Apr 11, 2006 (CIDRAP News) – A mathematical modeling study suggests that a modestly effective vaccine could keep an influenza pandemic from striking more than 10% of the US population, but only if large amounts of vaccine were distributed quickly and the virus was not too highly contagious. The modeling study seems to lend some support to the US strategy of stockpiling a vaccine based on recent strains of H5N1 avian flu, which won’t precisely match an emerging pandemic strain. But the model incorporates many assumptions that may or may not prove accurate in the event of a pandemic, and experts note that very little H5N1 vaccine would be available if a pandemic occurred anytime soon. Germann TC, Kadau K, Longini IM, et al. Mitigation strategies for pandemic influenza in the United States. Proc Nat Acad Sci 2006 Apr 11;103(15):5935-40 [Abstract] Germann and two associates, Kai Kadau and Catherine A. Macken, all of Los Alamos National Laboratory, worked on the study with Ira M. Longini Jr., a biostatistician from the Fred Hutchinson Cancer Research Center and the University of Washington in Seattle. See also: “Aggressive” production and distribution of vaccine could control a pandemic with an R of less than 1.9, the model predicted. “We believe that a large stockpile of avian-based vaccine with potential pandemic influenza antigens, coupled with the capacity to rapidly make a better-matched vaccine based on human strains, would be the best strategy to mitigate pandemic influenza,” the authors write. “This effort needs to be coupled with a rapid vaccine distribution system capable of distributing at least 10 million doses per week to affected regions of the U.S.” Other experts who were asked to comment on the study had different reactions. Travel restrictions alone would accomplish little, according to the simulations. A 90% reduction in travel would slow the virus’s spread by only a few days to a few weeks, depending on transmissibility, and would not dent the ultimate size of the pandemic. Other control strategies used alone could limit a pandemic only if the virus had relatively low transmissibility (R of 1.6), the model predicted. For example, targeted use of antiviral drugs could succeed in that case, provided the supply was adequate and close contacts of patients could be quickly identified. But if R were 1.8, the nation would need a “prohibitively large” 51 million treatment courses of antivirals. Dr. Gregory Poland, a vaccine expert at the Mayo Clinic in Rochester, Minn., said the situation with the H5N1 vaccine being made for the US government points up the problems with the predictions. As was reported recently, the vaccine seems effective in about half of recipients, but it takes 12 times the dose used in seasonal flu vaccines, he noted. The study was supported by the National Institutes of Health (NIH). Its goals, the NIH said in a news release, were to determine how to slow the spread of a pandemic virus long enough to permit development and distribution of a well-matched vaccine and also how to limit the number of cases to less than 10% of the population, the percentage in an average flu season. The model projected that without any control effort and an R of 1.9, the virus would spread across the nation within 30 days of its first arrivals, that 122 million people would ultimately fall ill, and that the pandemic would peak in 85 days. With an R number of 2.4 and no control effort, as many as 151 million would get sick, according to the model. William Schaffner, MD, a hospital epidemiologist and professor in the infectious disease division at Vanderbilt University in Nashville, said he found the study reassuring, though he had not examined it closely. “The ultimate take-home line was that even a partially effective vaccine is an important part of the strategy,” he said. For a highly transmissible virus (R greater than 1.9), it would take a combination of measures to limit the pandemic, the model predicted. For example, the combined use of vaccination, targeted antiviral use (3 million courses), school closures, social distancing, and travel restrictions could work at an R level as high as 2.4, the authors predict. With a moderately transmissible virus (meaning each case leads to fewer than 1.9 additional cases), “Our model suggests that the rapid production and distribution of vaccines, even if poorly matched to the circulating strains, could significantly slow disease spread and limit the number ill to less than 10% of the population, particularly if children are preferentially vaccinated,” says the report by Timothy C. Germann and colleagues. With a more contagious virus, additional measures such as school closings, travel bans, and antiviral drugs would have to be used in combination with vaccination, says the report published online last week by the Proceedings of the National Academy of Sciences. Michael T. Osterholm, PhD, MPH, a leading pandemic preparedness advocate, had a sharply different view of the study. “I think it’s based on a number of assumptions which in the real world won’t happen,” he said. “The idea that we’ll even have vaccine to consider in terms of dealing with the pandemic is at this point not likely for the vast majority of the world.” Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site, said “any number” of assumptions used in the model could be questioned. “I continue to worry that far too much credence is being put into theoretical models that lack reality testing in the likely world of a pandemic,” he said. “A moderately effective vaccine would work if you could get it into enough people,” said Poland, who directs the Mayo Vaccine Research Group and Program in Translational Immunovirology. “This current vaccine, if we used the whole world manufacturing capacity, offers enough doses for somewhere around 37.5 million people. So that’s not an answer.” He added that it may be necessary to make more than one vaccine, given the different clades (families) of H5N1 virus that have emerged. With a very limited supply of a vaccine for which two doses are recommended, the model showed it would be less helpful to vaccinate a given number of people with the two doses than to give just one dose to twice as many people. The model simulated the unfolding of pandemic flu in a US population of 281 million over 180 days. It factored in US census data about population distribution and commuting patterns and assumptions about the frequency of interpersonal contacts. It assumed that a few infected people would arrive from abroad each day at 14 airports in the United States. The researchers ran the simulations with four different reproductive (R) numbers (the number of additional people infected by each infected person), ranging from 1.6 to 2.4. He added that building up the capacity to treat the sick is important, but the main emphasis in pandemic preparedness should be on vaccination and other preventive measures. “The results [of the study] were so affirming of the general thoughts of the public health community that it’s really very reassuring, and I hope it stimulates further what I think is already a strong effort by HHS [the Department of Health and Human Services] to stimulate vaccine production and research on new ways to produce the flu vaccine and make better flu vaccines.” Poland also said no one knows how contagious the next pandemic virus will be. “My understanding is that the estimated R number for the 1918 pandemic was right around 3,” higher than the maximum of 2.4 used in the study, he said. “You wonder now if we truly have a novel subtype that’s easily transmissible, given the travel we have, if we wouldn’t have higher numbers. The average family is bigger than two people.” NIH news releasehttp://www.nigms.nih.gov/News/Results/FluModel040306
Mirae Asset Global Investments Group – The emerging market equities specialist has hired Jad Shams to the newly created role of head of MENA sales. Based in London, Shams will be responsible for building the firm’s sales distribution network across the region. He was formerly a director with Natixis Global Asset Management in Dubai, a senior investment adviser at Credit Agricole Asset Management in Abu Dhabi and a vice-president at Deutsche Asset Management in Frankfurt.M&G Investments – Claudia Calich has been appointed manager of the M&G Emerging Markets Bond fund, formerly managed by Mike Riddell, who will remain on the fund as deputy manager. For much of the last decade, Calich, who joined in October, worked at Invesco in New York, most recently as head of emerging market debt.State Street Global Advisors – SSgA has appointed three research analysts to its fundamental equity team. Robert Allen joins from private equity firm International Investment and Underwriting, while Eoin Ó hÓgáin joins from Centrica. James Savage joins from Depfa Bank.ING Investment Management International – Marcin Adamczyk joins has senior portfolio manager for emerging market debt (EMD) local currency, based in The Hague. He joins from Dutch fiduciary manager MN, where he was a senior EMD fund manager.Oddo Asset Management – Laurent Denize, currently a senior manager at Oddo Asset Management, has been appointed co-CIO. He will start in her new role on 1 December. He will take responsibility for investment management alongside chief executive Nicolas Chaput.Altius Associates – Rhonda Ryan has been appointed as a partner and head of investment for the EMEA region. She was previously managing director and head of the private funds group for Europe at Pinebridge Investments. Before then, she was head of private equity at Insight Investment.Alceda – Silvia Wagner has been appointed managing director at Alceda Fund Management in Luxembourg, subject to regulator approval. She will be responsible for Structuring & Portfolio Management, Finance & Controlling and Central Administration. Prior to joining, she was head of DWS Distribution Services and a member of the managing board at DWS Finanz-Service.Trinity Street Asset Management – Pauline Stuart has been appointed institutional business director, joining from BNY Mellon Asset Management, where she was executive director of institutional business for the EMEA region. Sean Landers has also been appointed institutional business director, most recently working at BMO Capital Markets, where he set up its US equity sales platform in the UK.Carbon Tracker Initiative – Anthony Hobley has been appointed chief executive at the London-based financial think tank. Hobley, a partner at law firm Norton Rose Fulbright and global head of its sustainability and climate change practice, will formally take the reins on 1 February. Länsförsäkringar, AP3, Schroders, Pioneer Investments, Mirae Asset Global Investments Group, M&G Investments, State Street Global Advisors, ING Investment Management International, Oddo Asset Management, Altius Associates, Alceda, Trinity Street Asset Management, Carbon Tracker InitiativeLänsförsäringar – The pension fund is planning to sign the UN Principles for Responsible Investment in 2014 and has hired Christina Kusoffsky Hillesöy to head up its responsible investment efforts. She joins from AP3, one of the Swedish national buffer funds, where she was head of communications and sustainable investments. She will join Länsförsäkringar on 1 March 2014 and report to finance director Cecilia Ardström. Ardström said Kusoffsky Hillesöy had been the driver behind the successful work on sustainable investments at AP3 and that, with her on board, Länsförsäkringar would sign the UNPRI next year.Schroders – The company has set up an in-house convertible bond team in Zurich. Peter Reinmuth, the fund manager of Schroder ISF Global Convertible Bond and Asian Convertible Bond; Martin Kuehle, product specialist for the two funds; and Urs Reiter, senior convertibles trader; have all transferred to the company. Damien Vermonet has also been appointed as convertible bond fund manager, joining from Acropole AM.Pioneer Investments – Matthias Inderbitzin has been appointed senior wholesale sales manager for Switzerland. He joins from Dendro Partners in Zurich. Before then, he served as head of sales at Falcon Private Bank and senior sales manager of German institutional clients at Lombard Odier & CIE.
The most common traffic violationswere illegal parking, road obstruction, disregarding traffic signs, jaywalking,and counter-flowing, he revealed. The objective is not to rake in hugefines but to curb traffic violations by instilling road discipline, stressedPSTMO head Jeck Conlu. ILOILO City – Fines from apprehendedtraffic violators at the Sen. Benigno Aquino Jr. Avenue in Mandurriao districtare projected to exceed half a million pesos. The Public Safety andTransportation Management Office (PSTMO) of the city government, however, isnot happy. As of Feb. 16, 2,438 apprehensionswere made for various traffic violations along the 14-kilometer avenue, a pilottraffic discipline zone (TDZ) in the city where all traffic regulations areenforced strictly. Having a traffic discipline zone isone of the moves of the city government to ease traffic congestion and curb road accidents. But itslong-term plan is to have an intelligent traffic system (ITS) that former mayorJed Patrick Mabilog proposed in 2017. The Philippine National Police,Highway Patrol Group and Land Transportation Office are helping the PSTMO. These include the speed limitordinance, the ordinance against modified mufflers, points where to load andunload passengers, the law on the use of helmets and other body protectivegears by motorcycle riders and the maximum number of back riders allowed, thelaw on the use of seatbelts, the law on the non-use of cellphones while drivingand clearing of windshields from gadgets that directly distract the driver’sline of sight, among others. Conlu, however, clarified that thegoal of the TDZ is the promotion of road discipline among drivers andpedestrians and not raising money. The avenue, also known as theDiversion Road, as TDZ started on Jan. 16 “Given ‘ni iya that on the first one month of TDZ implementation mataas ang apprehension kay gina enforce ta pa lang strictly ang mga trafficrules and regulations,” he explained. After the Sen. Benigno Aquino Jr.Avenue, next to be made a traffic discipline zone is McArthur Drive fromBarangay Tabuc Suba, Jaro district to Barangay Balantang. “The projected total amount ofpenalties, although some have been collected already, is P683,900,” said Conlu. Like the Sen. Benigno Aquino Jr.Avenue, McArthur Drive is also “problemadopirmi sa traffic because of lack of discipline,” he explained. SPEED CHECK. A traffic enforcer checks the speed of these vehicles on Sen. Benigno Aquino Jr. Avenue, a traffic discipline zone in Mandurriao, Iloilo City. Drivers’ lack of discipline contributes to traffic congestion and causes vehicular accidents. PN PHOTO “TDZ will be successful kon mapanubo naton ang dakpanay,” hesaid. As proposed by Mabilog, the firstphase of the ITS would be on the Sen. Benigno Aquino Jr. Avenue because thishighway is prone to vehicular accidents due to overspeeding drivers. Phase II would be on the coastal road,Phase III on the McArthur Highway Drive going to the municipality of Leganes,Iloilo and Phase IV on the Circumferential Road going to Oton, Iloilo./PN “I want this scheme initially tried onthe Diversion Road para mapakita ngapwede maobra ini,” said Mayor Jerry Treñas. An ITS involves the use ofclosed-circuit television cameras capable of determining the speed of vehicles(if they are overspeeding) and of recording them. It would also entail theestablishment of a command/monitoring center. An ITS is projected to discouragedrivers from disregarding traffic rules and regulations. It would also help lawenforcers to easily identify and catch violators. What are the traffic rules andregulations being enforced? Traffic enforcers are armed with, amongothers, breath analyzers to catch those driving while under the influence ofalcohol and speed guns to catch drivers who are exceeding the speed limit.