H1N1 COUNTERMEASURES STRATEGY AND ... - PHE Home

NBSB Pandemic Influenza Working Group
Detailed Report
Dr. Edwards: I think Dr. Schonberger makes sense. We may have to decide whether
we will go forward with just a few answers, otherwise it may be too late and we’ll be
spending money on vaccine we may not need. We need to find out quickly what happens
with one dose. I’m worried that the trials will miss the mark.
Dr. Schonberger: Maybe there’s a precedent. In 1977, we did not call it a pandemic;
we just slipped the antigen into the regular seasonal vaccine.
Dr. Dowdle: There was small, simple field trial, but no consideration of a new subtype,
and it was very quietly done.
Dr. Quinnan: Dr. Treanor gave data on clinical trials in 1977 from the Russian
influenza vaccine that showed very good responses in people who had been alive in 1957.
However, that data reflects responses of people who had had multiple natural exposures
to H1N1 strains that were nearly identical to the 1977 H1N1 strain. It is important to
recognize that similar, very potent responses were observed in the same age groups
among people vaccinated in 1976 with the A/New Jersey H1N1 strain, since that strain
was very different from the strains that circulated prior to 1957. Those results indicate
that we should see the same degree of cross strain priming in people vaccinated now with
the novel H1N1 strain based on prior exposure to previously circulating H1N1 viruses.
Moreover, the cross priming should be evident in people who were alive before 1957 and
in people who have been exposed to circulating H1N1 strains over the past 30 years.
Dr. Murphy: Some respond well to one dose per data on the 1976 trials—about 80­
90%. Despite the uncertainty about the number of doses and ability to respond, I think
we can make a decision early.
Dr. Pavia: That’s all good for people over 50, but that’s not the target group.
Dr. Murphy: The viruses circulating in the 1940s and 1950s were priming the
population for the virus that circulated in the 1980s. Everybody over a certain age has
H1N1 priming.
Dr. Field: This is politically sensitive. Is there a procedure for getting public input and
perceptions?
CAPT Fiore: We have one public member [on ACIP] and we have public comment time
during meetings. Also, CDC sponsors public engagement.
Dr. Redd: The public engagement process is good for value decisions but not for
technical decisions.
Dr. Gellin: We went through the prioritization process for pandemic influenza planning.
There is a way to formalize the input, and we see it as a data point.
Dr. Modlin: I’m a veteran of the swine influenza outbreak. We studied the vaccine at
Boston’s children’s hospital and we found the vaccine poorly immunogenic in children,
even at two doses.
Dr. Meltzer: In terms of setting a goal, keep in mind that the valuation of a vaccine
changes, and you can’t transfer that value to others. I don’t think seasonal vaccine
valuations are comparable in the public’s mind to H1N1. As for the data we need to
make decisions, e.g., the case-fatality rate, I don’t think it’s that simple. Public comment
is important, but people say one thing and do another. Whether to use one or two doses is
important for logistics, etc., but to the public it’s a side issue. Regarding the decision
process, you need to get down to a few key points. There will never be enough data, but
if you start too early, you will be back in 1976.
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