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Avian Influenza Daily Digest
November 21, 2008 15:00 GMT
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Intelink Avian Influenza Resources:
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Article Summaries ...
Announcement
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Announcement
Quid Novi
Indonesia: Poultry Diue Off in Central Java
Regional Reporting and Surveillance
Follow up Report on the Sixth Intl Ministerial Conference on AI/PI Egypt
THE SIXTH INTERNATIONAL MINISTERIAL CONFERENCE ON AVIAN AND PANDEMIC INFLUENZA SHARM EL-SHEIKH EGYPT 25-26 OCTOBER 2008 The Sharm el-Sheikh Vision for the Future: Universal Solidarity, Justice and Equity Prepared by the Government of Egypt [Full text pdf] Approximately 530 Government...
Regional Reporting and Surveillance
FAO GLEWS--Myanmar Update
11/8/08? FAO field officer, Results of active surveillance undertaken during the month of October 2008 in Bago (East), which locates next to Yangon Division, indicated the presence of a large number of seropositive healthy ducks as follows: a total of...
Regional Reporting and Surveillance
Indonesia says 17 in Sulawesi not infected with bird flu
11/20/08 Reuters--Bird flu has been ruled out as the cause of illness in 17 people from the same neighbourhood of Makasar in Sulawesi, Indonesia, a health ministry official said on Thursday.
Regional Reporting and Surveillance
FAO GLEWS--Indonesia Update
11/13/08 ? FAO field officer, 32 H5N1 HPAI outbreaks were detected through Participatory Disease Surveillance and Response (PDSR) during the month of October. The 32-year old male suspected to die from H5N1 infection (reported on 3 November 2008) tested negative and so did the chickens and pigeons nearby.
Regional Reporting and Surveillance
Science and Technology
Malaria one-two could stop bird flu
11/19/08 Irish Times--A researcher at UCC is studying a vaccine that could protect against any form of influenza, including bird flu, informed by earlier work on a two-step anti-malaria vaccine, writes Dick Ahlstrom RESEARCHERS working to find a vaccine against the dangerous bird flu virus are borrowing an idea from boxing - that a one-two combination punch can win the day. They have devised a two-step vaccine that should work not just against bird flu but against any form of the influenza virus.
Vaccines
Pandemic Preparedness
System for Monitoring Effects of Pandemic Flu Vaccine Shows Promise in Pilot Test
11/19/08 Abt Assoc--The next influenza pandemic could have a profound impact on almost every sector of society, both in the United States and globally. In the 1918 influenza pandemic known as the "Spanish flu," about 20 million people died, including about 675,000 Americans out of a population of what was then only 105 million.
Pandemic Preparedness
HPAI and Pandemic Preparedness: Review of progress using the New Delhi Road map
Session 1: 25th October 2008: ?Setting the Scene? David Nabarro United Nations System Influenza Coordinator [full text pdf] I would like to take this opportunity to thank the Government of Egypt for convening and hosting this sixth in a series of International Ministerial Conferences on Avian and Pandemic Influenza. I also am pleased to thank the International Partnership on Avian and Pandemic Influenza and the European Commission for their crucial support.
Pandemic Preparedness
Report says pandemic will threaten coal, power supplies
11/20/08 CIDRAP--A new report from the University of Minnesota warns that an influenza pandemic could disrupt the coal industry, thereby endangering the nation's significantly coal-dependent electric power system and everything that depends on it.
Pandemic Preparedness
Qatar University hosts Avian Flu Forum
11/20/08 The Peninsula--Qatar University (QU) hosted the Avian Flu Forum yesterday where top global health experts discussed the global implications of the virus and the impact on communities in the Middle East and Asia.
Pandemic Preparedness
Full Text of Articles follow ...
Pandemic Preparedness
System for Monitoring Effects of Pandemic Flu Vaccine Shows Promise in Pilot Test
11/19/08 Abt Assoc--The next influenza pandemic could have a profound impact on almost every sector of society, both in the United States and globally. In the 1918 influenza pandemic known as the "Spanish flu," about 20 million people died, including about 675,000 Americans out of a population of what was then only 105 million.
As part of its Pandemic Influenza Operations Plan, the U.S. Centers for Disease Control and Prevention has begun a systematic series of preparedness exercises. One such exercise is to evaluate systems that can actively monitor, record, and analyze adverse reactions among people who receive a pandemic influenza vaccine. This exercise also involves learning about the effectiveness of various communication approaches that encourage vaccine recipients to be alert for adverse reactions. To respond to the threat of a new flu pandemic, CDC needs a vaccine surveillance system that includes:
* An easy-to-use tool to track vaccinees' status after their vaccination.
* A mechanism to reassure vaccinees that their health is being monitored.
* Rapid identification of adverse reactions to vaccines.
* Deployment to and access from multiple locations.
* Automatic alert and notification capabilities ? the system that Abt Associates pilot-tested was designed to generate automatic alerts including the vaccine lot number if a serious side effect was reported.
* Accurate, real-time statistics on post-vaccination reactions.
In 2007 CDC asked Abt Associates to create and pilot-test an active surveillance system for monitoring adverse vaccine reactions. This system, pilot-tested in the fall of 2007, allowed vaccinees to report their status daily for one week after being vaccinated. Reports could be made by telephone (using an interactive voice recognition system) or online. Study participants who did not log in or call to report their post-vaccination status were telephoned to obtain the necessary information. The system was tested at ambulatory care clinics in Washington, D.C. during the annual influenza vaccination season, with a small sample of persons who had received a routine flu shot. Abt Associates partnered with Kaiser Permanente of the Mid-Atlantic Region for the clinic sites where recently vaccinated adults were recruited to participate in the system test.
The 2007 pilot test found that vaccinated adults were generally willing to report in about their vaccine reactions, especially if given the choice of telephone or internet reporting. The telephone reminder for nonrespondents was also helpful. To expand on the small size of this pilot test ? 166 respondents, representing 79 percent of all those approached for the study ? further research with a larger sample and longer field period is being conducted in the fall of 2008, also by Abt Associates. The 2008 test has a target of 1,000 vaccinees who will be asked to report their status for 14 days after vaccination ? twice as long as the one-week reporting period of the 2007 pilot test. Data will be collected in Washington D.C. and in the Boston metropolitan area, from vaccinees visiting flu clinics operated by the area public health departments.
The surveillance system tested in 2007 and being tested again in 2008 had its origins in a 2003 study that Abt Associates conducted for the Department of Defense, that monitored reactions to the smallpox vaccine among military personnel. After being vaccinated, those vaccinees registered and then called or logged in to an electronic diary every day for 28 days to report the appearance of their vaccination site and any symptoms or concerns. Originally conceived as a counter-terrorism strategy, the system was versatile enough to be adapted for CDC to use to collect information on any vaccine.
Announcement
AI Outbreak Map
Quid Novi
Indonesia: Poultry Diue Off in Central Java
A local source reported that officials from the local agricultural agency found 3 dead chickens while spraying disinfectant against avian influenza in a wet market in Semarang city, Central Java province, in response to the declaration of "extraordinary occurrence" status in this city after the death of a 15-year-old female due to H5N1 infection. This wet market receives and distributes approximately 10,000 chickens from different areas. They have taken chicken samples for further investigations. Results are pending.
Pandemic Preparedness
HPAI and Pandemic Preparedness: Review of progress using the New Delhi Road map
Session 1: 25th October 2008: ?Setting the Scene? David Nabarro United Nations System Influenza Coordinator
I would like to take this opportunity to thank the Government of Egypt for convening and hosting this sixth in a series of International Ministerial Conferences on Avian and Pandemic Influenza. I also am pleased to thank the International Partnership on Avian and Pandemic Influenza and the European Commission for their crucial support.
Regional Reporting and Surveillance
Follow up Report on the Sixth Intl Ministerial Conference on AI/PI Egypt
THE SIXTH INTERNATIONAL MINISTERIAL CONFERENCE ON
AVIAN AND PANDEMIC INFLUENZA
SHARM EL-SHEIKH EGYPT 25-26 OCTOBER 2008
The Sharm el-Sheikh Vision for the Future:
Universal Solidarity, Justice and Equity
Prepared by the Government of Egypt
Approximately 530 Government Ministers and senior officials (representing more than
120 countries and 26 International and Regional Organizations), representatives of international
and regional organizations, non-governmental groups and private entities, and researchers,
participated in the 6th International Ministerial Conference on Avian and Pandemic Influenza in
Sharm el Sheikh, hosted by the Government of Egypt on 25-26 October 2008.
Conferences and Training
AI Job Announcements
Egypt
Title: Avian Influenza Technical Advisor/Program Manager
Location: Cairo, Egypt
Number: GHFP-08-120
Status: Open
Close Date: 12/19/2008
Global Health Fellows Program
Technical Advisor III: Avian Influenza Technical Advisor/Program Manager
USAID/Egypt
Location: Cairo, Egypt
Assignment: Two year fellowship
GHFP-08-120
https://www.ghfp.net/recruitment/index.fsp?FUNC=1&PID=12790
Indonesia
Title: Senior Avian and Pandemic Influenza Advisor
Location: Jakarta, Indonesia
Number: GHFP-08-101
Status: Open
Close Date: 12/15/2008
Global Health Fellows Program
Technical Advisor III: Senior Avian and Pandemic Influenza Advisor
Office of Basic Human Services, United States Agency for International Development
Location: Jakarta, Indonesia
Assignment: Two year fellowship
GHFP-08-101
https://www.ghfp.net/recruitment/index.fsp?FUNC=1&PID=11346
Pandemic Preparedness
Report says pandemic will threaten coal, power supplies
11/20/08 CIDRAP--A new report from the University of Minnesota warns that an influenza pandemic could disrupt the coal industry, thereby endangering the nation's significantly coal-dependent electric power system and everything that depends on it.
"Despite regional differences in coal usage, a pandemic is likely to break links in the coal supply chain, thus disrupting electrical generation. This has the potential to severely endanger the bulk electrical power system in most of the United States," says the report from the university's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News.
The report says that current federal preparedness plans do not address the possibility of power supply problems resulting from reduced coal shipments during a pandemic. A key planning gap, it says, is that federal plans put coal industry workers among those last in line for pandemic vaccines and antiviral drugs.
The authors, CIDRAP research assistant Nicholas Kelley, MSPH, and CIDRAP Director Michael T. Osterholm, PhD, MPH, recommend that power plants stockpile coal to last much longer than the average 30-day supply they have now and that the nation prepare now for disruptions in the coal-supply chain and electrical service. They also urge that coal industry workers be put in the highest priority group for pandemic vaccines and antivirals.
Coal-dependent nation
In 2007, the nation's 620 coal-fired power plants supplied 48.6% of the nation's electric power, the report says. The reliance on coal varies by region, ranging from 74% in the Midwest to 5% on the West Coast.
Almost 40% of the nation's coal production in 2007 came from the low-sulfur mines in Wyoming's Powder River Basin (PRB), which yielded 453.6 million tons, according to the report. With mines from neighboring Montana included, the basin's 17 mines produced 479.5 million tons. Most of this coal is hauled by train to distant power plants, some as far away as Georgia.
A pair of Wyoming train derailments in May 2005 suggested how an interruption in coal from the PRB could affect the energy industry. Two coal trains on a 103-mile line that connects the region's coal fields with the national rail network derailed on consecutive days in May. The line, which has three tracks, was out of service for 3 weeks.
During the shutdown, power plants burning PRB coal had to draw down their stockpiles. "By September 2005, many power plants were down to less than 10 days of coal in their stockpile, with some reporting only 2 days of coal on hand," the report states. "Plant Schere, in Juliette,Georgia, for example, . . . was reduced to 2 days of coal and chose to import coal from Indonesia in an effort to rebuild its coal stockpile."
As a result of the incident, 25 of 27 utilities and other entities that relied on PRB coal took coal-conservation steps, such as buying electric power from other utilities, reducing generating time, and buying coal from other sources. In the wake of the episode, the energy industry was still rebuilding coal stocks through 2007, the federal Energy Information Administration reported.
"The disruption in 2005 could've been catastrophic if we didn't have the coal conservation strategies the report talked about," CIDRAP's Kelley said in an interview. "People say 2005 wasn't bad, but those conservation strategies likely wouldn't be available in a pandemic. That's one of the big take-homes from the report."
Kelley and Osterholm also examined records related to the flu pandemic of 1918 and found that it caused "serious disruptions" in coal supplies. Their report doesn't cite evidence of effects on energy production, but anthracite (hard coal) shipments dropped about one sixth, there were reports of coal shortages in New York City, many mines cut production, and some had to shut down for weeks.
Gaps in guidance documents
The authors reviewed a dozen pandemic planning guidance documents, including those from the federal government, the World Health Organization, and energy industry groups such as the North American Electric Reliability Council. While one plan, that of the National Infrastructure Advisory Council, notes the importance of coal transportation, "none of the 12 documents prioritizes the mining of coal," the report says. "This absence is likely due to coal not being listed as a critical infrastructure or key resource."
Further, coal industry workers, depending on their age and health, are classified with the general population, the lowest priority group, for access to pandemic vaccines and antivirals, the report says. Critical transportation workers, such as train engineers, rank slightly higher?in the third tier?for a severe pandemic, but are placed in the general population in a moderate pandemic, according to the federal allocation plan.
The report asserts that federal pandemic plans have failed to "(1) conceptualize the magnitude of supply chain disruptions that will occur in a global just-in-time economy, (2) address how to prevent pandemic-related electric power disruptions, and (3) offer guidance on how to respond if electrical power is disrupted during a pandemic."
The authors conclude, "Current levels of pandemic planning are likely insufficient to sustain the coal supply chain during a pandemic; the link between the public health response and reliable access to coal-fueled electricity is neither understood nor addressed in current pandemic plans in the United States." They add that the public health sector would have great difficulty functioning without a stable supply of electricity during a pandemic.
The reasons for this gap, the authors suggest, include the perception that pandemic planning is largely a public health issue, the lack of a meaningful model or conceptual framework for assessing pandemic-related supply chain disruptions in today's economy, and a lack of leadership in pandemic planning for the nation's critical infrastructure.
Fuel left out of the picture
In an interview, Osterholm said pandemic planning in the electric power industry has focused on the power plants and components downstream from them, such as the transmission lines, giving little attention to fuel supplies. In part this reflected a planning model from Ontario, which didn't address fuel, because the power plants there are mostly hydroelectric.
"The coal industry was almost forgotten. The fact that coal miners were not placed in any of the top three tiers for vaccines is indicative of that," Osterholm said.
Utility regulatory agencies have generally ignored the issue, he added. "This has almost been a non-issue for them; they have not made coal stocks for a naturally occurring event like a pandemic a priority in any way. It's not on their radar screen."
Four recommendations
The report recommends four steps to address the vulnerability of the coal and power industries to pandemic-related disruptions.
The first is to increase power-plant coal stockpiles so that plants could keep going longer if coal shipments are interrupted. Currently, stockpiles reach their annual peak as utilities prepare for peak summer power demand. The report says this current peak should become the year-round minimum stockpile at all coal-fired plants.
Second, coal miners and support workers should be in the highest priority group for access to antiviral drugs, pandemic vaccine, and other critical products and services. "The entire coal supply chain, from mine to transport, and critical electrical-sector employees, should be placed in tier 1 of the federal vaccine allocation plan," the report states.
Third, the nation should plan for disruptions in the coal supply chain. Without careful planning, the disruptions may be similar to what happened after the 2005 derailments: "Coal shipments are likely to be reduced by at least 15% to 20% for periods up to 60 days," the report says.
Finally, the country should "anticipate and develop strategies for responding to disruptions in electrical service." Utilities are prepared for outages caused by storms, but most are not prepared to deal with fuel shortages, because they are rare and localized, the report asserts.
Increasing stockpiles tops the list
The most urgent of the four steps is to increase power-plant coal stockpiles, Osterholm said. With larger stockpiles, he said, "Even if the mines go down or rail service is interrupted, we may be able to get through extended periods of time until we can get the mines back up and running and the trains moving."
He added that even if miners have priority access to pandemic vaccines, they might still have to wait months for a vaccine well-matched to the pandemic virus. "Increasing coal stocks gives us a better opportunity to reduce that impact," he said.
The report says energy industry experts are aware of pandemic-related risks, but little has been done about them, mainly because of the cost of increasing power-plant coal stocks in current market conditions. In the 1970s, power plants kept a 2- to3-month supply of coal on hand, but utility commissions encouraged them to reduce that to 30 days to save money.
"Most public utility commissions will not allow power companies to raise their electricity rates solely for the purpose of increasing their coal stocks," the document states.
Also, Osterholm acknowledged that spending money to build up coal stocks is likely to be a tough sell amid the current economic downturn. "I realize that you can't ignore the realities of this historic financial crisis, but if we don't address these issues, we'll pay a very heavy price at the time of the next pandemic," he said.
Miners union endorses report
After receiving a copy of the report, a spokesman for the United Mine Workers of America (UMWA) strongly endorsed the recommendation that coal miners have priority access to pandemic vaccines and antivirals.
"Without coal, more than half of the nation?s lights go out and computers go off. Without coal miners, there is no coal," said Daniel J. Kane, the UMWA's international secretary-treasurer. "Leaving America?s coal miners out of contingency planning for a potential nationwide influenza pandemic makes no sense and puts America at risk. CIDRAP?s study demonstrates the clear need for miners to have priority access to antiviral drugs, vaccines, and critical services should a pandemic strike our nation. We wholeheartedly support that finding.?
CIDRAP News also asked the US Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS) to comment on the report. HHS officials did not respond in time for this article. Shannon Feaster of DHS deferred the request to the Department of Energy, saying DOE oversees energy security issues.
Pandemic Preparedness
Qatar University hosts Avian Flu Forum
11/20/08 The Peninsula--Qatar University (QU) hosted the Avian Flu Forum yesterday where top global health experts discussed the global implications of the virus and the impact on communities in the Middle East and Asia.
The Forum, organised by QU?s Department of Health Sciences, was also the opportunity to celebrate the 25th Anniversary of the institution?s Biomedical Sciences Programme.
Representatives from the World Health Organization (WHO), Johns Hopkins Hospital USA, Qatar Ministry of Health, Ministry of Agriculture, and Hamad Medical Corporation topped the list of over 100 participants who participated the significant forum.
QU President Prof Sheikha Abdulla Al-Misnad noted , in her opening address, said the forum was timely in this age of globalization since there are no barriers in dealing with an issue as far-reaching as avian flu.
Prof Al Misnad also lauded the achievements of the Biomedical Sciences Program, its faculty and students and pointed to its partnerships with such institutions as Hamad Medical Corporation and the Institute of Biomedical Sciences UK.
?A notable milestone was the Program?s achievement as the first international program to receive accreditation from the US-based National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), Prof Al-Misnad said.
The mission of the Forum is to explore, track and compare the local and global preparedness to the spread of the virus, said Dean of the College of Arts and Sciences Dr Siham Al Qaradawi.
?Our biomedical team is especially concerned with the H5N1 flu strain and has launched sustained efforts to combat its virulent spread?, she said, adding, ?they are currently addressing a wide range of related topics including the basic biology of the virus, diagnostic and intervention options and public health pandemic planning?.
Dr Nahla Afifi, Head of Health Sciences Department, noted that since its inception 25 years ago, the Biomedical Sciences Program has produced graduates who are some of best ambassadors, working at medical institutions in Qatar and around the world.
Regional Reporting and Surveillance
FAO GLEWS--Myanmar Update
11/8/08? FAO field officer, Results of active surveillance undertaken during the month of October 2008 in Bago (East), which locates next to Yangon Division, indicated the presence of a large number of seropositive healthy ducks as follows: a total of 1,476 serum samples tested, 182 showed positive by HA/HI tests (12.3% positive). The sero-prevalence were particularly high in two townships, Tanatpin (118/510=23.1%), and Waw (46/270=17%), respectively.
The presence of sero-positive healthy ducks in Tanatpin Township has been known since early 2007 when H5N1 virus hit Yangon / Bago Divisions and Mon State. At moment, the government placed high alert on these duck farms and enforces a strict movement control by which live ducks and their eggs are allowed to move only within the same township and consumed there. In Myanmar, the last case of HPAI outbreak was in December 2007 in East Shan State which shares the border with China
Regional Reporting and Surveillance
Indonesia says 17 in Sulawesi not infected with bird flu
11/20/08 Reuters--Bird flu has been ruled out as the cause of illness in 17 people from the same neighbourhood of Makasar in Sulawesi, Indonesia, a health ministry official said on Thursday.
The 17 were hospitalised this month after falling sick shortly after a rash of unexplained chicken deaths in the area.
"The result of the tests is negative," said Lily Sulistyowati, spokeswoman of the ministry, without giving details.
Suspected outbreaks raise concerns about rare human-to-human transmission or that the virus might have mutated into a form that can pass easily among people.
The country's largest known cluster of bird flu cases in humans occurred in May 2006 in the Karo district of North Sumatra province, when as many as seven people in an extended family died.
The World Health Organisation said at the time that limited human-to-human transmission could not be ruled out but that the virus samples from the scene did not show any significant genetic mutations.
Bird flu remains mainly an animal disease, but experts fear the H5N1 virus might mutate into a pandemic strain that would sweep the globe, possibly killing millions and hobbling economies.
Indonesia has the highest toll of any nation. Some 112 people have died because of the disease.
Last week, a health official said a 15-year-old Indonesian girl had died of bird flu in central Java, but Chandra Yoga Adhitama, acting director-general of communicable disease control, said tests showed bird flu was not responsible. (Reporting by Telly Nathalia; Editing by Sugita Katyal)
Regional Reporting and Surveillance
FAO GLEWS--Indonesia Update
11/13/08 ? FAO field officer, 32 H5N1 HPAI outbreaks were detected through Participatory Disease Surveillance and Response (PDSR) during the month of October.
The 32-year old male suspected to die from H5N1 infection (reported on 3 November 2008) tested negative and so did the chickens and pigeons nearby.
Vaccines
Malaria one-two could stop bird flu
11/19/08 Irish Times--A researcher at UCC is studying a vaccine that could protect against any form of influenza, including bird flu, informed by earlier work on a two-step anti-malaria vaccine, writes Dick Ahlstrom
RESEARCHERS working to find a vaccine against the dangerous bird flu virus are borrowing an idea from boxing - that a one-two combination punch can win the day. They have devised a two-step vaccine that should work not just against bird flu but against any form of the influenza virus.
A collaborative effort is under way involving researchers from Britain, France, the US and Ireland, and such a vaccine could possibly be ready for use within three years, explains Dr Anne Moore, who heads the Irish research team. The great advantage of the approach being used is that human trials can begin immediately, even as she studies how the vaccine works, she says.
Moore heads the immunology group within University College Cork's school of pharmacy. Her role is to explain the biochemistry behind the idea. It is based on giving an initial vaccine to sensitise the patient against influenza, followed by a second, very different flu vaccine that produces a strong immune response against all types of the virus.
A high level of safety is assured, given that the first jab involves the adenovirus, a well-understood organism responsible for the common cold, and the second involves the poxvirus, long used in vaccines against diseases such as smallpox, she says.
The two-step approach was informed by earlier collaborative work by an international team including UCC, which reported progress towards a promising malaria vaccine in the journal Nature Medicine.
The new malaria vaccine used this one-two combination and the idea was then carried across to a project including the University of Oxford funded by the UK's Meical Research Council and the Wellcome Trust and UCC, funded here by the Health Research Board.
Oxford is overseeing the human trials, which could begin next summer, Moore says. These patients would then be challenged with live flu within the following year.
Meanwhile, her team is studying the complex biochemistry behind the two-step approach. "For reasons we don't understand, some of these viral platforms are very good at boosting the immune response while others work on building immune memory," she says. "We are working on the mechanism of protection and trying to understand it."
If invaded by a virus our immune system produces antibodies to clear the virus and also imprints a memory of the organism in special central memory "T-cells" located mainly in the lymph nodes, Moore explains. You need a strong immune memory to produce the "effector" cells that release fresh antibodies should the invader ever return.
The adenovirus is particularly good at producing a powerful immune memory and this can be targeted against flu by building a harmless piece from the surface of the flu virus into the adenovirus, she says.
Flu is notorious for changing its surface proteins, however, which is why every year we need a new kind of vaccine. The researchers got around this in the malaria vaccine and now with flu by using the poxvirus. It is engineered to carry harmless but essential pieces from inside the flu virus, parts of the virus that never change.
They found in the case of malaria that once the immune memory was in place the second vaccine strongly boosted the immune response. This should also work with flu, and because the poxvirus vaccine includes essential bits found in every type of influenza, it means the person should be vaccinated against any kind of flu including the dangerous H5N1 bird flu, Moore says. "This means you can stockpile just one vaccine instead of trying to hold seasonal vaccines," she says.
They are studying these complex processes, but the trials can go ahead independently because all parts of the vaccine are known to be safe for humans.
