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Scientists’ new approach raises hope for a universal flu vaccine

Dr. Anthony Fauci says the “structural-based vaccine design” could result in lifelong protection against flu from a one-time shot and a possible booster.

A rendering of an influenza virus, showing the

A rendering of an influenza virus, showing the spiny proteins, or hemagluttinin, that attach to cells in the respiratory tract. Photo Credit: A rendering of an influenza virus, showing the spiny proteins, or hemagluttinin, that attach to cells in the respiratory tract.

Scientists have laid the foundation for a type of influenza vaccine long considered the Holy Grail of flu shots: a universal vaccine, an immunization that would be given only once or twice in a lifetime.

The discipline known as structural biology is believed to hold the key to a vaccine that is constant across all influenza strains and would not require a change from season to season, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

“It will not happen overnight, but the bottom line is that the time has come for a universal flu vaccine,” Fauci told Newsday in an interview Friday.

He and a team of scientists last week released what they call a “Strategic Plan for Developing a Universal Vaccine” in a scientific paper published in the Journal of Infectious Diseases. The article is based on a workshop convened by Fauci’s agency last June.

The workshop brought together some of the best minds in flu science from around the world, hailing from academia, the pharmaceutical industry and government health agencies.

A vaccine that hinges on a non-changing structure means a one-time shot, and a possible booster could provide a lifetime’s protection against any type of strain.

“We refer to this as structural-based vaccine design,” Fauci said.

A universal vaccine would end the autumn ritual of rolling up a sleeve for a flu shot and would bolster immunity against all seasonal and any pandemic strains of flu.

Word of a blueprint for a 21st-century flu shot comes amid one of the most brutal flu seasons in a decade. New York public health authorities and officials at the national Centers for Disease Control and Prevention declared within the past few days that the worst of this flu season has passed, but the season still has at least 10 weeks to go.

At its height last month, an estimated 4,000 people were dying nationwide each week of influenza and pneumonia, the flu’s leading respiratory consequence.

Fauci said he has discussed the proposed universal vaccine with Sen. Ed Markey (D-Mass.), who with 14 other senators, including Sen. Kirsten Gillibrand (D-N.Y.), is co-sponsoring the Flu Vaccine Act.

That measure, introduced in mid-February, requests $1 billion in research funding to create the vaccine over the next five years.

Up close, the infinitesimal flu virus looks like a spiny ball, featuring dozens upon dozens of mushroom-like structures — each with a stalk and an umbrella-like head, called a cap.

The stalk and cap on a flu virus together make up a key flu protein called hemagglutinin, which the virus uses to attach to cells in the respiratory tract.

Since the 1940s, flu vaccines have been aimed at the cap, which is the part of the flu virus that changes wildly from season to season in a process called antigenic drift.

But by instead aiming vaccines at the stalk, it would be possible to produce a vaccine that prompts the human body to mount antibodies against a structure of the flu virus that is essentially the same in all A and B strains of flu season after season, decade after decade, Fauci said.

Long Island infectious disease and immunology experts called the idea brilliant.

“On a scale of 1 to 10, that’s a 10. Absolutely,” said Dr. Aaron Glatt, chairman of the Department of Medicine at South Nassau Communities Hospital in Oceanside.

Glatt, who also is a national spokesman for the Arlington, Virginia-based Infectious Diseases Society of America, said, “There would be no guessing six months in advance as to what the next season’s vaccine should be like. So this is phenomenally important.”

He said a cadre of top flu scientists have been searching for ways to make a universal flu vaccine for years, but the precise way of doing it has remained elusive.

Dr. Harvey Miller, an Islip allergist and immunologist who treats a large Long Island population with asthma, said having a universal vaccine would be invaluable when a pandemic strain sweeps around the globe, as was the case in 2009 and in the horrific outbreak a century ago that killed 600,000 people in the United States and 50 million worldwide.

The flu pandemic in 2009 affected “a large proportion of young people,” Miller noted, and vast numbers of people killed by the novel flu strain in 1918 were between the ages of 18 and 40.

“I think it would be fantastic to have a universal vaccine,” Miller added, noting that more people might be persuaded to get a single vaccination as opposed to one requiring an annual inoculation.

Miller also believes that a universal flu vaccine would be a godsend to physicians such as himself, who treat patients with an underlying medical condition and for whom a flu shot is vital.

The annual respiratory infection can lead to complications, particularly pneumonia, which can prove lethal, he said.

Fauci noted that the key drawback of the current seasonal vaccine is that it must be made anew each year, forcing flu scientists to match strains that are predicted to circulate in the upcoming season.

“It’s a process that takes six months every year,” Fauci said. “I think we need to graduate out of that. It’s a time-honored technique that people feel comfortable with, but I feel we have to get out of growing the virus over a long period of time.”

The U.S. Food and Drug Administration chose the strains for the 2018-19 flu season just last week, based on recommendations from the World Health Organization that were announced Feb. 22.

For next season, the FDA chose A/Singapore, an H3N2 viral strain that caused flu this season in Australia and other parts of the Southern Hemisphere. That strain is completely different from the H3N2 strain that was in the 2017-18 vaccine, which was only 25 percent effective.

The FDA’s 12-member Vaccines and Related Biological Products Advisory Committee makes the choices. The panel also voted on three other viruses to be included in the next vaccine.

The approach has severe limitations, especially in a pandemic, Fauci said, which requires a vaccine to be made quickly and to have great efficacy.

A team led by the Centers for Disease Control and Prevention estimated that the pandemic H1N1 strain in 2009 caused 201,200 respiratory deaths worldwide, with an additional 83,300 deaths globally from cardiovascular disease associated with influenza.

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