed a small spike in the summer. Come October, that mild hill was overwhelmed by the shocking spike of influenza deaths that raged across the United States and Europe. In 8 weeks, 25 million people were infected with the virus, and some 600,000 died - in the U.S. alone.

“That’s more than the number of soldiers that were killed on both sides in the U.S. Civil War,” David said. “It’s something that’s really hard for us to grasp with our imaginations.”

[If you have a JAMA subscription, you can read this 1918 first-hand account of the pandemic at Cook County Hospital in Chicago - "During the past five weeks, more than 2,000 patients were admitted to the hospital. The disease is highly contagious and the mortality among our patients has totaled 31 percent. The epidemic has seriously crippled the medical and most especially the nursing staff of our hospital."]

In addition to its ferocious spread and mortality rate, the 1918 influenza was also unusual for the victims it chose: 20 percent of the deaths were in children under the age of 5, and 15 percent were between 20 and 25 years old. The line formed by these two mortality peaks combined with deaths in the elderly formed the pandemic’s characteristic “W curve” (pictured above), in contrast to the usual “U curve” seen when only the very young and old die from influenza.

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RN Debbie Pienta of the Student Care Center at the University of Chicago gives a flu shot. (Photo by Yvette Marie Dostatni)

Until last year, the advent of the new influenza season was a pretty routine event on the health care calendar. Around October, people would be urged to receive vaccinations against the viral strains expected to plague North America in the coming months, with young children and older adults encouraged more strongly to get their annual shot. Other folks received their vaccine with all the enthusiasm of a trip to the dentist - something you know is good for you, but not exactly an urgent concern.

That all changed last year, thanks to the novel H1N1 virus, aka swine flu, aka the global flu pandemic. Suddenly, seasonal flu clinics used to a slow trickle of customers were faced with lines out the door and around the block, as the combination of limited H1N1 vaccine supply and media hysteria created unusual demand. Caught short by the late-breaking new strain, suppliers had to prepare a separate vaccine for the H1N1 virus, requiring people to get stuck with a needle twice for full protection.

The good news heading into the 2010-11 flu season is that many of those logistical headaches have been resolved. With no new strains rearing their head since last year, vaccine makers were able to consolidate protection against H1N1 and two seasonal strains into one injection or nasal spray. The Centers for Disease Control and Prevention recommendations have also been simplified: all people above the age of 6 months are advised to get the flu vaccine, full stop. All signs this season also point to better preparedness across the board from government and private organizations dispensing the vaccines - local Walgreens in Chicago were advertising vaccine availability well in mid-September.

To raise awareness of vaccine availability on the University of Chicago campus, ScienceLife talked to two of our flu experts: Stephen Weber, medical director of infection control at the Medical Center, and Ken Alexander, chief of pediatric infectious diseases. Here’s a few of their answers about this coming flu season and the research taking place one year post-epidemic.

Q: If 2010-11 is expected to be a routine flu season, what does that mean?

Weber: A regular flu season doesn’t mean that it’s easy or that people don’t get sick. We have to remember that while flu is a very common illness, folks who are not vaccinated are at an increased risk.

In many resepects we return to our usual state of flu awareness and preparedness. Bearing in mind, we are talking about infections that kill 24,000 Americans each year, and that’s not something that we want to neglect or that we want to be anything but vigilant about. We have an opportunity to save lives, and whether it happens to be a pandemic or a seasonal year, we still have an important responsibility.

Q: Why is it especially important for parents of infants to be immunized against flu?

Alexander: It’s the notion of a “cocoon.” The idea here is that babies under 6 months don’t respond well to flu vaccine, so we don’t get give shots. So you have this window of vulnerability, and babies are at high risk. With cocoon immunization, if can’t immunize the kid, we can immunize everybody around the child.

There are good data on pertussis transmission to babies, that they receive the virus one-third of the time from the mother, a quarter of the time from dad, and a quarter from their grandparents. Flu is probably pretty much the same, and the idea is we can protect them if we immunize people around the baby.

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Hyde Park Research Flurries

There’s been a lot of great research around the University of Chicago this week that hasn’t fallen into our territory at the Medical Center. Not that we’re jealous - we had cancer-fighting nanodiscs and sharp-toothed dinosaurs, after all! But in case you missed these stories from other departments around campus, here’s a quick review.

From our colleagues in Psychology came the latest in a fascinating series of papers looking at how social isolation affects the risk of acquiring breast cancer. Published in the Proceedings of the National Academy of Sciences, the paper by Gretchen Hermes and Martha McClintock found that isolating rats elevated the stress-related hormone corticosterone, an observation previously seen in the very social species. But as the animals were allowed to grow into “middle age” (about 15 months) the isolated rats also showed a much increased chance of contracting mammary tumors - 135% more tumors and 84 times the tumor load (which takes into account tumor size) of socialized control rats. “There is growing interest in relationships between the environment, emotion and disease,” Hermes told the BBC. “This study offers insight into how the social world gets under the skin.” (see also Time, Reuters, and U.S. News & World Report)

A good case of lemonade-from-lemons came from the Divinity School, where a miniature book thought to be a 16th-century artifact turned out to be a very well-crafted forgery. The Archaic Mark, an illustrated Greek translation of the Gospel of Mark, has been in the University’s collection since 1937. But questions have always lingered about the book’s authenticity, until Alice Schreyer, Director of the Special Collections Research Center brought together experts in imaging and Biblical texts to settle once and for all whether it was the real deal. The conclusion? It’s a fake, possibly made as late as the early 20th century. But it’s a good one, with an animal hide covering that legitimately dates back to Medieval times, and the University will give it a second life as an example of skilled forgery. “It’s actually tremendously satisfying to have a definite result,” Margaret Mitchell, a Divinity School professor, told the Chicago Sun-Times. “Scholarship depends as much as possible [about] being absolutely certain about these things.”

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With the weather cooling and the kids back in school, the media coverage of the H1N1 flu - last spring’s “swine flu” - is building back to a fever pitch, if you’ll pardon the pun. As expected, colleges immediately found themselves dealing with campus outbreaks, and elementary and high schools have also already seen flu cases in the first few days of the school year.

In April, scientists knew very little about the nature of this novel H1N1 strain, and the worst-case scenarios suggested by some flu experts fueled the frenzy over whether this virus could be as deadly as the 1918 pandemic that killed as many as 100 million people worldwide. Now, six months later, there has been a lot more time to study the virus, observe its movements through the Southern Hemisphere’s flu season, develop and test vaccines and estimate the damage us citizens of the Northern Hemisphere can expect as a our flu season traditionally begins in October.

Because the novel H1N1 pandemic is such a fast-developing and important topic, much of the research into it is happening at an accelerated pace and is being disclosed to the public more quickly and openly than is typical for the traditionally slow march of science. Other sites have done excellent overviews of influenza in general and what we know about this particular strain or have followed every turn of this story. Below are summaries for a few of the main H1N1 subtopics.

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Much of the latest news on the H1N1 virus, colloquially known as swine flu, indicates that the next flu season has the potential to be unusually rough. In some ways the last flu season never really ended; the Centers for Disease Control and Prevention report that 20 states are still seeing widespread or regional flu activity, with H1N1 accounting for the vast majority of cases.

The coming flu season could fall within normal ranges, but CDC planners are bracing in case it resembles an especially bad pandemic year, such as 1957. The details on how H1N1 affects patients are still coming in. Certain populations appear to be at high risk for severe symptoms and, occasionally, death. Widely covered today was a Lancet report that suggested pregnant women may be more susceptible to the virus, with a higher rate of hospitalization and an elevated death rate in the pandemic’s early days. Between mid-April and mid-June, six pregnant women (including one in Chicago) died from the novel flu strain, 13% of the 45 American deaths reported during that time period.

The authors of the Lancet paper recommend that pregnant women receive antiviral medication, such as Tamiflu, as soon as possible after developing flu symptoms - none of the six deceased patients addressed in the paper received antivirals until at least 48 hours after illness onset.

But the best way to protect pregnant women from the flu strain when it likely returns in force this fall is through vaccination. The H1N1 story of the summer has been the frantic race by governments and scientists around the world to have a vaccine against the strain ready in time for the Northern Hemisphere’s next flu season. Manufacturers told an FDA panel last week that about 100 million vaccines could be ready in the U.S. by mid-October, but with roughly 300 million Americans, not everyone is going to be immediately vaccinated and priorities will have to be set.

That sober reality set the stage for a fascinating meeting today in Atlanta, where the federal Advisory Committee on Immunization Practices - a panel of doctors, scientists and public health experts - attempted to pick and choose which groups deserved the first crack at the limited vaccine supply. Given the numbers released yesterday, it was no surprise to find pregnant women in the top priority group for this fall’s vaccinations. Also given priority in the ACIP’s recommendations were caregivers for children younger than 6 months (who cannot themselves be immunized), healthcare and emergency medical personnel, children and young adults from 6 months to 24 years old and adults with chronic medical conditions.

Added together, that’s about 150 million people, roughly half the U.S. population. But with compliance among the priority groups expected to be far below 100% (it’s only around 40% for the regular old seasonal flu), it’s thought that the initial batch of 100 million will suffice, even if each person needs two doses to be fully protected, which experts predict may be necessary. As more vaccines become available, people between 25 and 64 will get it next. Those above 65 years old, who have seemed less affected by H1N1, are in the third, lowest priority group.

Much of the debate Wednesday (helpfully webcast on the government’s flu.gov website) centered over whether the younger population targeted in the first wave of vaccinations should be capped at age 19 or age 24. The argument of some panelists: college kids are as good at spreading viruses as they are at sleeping in late. Others argued that colleges are also an excellent distribution system for getting vaccines to this particular population. So young adults will join the front of the queue for the first batch.

The effects of H1N1 on different age groups appear to vary in a striking way, according to epidemiology discussed at the meeting. With nearly 44,000 American cases of H1N1 now documented, elderly folks appear to be less susceptible to the strain than younger populations. That observation runs counter to the pattern in most flu seasons, when senior citizens are more sensitive to the effects of seasonal strains and thus are heavily encouraged to get the yearly vaccine. At a CDC press conference announcing the panel’s recommendations, Assistant Surgeon General Anne Schuchat urged American seniors to get the seasonal flu vaccine as usual this coming fall. But for the H1N1 vaccine, they’ll be at the back of the line behind their children and grandchildren.

(Not to be a scaremonger, but for a gripping tale of H1N1 overseas, see this article by New York Times reporter Sheryl Gay Stolberg and her daughter Olivia Robinson, who contracted the virus while on a school trip to China)

Ever since the swine flu outbreak hit, Patrick Wilson has been immersed in what he calls “emergency science.”

The emergency may have abated thanks to the low mortality rate observed from the H1N1 strain, but Wilson’s group is working with scientists at Emory University and the Centers for Disease Control and Prevention to help combat the novel flu variety.

Wilson’s skills suddenly are in high demand because of a paper he co-authored in the journal Nature last year, demonstrating a rapid method of making antibodies to specific types of flu. The technique one day could help protect against new pandemic strains for which a vaccines do not yet exist. In the short term, the method offers a new way of rapidly diagnosing cases of H1N1 flu.

“The first application the CDC wants is to make a rapid diagnostic,” said Wilson, an assistant professor in the department of medicine at the University of Chicago.

The method that Wilson’s team published last year could be a new chapter for an old way of dealing with infection through “passive immunization.” The idea of harvesting antibodies for sick patients began in 1891, when Emil von Behring and Shibasaburo Kitasato cured a patient with diptheria by injecting serum from sheep that had antibodies to the disease. Von Behring later won a Nobel Prize as “The Founder of Serum Therapy.”

Before the advent of antibiotics, such treatments with antibodies became widely used for many infections, including anthrax and Streptococcus pneumoniae.

“Doctors used to keep vials of antibody serum that they could use off the shelf for various infections,” Wilson said.

The risk of anaphylactic shock and other drawbacks of antibody serum made doctors turn to antibiotics and vaccines once they became widely available. But even today, the idea of using antibodies has appeal for emerging viral infections, for which scientists have not yet developed a vaccine.

Flu vaccines typically take months to make, but the technique that Wilson devised with colleagues from Emory and the University of Oklahoma Health Sciences Center can produce monoclonal antibodies to a specific strain of flu in just a few weeks.

No one knows yet if the flu antibodies would offer meaningful protection in the case of an emerging pandemic. Wilson said it’s possible that the technique would prevent infection in people at high risk of exposure during the period when scientists are still working on a vaccine.

“It’s controversial how useful antibodies would be in treating this kind of infectious disease,” Wilson said.

But using the antibodies to develop a rapid diagnostic tool could be almost as valuable. Currently, most hospitals use an antibody-based test to see if a patient has influenza, then they ship samples to state labs or the CDC for further testing, which usually takes several days. The new method of producing monoclonal antibodies would allow for faster and more widespread testing of new flu viruses as they emerge.

This may be the best expression I’ve seen yet of why swine flu still is a source of concern, even though it’s looking about as severe as normal influenza. From the Wall Street Journal’s coverage of a press conference today with Keiji Fukuda of the World Health Organization:

The reason why we’re paying so much attention to this virus is that the seasonal flu viruses have been around and circulating for many years. We understand their behavior and know most people have had previous infections and some immunity to them. When a new virus enters the human population and people do not have immunity to this virus, then the levels of serious illness and the levels of death can be higher than what we see with regular seasonal influenza.

…In the past, we’ve seen pandemics cause relatively fewer deaths, and some cause relatively huge amounts of death. One of them started out mild in the spring and over the course of several months became a severe illness. This is a situation in which things can evolve, and can do so quite differently. That’s why so much attention is being paid to what’s going on and why we’re jumping so hard on it. If it stays mild and people stay healthy, then that is great. But if it turns severe, then it’s something we have to know about, be prepared for and jump on.

Here’s Part 2 of our conversation with Kenneth Alexander, M.D., chief of pediatric infectious diseases. In this second and last installment, we discuss what ordinary people can do to avoid getting or spreading swine flu, some steps that medical professionals can take, and what would constitute a flu pandemic.

Here’s a video we shot yesterday of Kenneth Alexander, M.D., chief of pediatric infectious diseases, answering common questions about swine flu.

The news of unusual swine flu cases in Mexico and the American southwest has raised concerns that the outbreaks could herald a new flu pandemic - though the anxiety level in this AP story on today’s news seems just a bit too high at this stage. Something about the tone smacks of that movie “The Andromeda Strain” - “it’s something we’ve never seen before…”

It’s important to be vigilant, but overreaction also can have costs. In 1976, the CDC instituted an emergency immunization program in response to an outbreak of swine flu. The vaccine they used may or may not have been the cause of an uptick that year in cases of Guillain-Barre Syndrome (see this for an account of the 1976 experience by the former directors of the CDC and the immunization program).

President Obama has a history of interest in flu pandemic preparedness. He co-wrote a 2005 op-ed in the New York Times on pandemic measures, and later that year I interviewed him on that subject for the Chicago Tribune. You can see the transcript here. Two passages from that interview may offer clues about how Obama’s administration will handle the latest outbreak: 

Even when the SARS scare struck, the losses were in multiple billions of dollars. And that proved to be a false alarm essentially. If something like this genuinely occurred, you’d see global trade come to a standstill. And in addition to obviously the loss of life, the breakdown of our health systems, the economic consequences would be huge.

…you hate to be Chicken Little on this thing - no pun intended. But this is actually one of those situations where getting people a little scared, and certainly getting our government a little scared is probably a useful thing. And as I said, whatever investments we make are not going to be wasted, because the likelihood of pandemic is so high, even if it isn’t this particular pandemic. 

Perhaps Obama will see the issue differently as president than he did as a senator. But his instincts seem similar to those of the people who ran the 1976 immunization program - “When lives are at stake, it is better to err on the side of overreaction than underreaction.” If this outbreak continues, we may see another test of that idea.