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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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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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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This is the third day of our coverage of the 2010 BIO International Convention, a massive biotechnology conference being held this week at McCormick Place in Chicago. Come back all day for reports from panels, lectures, and the exhibit floor on how scientists, government leaders, and industry hope to use the combined forces of science and technology to tackle some of the world biggest problems. For the first two days of our coverage, click here and here.

6:00 PM - Biotechnological Patriotism and the Petabye Age

Walking through the elaborate castles erected by countries from Europe, Asia, and South America on the exhibit floor (pictured below), an American might develop some anxiety about their country’s status as undisputed champion of biotechnology. That’s partially an illusion - if all of the kiosks for individual American states and U.S.-based biotech companies were pooled into one giant USA! USA! booth, it would take up the majority of the exhibition. But paranoia that the rest of the world is hot on America’s trail was palpable through the conference, with rumblings of new biotech epicenters in China and India rippling through McCormick Place.

A panel organized by Scientific American this afternoon sought to set some of those fears at bay, and the message was delivered through a persuasive moderator: CNN’s Fareed Zakaria. With his keynote address, Zakaria talked about the economic landscape as the world recovers from a global financial crisis, but said that the real economic story of the last 50 years was not bubbles and recessions, but the broader participation in the world economy. No longer is all the exciting innovation and economic development happening in a few North Atlantic nations, Zakaria said; now even small countries have robust, independent economies and an impact on the global system.

The downside of that phenomenon, for Americans at least, is that we are no longer the one place where the world’s biggest achievements are located. The biggest mall in the world, Zakaria pointed out, is no longer Minneapolis’ Mall of America - it’s the South China Mall in Beijing. The richest man in the world lives in Mexico City. The world’s largest refinery is in India. But the United States can still lay claim to the most highly-respected universities in the world, and the “extraordinary quantity of high quality research” that goes along with that system.

Joined by a panel of biotechnology industry leaders, the reassurance continued. China and India - while several orders of magnitude larger in population than the United States - are too concerned with building infrastructure to pose a near-term threat to American biotech expertise. The American investment system, which rewards creativity and understands that many big ideas fail, remains a model for the world. And as long as United States universities are perceived as the world’s best, they will attract the best students from around the globe to our shores - even if, increasingly, those students return to their home countries to apply their education.

With all those warm feelings, it was a little disheartening to find what I thought would be one of the day’s most engaging research sessions - on applications of computational science to drug discovery - to be also the day’s most sparsely attended. Fascinating, exciting research was presented by scientists from the University of Illinois and Argonne National Laboratory on how the rapid growth of computing power capabilities has made new types of experiments possible.

Emad Tajkhorshid showed animations representing the dynamic wobble of protein interactions, drugs and targets undulating like ocean waves - suggesting that scientists will no longer be constrained by the necessary simplifications of benchtop science. Rick Stevens, from Argonne, talked about grabbing a small soil sample and sequencing every organism within, grabbing potentially thousands of complete genomes - many of them never before seen - at once. As one questioner said, we’ve brought everyone into the genomic age, but the next step will be the petabyte age, an age of previously unfathomable computation enabling the creation of new science. Unfortunately, this afternoon there were few there to witness the new age’s early steps.

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Bill Gates walks across the University of Chicago campus April 20, 2010. (Photo by Jason Smith)

A College Dropout Returns to Campus

The per capita income of Hyde Park experienced a brief spike on Tuesday as Microsoft founder/billionaire philanthropist Bill Gates paid a campus visit as part of his three-day college tour. After meeting with students and professors - including a walk-and-chat with Kevin White, pictured at left - Gates spoke and answered questions in a building named for another ultra-wealthy benefactor, the Rockefeller Chapel.

As Gates’ first college tour since resigning from Microsoft to focus full-time on his Bill & Melinda Gates Foundation, the focus was less on technology and more on the humble task of solving the world’s problems. With only a limited amount of time to speak, Gates focused on two priority areas for his foundation: child mortality and education. On the former point, Gates highlighted the vast differences between the wealthy world and the poor world in childhood death rates, with less than one percent of children dying before the age of 5 in rich countries while the death rate for young children remains around 20 percent in the third world. Vaccines are a big part of that change, Gates argued, which is why his foundation recently sunk another $10 billion into vaccination efforts around the world.

Interestingly, Gates said he once worried whether reducing infant mortality in developing countries could lead to more problems in terms of overpopulation and resource scarcity. But in fact, Gates said, studies have found that better health leads to smaller families, as parents choose to have fewer children when the chances of them living to adulthood increases.

You can find more coverage of Gates’ visit at the University of Chicago News Office.

A Year of Swine Flu

Hard to believe it was only one year ago that the world first learned to be afraid of the collection of letters and numbers known as H1N1. As a newspaper reporter at the time, I recall being impressed by the speed of the outbreak - not the virus outbreak, mind you, but the outbreak of media hysteria over the virus. For sure, there was reason to be alarmed about the novel H1N1 influenza, especially in the early days when the epidemiology was sketchy at best and seemed full of dire warning signs. But the leap from “new mysterious flu strain” to “1918 Pandemic Redux!!!” happened almost overnight, and spread far more quickly than the actual virus. I found myself writing “calm down, everybody” articles almost from the time I was put on the story, as the flu experts I interviewed balanced their concerns with a healthy dose of scientific skepticism.

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An African Pygmy Kingfisher (Ispidina picta) from the Malawi expedition. (photo by Jason Weckstein)

The scenario played out last spring when “swine flu” suddenly became a household name. As public health agencies sprung emergency policies into place, scientists set about tracing the new H1N1 virus back to its source, following it from person to person and eventually to the animals where it originated. Understanding how the virus’ genes mutated in pigs could help scientists determine how it jumped to humans, and give clues as to the most effective ways to fight the disease. But in the time it took to reconstruct the origins of swine flu, thousands and thousands of people were were newly infected with the virus.

Fortunately, last year’s novel H1N1 virus ended up fizzling out into a run-of-the-mill flu - still deadly in a small percentage of people, but not the runaway killer it threatened to be in its earliest days. But we might not be so lucky with the next disease to jump from animals to humans, so monitoring potential threats before they crossover is a scientific priority. While the genetic sequences of more and more organisms are cataloged every day, the viruses, bacteria and parasites those organisms living inside those animals have barely been characterized.

That knowledge gap is the target of the Emerging Pathogens Project, a collaboration between scientists at the University of Chicago and the Field Museum announced Tuesday morning at the museum’s very cool DNA Discovery Center. Blending the centuries-old practice of gathering animal specimens on field expeditions and the bleeding-edge technology of large-scale genomics, the project hopes to give scientists advance warning and knowledge about tomorrow’s epidemics.

“We plan to treat each one of these animals as an ecosystem in and of itself,” said Shannon Hackett, head of the bird division at the Field Museum and co-leader of the project. “We’re really interested in what lives in and on these organisms.”

Those animal ecosystems were collected during an expedition last fall in the African country of Malawi, a trip that brought back roughly 1,100 bird and mammal specimens. A sampling of those (pictured above) were on display at the announcement of the project; just one shelf from the tens of thousands that store critters of all types in the museum’s vast collection facilities. In categorizing those specimens, the museum has moved increasingly to genetic analysis, but the Emerging Pathogens Project brings those efforts to a much larger scale.

That’s possible thanks to the genomics infrastructure established by Kevin White, director of the University’s Institute of Genomics and Systems Biology and Hackett’s leadership partner in the Emerging Pathogens Project. Having previously launched massive projects to study genetic regulation and the genetic makeup of tumors, White said there was still time to take on another scientific challenge. Gesturing at the DNA laboratory that was the backdrop for Tuesday’s event, White aid that the high-throughput sequencing technology now available could do an amount of work equivalent to several million of such labs.

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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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Our weekly roundup of science news from around the world that doesn’t easily fit anywhere else.

A cuscus. Crazy. (photo from Wikimedia Commons)

Wild Kingdom Gets Weirder

If you’re a fan of weird animal stories, this was a week for you. First, there was the discovery of a never-before-seen giant rat and about 40 other unidentified species by a group of British and American scientists in a volcano crater on the island of Papua New Guinea (they also stumbled upon Doria’s tree kangaroos and cuscuses while they were at it; adorable photo gallery here). Christened the Bosavi woolly rat, it’s 32 inches long and 3.5 pounds, and was completely friendly to humans, having never really seen them before.

Then a report came out in Biology Letters about a group of birds called tits in Hungary that were forced to add an unusual menu item when food became scarce: bats. These cute little birds apparently get on a real mean streak when they’re hungry, attacking hibernating bats (small ones - only 4cm) and dragging them out of their caves for dinner. The paper’s authors found that the tits (okay, stop giggling) would only go for bat meals when other food wasn’t available, which they proved by satiating the carnivorous birds with…bacon. I’d provide some more links on this story, but it’s not exactly the kind of topic you want to be caught Googling at work.

Finally, in a study that will probably end up on some politician’s pork-barrel list, NASA revealed this week they can now make mice float with magnets. The superconducting magnet is powerful enough to use a mouse’s natural water content to cause its entire body to float, an unusual sensation that the mice apparently get used to fairly quickly (3-4 hours). Why levitate mice? To study the effects of microgravity on astronauts, of course, though Switched points out rightly that NASA has already been bringing rodents for ride-alongs into space for decades. Alas, there is nary a video of levitating mice to be found, and the article is accompanied only by terrible overhead pictures. C’mon, NASA. read more

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.