## Influenza vaccines

I have recently been reading about influenza vaccines and I am summarizing some of the information I found here. I start with some remarks on the classification of influenza viruses. The first distinction is between influenza A and influenza B viruses. The former are classified further into subtypes HnNm for numbers $m$ and $n$. Well-known examples are H5N1 (which includes the recent ‘bird flu’) and H1N1 (which includes the pandemic of 1918 and the current ‘swine flu’.) Influenza B does not carry a pandemic threat and will not be considered further here. Every year a vaccine is produced for the seasonal flu epidemic (in fact two – one for the southern and one for the northern hemisphere). It is trivalent, being directed against three types of virus. In recent years this has always been of the form H3N2 + H1N1 + B. In particular this is the case for the present vaccine for seasonal flu. It is not expected that this vaccine will be effective against the pandemic H1N1 swine flu. Thus a separate type of vaccine has been developed for that. In the classification H and N stand for haemagglutinin and neuraminidase, two proteins which occur on the surface of the virus and come in different forms in different strains. These are the main molecules of the virus recognized by antibodies. They are involved in the processes by which the virus enters and leaves host cells, respectively.

Next I come to some details concerning the vaccines themselves. I concentrate on those being applied in Germany since this is what would be relevant for me if I got vaccinated myself. I get the impression that there are a lot of unreliable and misleading statements on this subject in the media and so some care is necessary in judging the information available. On the web page of the Paul Ehrlich Institute there is a list of vaccines against seasonal flu approved in Germany in this season. Twenty products are listed. All are classified as inactivated. This means that if manufactured successfully the vaccine cannot lead to any reproduction of the virus. In other words the vaccine uses (parts of) ‘dead’ virus particles. Three of the vaccines are described as ‘virosomal’ which means that they can be administered as a nasal spray. Presumably all the others are administered by injection. Two of them include an adjuvant, a substance which is intended to amplify the immune response. This is one theme which has led to recent controversy in connection with swine flu vaccines and I will return to it later. One vaccine (Optaflu) is said to be produced in cell culture. This is connected to another theme of recent controversy, with discussion in the media about vaccines produced using cancer cells.

Now to the question of the cancer cells. Celvapan is produced using a cell line called Vero cells which is derived from monkeys. It seems that these cells arose from kidneys of normal monkeys and have nothing to do with cancer. Usually normal cells can only undergo a limited number of divisions while cancer cells can be immortal. Vero cells are not cancer cells but they do seem to be able to survive in cell culture for an unlimited time. I do not understand how this works. It may be noted that Vero cells have been used in a routine way to produce millions of doses of polio vaccine and so there has been ample opportunity to discover any possible dangers associated to their use. In the production of Optaflu a cell line called Madin-Darby canine kidney cells is used. This looks like the same kind of tissue as with Vero cells, except derived from a different animal. I have not found a reference anywhere claiming the use of cancer cells in this context which looks trustworthy.

To finish, here is a piece of news from the web site of the ECDC in Stockholm. In the Ukraine there have now been 500 000 reported cases of acute respiratory illness and it seems that the expert opinion (cf. also the WHO website) is that most of these are related to the new H1N1 influenza. There have been 86 deaths reported from there. So it seems that the pandemic is alive and well.

### 6 Responses to “Influenza vaccines”

1. Uwe Brauer Says:

Hello

I don’t hope to start a “flamewar” on this, but the article
http://www.spiegel.de/wissenschaft/mensch/0,1518,druck-637567,00.html
unfortunately in german, gives some interesting insights.

Tom Jefferson an expert in epidemics from the Cochrane Collaboration claims, that based on statistical analysis only 7% of all the infection which have flu like symptoms are actually caused by the by the influenca virus.

Moreover washing the hands is the best protection.

It calls his attention (and I must say mine) that the influenca virus is unique among all the other groups of virus in the sense that it is the only one for which a vaccine has been developed.

Uwe Brauer

2. hydrobates Says:

Hello Uwe

I am not sure you should believe everything you read in ‘Der Spiegel’ on this
subject. You might like to look at the comments on an article there on the home page of the Paul Ehrlich Institute (http://www.pei.de/)

By the way, there must be some misunderstanding with the ‘no vaccine for a virus’ statement. For instance, I got vaccinated against yellow fever before I visited Cameroon.

3. hydrobates Says:

This evening I went to a lecture on pandemics at the Einstein Forum in
Potsdam. The speaker was Stefan Kaufmann who is director at the Max Planck Institute for Infection Biology in Berlin. I have a very high opinion of him and the lecture, which was excellent, only served to reinforce this.His main subject was tuberculosis, not swine flu, but he said some things which were relevant to your comments. I should mention that this talk was not mainly about medical science, but rather about public health policy and its relations to economics and politics. He mentioned the fact that the WHO changed its definition of ‘pandemic’ at a critical moment, confirming what you mentioned in your comment. His reaction was that it was unwise of them to do that since it just led to making people suspicious. In that context he said that reacting to a disease with a vaccine is 10 per cent medicine and 90 per cent mass psychology. Another interesting remark concerned adjuvants. He believes that with a sufficiently good adjuvant (which does not yet exist) vaccinations to the seasonal flu could be made to last ten years instead of one. To finish let me mention that Kaufmann has written a book entitled ‘Waechst die Seuchengefahr? Globale Epidemien und Armut: Strategien zur Seucheneindaemmung in einer vernetzten Welt’ of which I bought a copy. [For readers who do not speak German: there is also an English version with the title ‘The new plagues. Pandemics and poverty in a globalized world’]

4. Some vaccinations I have had « Hydrobates Says:

[…] consult. I will start with hepatitis A and B since that involves some themes which I mentioned in a previous post on influenza vaccines. A point I want to make is that the swine flu vaccines about which there has been so much public […]

5. The immortal Henrietta Lacks « Hydrobates Says:

[…] By hydrobates I find immortal cell lines a fascinating topic and I mentioned the subject in a previous post on influenza vaccines. From time to time I had heard about HeLa cells. I knew that this was a cell line derived from […]