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WASHINGTON (Reuters) – Closing schools, stopping large gatherings and other such measures are unlikely to do much to prevent the spread of the H1N1 swine flu pandemic, a team of experts predicted on Wednesday.

They said pandemic closely resembles the pandemic of H2N2 influenza in 1957 when it quickly became apparent that there was little officials could do to stop it.

“Efforts to mitigate it were futile,” Brooke Courtney Center for Biosecurity at the University of Pittsburgh Medical Center said in a telephone interview.

Federal officials are expected to announce their recommendations for school closures on Friday. Local school districts and states usually make the decision to close schools, but they look to the federal government for advice.

At the height of the epidemic in May, more than 700 schools closed in the United States, according to the Department of Education.

In Mexico, where the pandemic started, officials closed government offices and schools for around two weeks in April and May, and encouraged businesses to close.

H1N1 is still circulating and, just as influenza did in 1957, it is dominating the mixture of viruses in the southern hemisphere’s flu season going on now.

In its latest update last week the World Health Organization reported 162,230 confirmed cases and 1,154 deaths. But flu experts said this probably reflected only a fraction of the true count as not every patient can be diagnosed with a lab test.

Experts expect the flu will pick up activity in the northern hemisphere’s autumn and the WHO predicted one third of the world’s population — two billion people — will eventually be infected.

TOO WIDESPREAD

Governments are taking different approaches to slowing the spread of the virus. Last month, British experts on the spread of disease said closing schools at the first sign of a new pandemic might delay the worst so health officials can prepare, but cannot prevent the spread of the disease.

Writing in the journal Biosecurity and Bioterrorism, Courtney, Dr. D. A. Henderson and colleagues said it appears that the new H1N1 is now too widespread to try to stop.

“In 1957 it was decided pretty early on that efforts to quarantine or isolate people would not be effective,” Courtney said.

As happened this year, the virus first appeared in the northern hemisphere’s spring. It worsened in the fall. “The opening of schools in September appeared to be a major factor in initiating community epidemics,” the researchers wrote.

“Schools were not closed for the purpose of trying to control the spread of disease. They were closed because too many teachers or administrators or students were out,” Courtney said.

In 1957, 25 percent of the U.S. population became ill. Global health experts estimate two million people died.

“What we saw was that the federal government took very practical steps to deal with the expected pandemic in the fall in 1957,” Courtney said. “They understood that, yes, it was expected that there would be a lot of people who got sick.”

In 1957 it took months to make a vaccine and then it was not very effective, the researchers found.

Drug companies have started making vaccine against H1N1 swine flu. But the recommended population of 160 million people, including healthcare workers and pregnant women, cannot be fully immunized until December, experts estimate. Two doses are needed for full protection.

Two new studies suggest that vertebroplasty, a widely used surgery to help heal compression fractures, is no better than “sham” surgery when it comes to relieving pain and improving daily function.

But both procedures resulted in a significant decline in pain, so this is unlikely to signal the death knell for this widely performed surgery, experts noted.

“From a clinician’s standpoint, it’s important to read this data and be aware of it,” said Dr. L. Gerard Toussaint III, an assistant professor of neuroscience and experimental therapeutics at Texas A&M Health Science Center College of Medicine and a neurosurgeon at Texas Brain and Spine Institute in Bryan.

Vertebroplasty involves injecting a type of “cement” into the spine to stabilize it, thereby relieving pain and reducing disability in people who have had osteoporotic fractures.

The procedure is minimally invasive and often performed under local anesthetic, with the patient going home the same day, Toussaint said.

In the United States alone, some 750,000 people have vertebral compression fractures each year. According to an editorial that accompanies the studies, all appearing in the Aug. 6 issue of the New England Journal of Medicine, the number of vertebroplasty procedures performed in the United States has doubled in the past six years, from 4.3 to 8.9 per 1,000 people.

Several studies have found great benefit from the procedure, but none of those were placebo-controlled.

Experts also worry that there may be a downside, with the surgery putting patients at higher risk for future fractures.

One trial, from Mayo Clinic researchers, randomly assigned 131 patients who had had one-to-three osteoporotic vertebral compression fractures to receive either vertebroplasty or a “sham” surgery without cement.

Those in the placebo arm went through the motions of surgery, including being brought into the procedure room and being sedated before surgeons put novocaine in the skin and over the bone, said study author Dr. David F. Kallmes, a professor of radiology at the Mayo Clinic in Rochester, Minn.

After one month, both groups had experienced a similar, and significant, reduction in pain.

“Like every other trial, patients with vertebroplasty gained substantial benefit. Pain was cut almost in half,” Kallmes said. “To our shock and amazement, however, there was no difference in pain relief, function or quality of life between the groups.”

The second study, done in Australia, used essentially the same methodology with 78 participants.

Again, there were significant and similar declines in pain and other measurements in both groups six months after surgery.

“We conclude that the procedure seems to work but not apparently because of the cement,” Kallmes said.

It could be the placebo effect or something as simple as the effect of the novocaine on the bone, breaking the cycle of pain, he added. Kallmes is currently enrolling patients in a trial to see if novocaine on the bone gives the same benefit as vertebroplasty.

But even now, many physicians do not favor vertebroplasty as the first-line treatment.

“I think we should take the middle road,” Kallmes said. “We should discuss with the patient in a completely informed manner what the options are, and I think we have options. I still counsel patients that they should try ongoing medical therapy but I don’t think it’s unethical to do the procedure at this point. I think it’s suboptimal.”

“I always try bracing and analgesics and physical therapy to try to get the patients to feel better without any intervention at all,” Toussaint added. “But if those measures don’t work, I still think it is an option.”

Also, Toussaint noted, “a lot of patients can’t get their insurance companies to pay for medications that are more effective for osteoporosis treatment because they’re expensive and new, but they will pay for the surgery.”