“Jab & Dab” is still in the realm of a concept in the process of getting tested. As I mentioned on an earlier post, the rate of progress of this clinical trial in the UK has been disappointingly slow. I feel very frustrated about it, especially since we funded it with our hard earned cash.

The concept is using imiquimod (trade name Aldera) as a topical cream and then getting the vaccination at the same spot. Imiquimod is a “TLR activator” which is thought to make dendritic cells more active as antigen presenting cells and therefore increasing the chances of the vaccination actually working in immune compromised patients such as CLL folks. You can read more about it and the scientific rationale behind this concept by clicking on the links:

http://www.clltopics.org/SponsoredProjects/LHF.htm
http://www.clltopics.org/SponsoredProjects/JabNDab.htm

But please be sure to understand that this is still just a concept, not proven in a clinical trial. While Aldera has enviable safety profile (it is FDA approved for actinic keratosis – pre skin cancer, as well as genital warts) and furthermore we are talking of topical application and not systemic use, there is no guarantee that using it in combination with flu vaccinations will be any more effective than simple vaccination without any bells and whistles.

If you plan to go ahead with this approach I strongly urge you to discuss the whole concept with your doctor before you do anything. Guys, this is not an empty CYA style caveat on my part. Untested concepts all sound wonderful but very few actually pan out in clinical trials. Please be careful out there.

Beth Havey

Ethical considerations for withholding transfusions for patients whose prognosis is very poor, with or without transfusion, should be explored. For example, patients with relapsed leukemia that is not thought to be treatable may not be able to receive transfusions.

Here is the WHO’s official statement:
“Temporary loss of blood donors and the impact on the blood supply:

As infection spreads through any population, the number of blood donors available at any one time decreases. This is due to infection in the donors themselves; infections in the families and contacts of donors; restrictions on movements, including blood collection activities in areas where outbreaks have been recorded; and the unwillingness of some individuals to donate due to a perceived risk of infection through being in close contact with others.”

Even getting IVIG therapy during a pandemic is a risk/benefit issue. While the benefits of the therapy remain constant, the exposure risk in going to a facility to get the therapy will have increased.

IVIG (intravenous immunoglobulin) infusions do give some level of protection against community acquired infections in people with low IgG levels. But as you pointed out, IVIG therapy is very expensive and chronically in short supply. I doubt the short supply will get any better in the months to come and it may get a whole lot worse. I would not be surprised to see more draconian rules regarding who can get access to IVIG.

By the way, does anyone have insight and information regarding status of blood and blood product supplies? Peter, does your group think we have reasons to worry about safety and availability of blood products during a pandemic? This is a special need that many of our members face and I wondered how blood drives and donations would work during a flu pandemic. We all depend on the kindness of strangers to survive.

Thank you so much for your timely article. And thanks also to Rick for his timely comments.

Rita