As reported by the Bristol Press, November 7, 2005.

Hygiene, Not Vaccine, Seen Best Way to Stop Bird Flu

By Abram Katz

Getting into the habit of simple respiratory hygiene is probably a better way to combat a future pandemic of avian influenza than following President Bush’s proposal to spend $1.2 billion on a vaccine that may not work, the chief of emergency preparations for Yale-New Haven Health System says.

Christopher Cannon, system director in the office of emergency preparedness in the multi-hospital group said his office is also recommending that doctors and hospitals not stock up on the antiviral drug Tamiflu.

With 1,500 beds, three hospital complexes and a $1.3 billion budget, Yale-New Haven Health System is purported to be the largest health system in Connecticut.

Physicians and public health officials around the world fear that the H5N1 avian flu, which has sickened about 120 and killed 62 people in Southeast Asia, could become easily transmissible between people.

Now only people who handle poultry or are in close quarters with the birds have been infected.

However, the modified virus could then cause a pandemic capable of killing millions.

President Bush proposed a $7.1 billion plan this week to fight an avian flu pandemic, including $1.2 billion for 20 million doses of an experimental vaccine that might not be effective.

"We want a solution to this but all of the magic bullets are not really there. No one wants to hear this," Cannon said.

"Whether expending $1.2 billion on a unproven vaccine is effective policy is a good question," he said. "... We’re strongly suggesting that preventing the spread of the virus is the best way to stop a pandemic," Cannon said.

"It’s not rocket science.The best way to minimize your risk is personal hygiene -- what your mother told you to do in kindergarten that you didn’t do," Cannon said.

These measures include covering the nose and mouth when coughing or sneezing, washing hands frequently to reduce flu viruses literally picked up from the environment. Keep a safe distance from people who are sneezing or coughing and people who are ill should stay home, Cannon said.

Cannon said many worried people are counting on Tamiflu, a drug made by Roche, for protection against avian flu. Cannon said doctors in the Yale system are being advised not to prescribe Tamiflu.

"For prophylaxis [preventing flu] a person would have to take Tamiflu every day. Widespread self-medication with Tamiflu would inevitably lead to resistant viruses, he said.

"We don’t know if Tamiflu will be effective against H5N1. There’s no evidence that it lowers the death rate for flu," he said.

Cannon said the government should stockpile Tamiflu and distribute it when necessary.

Dr. Louise Dembry, Yale-New Haven Hospital epidemiologist and infectious diseases physician, said that there is no way to predict how or when H5N1 would assume a form that spreads from person to person.

The efficacy of a vaccine based on H5N1 is also questionable, she said,

"The concern now is whether H5N1 changes enough to transmit from human to human," Dembry said.

Like all influenza viruses the avian flu undergoes genetic drift, she said. This means that the hemagluttin (H) and neuraminidase (N) proteins on the viral surface change slightly to become a "different" H5N1.

Avian flu could also mingle with other flu types in a person or pig, acquiring the necessary genes to spread through people. In that case the virus might change dramatically, Dembry said.

"People say we’re not prepared, but prepared for what?" she said.

"The Bush plan deals with drift," she said. An H5N1 vaccine slightly different from the circulating virus could still be partially effective. Even in a normal year the vaccine is not 100 percent effective, Dembry said.

The H5N1 vaccine under development by the U.S. Department of Health and Human Services might lessen the severity of avian flu. But if another strain emerges the vaccine would be useless, she said.

About $2.8 billion of the president’s plan is slated for research into vaccine development and production.

"A new quick way of developing vaccines would help us in a few years. "Then we wouldn’t have to guess," Dembry said.

Charles Huntington, president of the Connecticut Public Health Association, said preparing for a possible pandemic makes sense, "It’s a lot of money for a vaccine, but prevention is by far the best approach," said Huntington, who is also assistant professor of community medicine at the University of Connecticut Health Center.

Huntington said Bush’s plan to allot $100 million to help states develop and test pandemic plans is insufficient.

"The plan appropriately recognizes the role of state personnel and health professionals, but $100 million won’t go very far. Connecticut is already low in trained public health personnel," he said.