Flu strain raises concerns about H5N1 outbreak
■ Researchers developed a type of influenza that can be transmitted easily among mammals. Infectious diseases experts fear the virus could be released to the public.
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Infectious diseases experts are alarmed by two recent studies in which scientists engineered a strain of the H5N1 avian influenza virus that can be transmitted easily among mammals.
The virus, which largely is found among birds in Africa, Europe and Southeast Asia, is more pathogenic than other influenza strains, said virologist Susan Fisher-Hoch, MD, MSc. Data show that about half the people who contract the virus die, experts said.
An outbreak of H5N1 in humans "really is a serious threat," said Dr. Fisher-Hoch, a professor of epidemiology at the University of Texas Health Science Center at Houston.
For years there have been concerns that the H5N1 virus could naturally mutate into a strain that could infect humans easily. But the two studies, completed in 2011 in the United States and the Netherlands, show that scientists now can create such a mutation in the laboratory.
Some infectious diseases experts fear that a researcher accidentally could become infected with the lethal strain while working with it and spread the virus through the community. Others worry that the information on how to engineer this mutation could get into the hands of someone who wants to do harm.
Among the goals of the recent H5N1 studies is to help scientists identify when genetic changes begin to occur in nature in the lethal strain of influenza. Identifying such a change early would help vaccine manufacturers develop an immunization before the virus becomes widespread among people.
But a federal advisory committee considers some aspects of the research too revealing about how to engineer the mutation. The U.S. National Science Advisory Board for Biosecurity requested in December 2011 that certain details of the research be withheld when the studies are published. The National Institutes of Health funded the research.
Nature and Science, the journals set to publish the studies, had not decided whether to omit the information as of this article's deadline.
Science Editor-in-Chief Bruce Alberts, PhD, said knowledge about the virus that was engineered by the research team in the Netherlands could be essential for developing new treatments to combat the lethal form of influenza.
"We strongly support the work" of the science advisory board, Alberts said. But he added that the journal "has concerns about withholding potentially important public health information from responsible influenza researchers."
In an effort to address this concern, the government is working to establish a mechanism that would allow secure access to the full studies for individuals who need the information legitimately to improve public health.
The Dept. of Health and Human Services agrees with the request to withhold certain details of the studies, according to a statement issued by the NIH.
"While the public health benefits of such research can be important, certain information obtained through such studies has the potential to be misused for harmful purposes," the NIH said.
Regardless of the recommendation to omit data, William Schaffner, MD, said details of the study probably will be common knowledge in three or four years, because enough scientists involved with the research know about it.
"When you have that kind of information out there, you can't keep it a secret," said Dr. Schaffner, chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn.
For the time being, the studies serve as a reminder of the seriousness of influenza. There are steps that physicians should take to ensure they are ready for such an outbreak, if one occurs, infectious diseases experts say.
Dr. Fisher-Hoch said primary care physicians should talk to their staffs about how they would handle a large number of healthy, young people who have serious complications from influenza. She also recommends that physicians know whom to contact at their local public health departments for information if an outbreak occurs.
Dr. Schaffner encourages primary care doctors to focus on getting all their staff and patients 6 months and older in the habit of receiving an annual influenza vaccine. Doing so would make it easier for practices to administer a pandemic flu immunization if it is needed, he said.
"Everyone would be trained in the mindset" that an influenza vaccine is necessary, Dr. Schaffner said.