4-Week Decline In Flu-Like Cases

USA Today

Federal health officials reported Monday that cases of flu-like illness in the USA have declined for four weeks in a row, though hospitalization rates remain high, especially for children younger than 4.

The steady decline in the USA and elsewhere prompted the World Health Organization to propose Friday that swine flu may have peaked in North America, the Caribbean and parts of Europe, though the "winter influenza season continues to be intense."

U.S. officials challenged WHO's hopeful assessment, saying it is too soon to declare that swine flu is tapering off.

"We are certainly nowhere near the end," says Daniel Jernigan of the Centers for Disease Control and Prevention, noting that, even after the monthlong decline, "we're still above the peak we had last winter."

Jernigan says there also was a drop in cases at this stage of the 1957 pandemic, which appears to offer the closest parallel to today's outbreak. But flu cases and deaths rebounded after the Christmas and New Year's holidays. "The conditions that influenza likes – winter with people crowding together – haven't even come yet," he says.

Deaths of children continue to mount, the CDC reported, with a record 27 during the week ending Nov. 21. That's the highest one-week total since swine flu, also known as H1N1, was identified in April. Doctors have reported about 200 pediatric swine flu deaths to the CDC, which says many more deaths probably have gone unreported.

As of Monday, 66 million doses of swine flu vaccine were available for states to order, and more were on the way, the CDC's Thomas Skinner says.

He Knows If You've Been Sick Or Not

Mall Santas ask for H1N1 vaccine priority.

St. Petersberg Times

TAMPA — Victoria, an infant in green pajamas, sat in Santa's lap Wednesday at WestShore Plaza representing both the joys and dangers of playing jolly old Saint Nick.

The girl didn't pout and she didn't cry. But when she reached for Santa's Christmas necklace and stuck it in her mouth, an alarmed look crossed Santa's bespectacled eyes.

'Tis the season for swine flu. And the girl, like all children, carries plenty of naughty germs.

"Now don't put that in your mouth," white-bearded Jack McElhinney said gently while pulling the necklace out.

McElhinney is known in his profession as the "Iron Santa." Seven days a week for 16 holiday seasons, the Lutz senior has not missed a day as the WestShore mall Santa. But this year, the H1N1 scare has Santas nationwide shaking in their sooty black boots.

"If the Santas across the country get sick, there's going to be a lot of disappointed kids around the world," McElhinney said. "When you think of it, I get exposed to every illness known to man and then some. I'm in a high-risk category here."

That's why many Santas think they should become a priority group to receive swine flu vaccines, which are in limited supply. Santa America, a national group, even asked an Alabama congressman for legislative help last week.

Around here, the Hillsborough County Health Department plans to stick to the Centers for Disease Control guidelines on who should get the vaccine: pregnant women, students, people with chronic conditions and health care and emergency workers.

Stephen Huard, department spokesman, didn't need to check the list twice. "Santas didn't make the priority list," he said.

Same goes for Pinellas County.

"I can picture Santa saying, 'You've been naughty, where's my shot?' " said Maggie Hall, health department spokeswoman. "Our supplies are so small, I'm sorry, Santa."

Across the nation, Santas are taking their own precautions. The Amalgamated Order of Real Bearded Santas, a trade group, featured a seminar on swine flu at a recent conference in Philadelphia. It urged members to take vitamins and use hand sanitizer.

The 200 or so Saint Nicks who volunteer to visit sick or grieving children through Santa America will be washing their suits daily instead of weekly. And they won't be wearing gloves so they can wash their hands more frequently.

At Tyrone Square Mall, officials didn't allow Santa to be interviewed or photographed. Same at International Plaza. But at both places and WestShore Plaza, hand sanitizer dispensers were in the Santa station lines.

Health officials say if Santas want the vaccine, they should check with their private physicians.

That's what McElhinney did.

"I told my doctor, 'Look, I am in a high-risk category,' and he said, 'You sure are,' " said McElhinney, 76, "And I went to the head of the list."

Beside the swine flu shot, the WestShore Santa has been taking Amantadine, used to prevent and treat the flu, and a daily regimen of multivitamins, plus extra vitamin C, D3, E, and B-complex, and Omega 3, as well as garlic, liquid glucosamine and cinnamon for his blood sugar.

He hopes it's enough.

McElhinney hears the wishes of as many as 300 children a day. They pull beards and spill drinks. Some have tender stomachs.

"Babies. Babies are always erupting on me," he said.

For all this, Santa wonders why health officials won't put old Saint Nick at the top of the H1N1 vaccine priority list.

"We represent one of the most important things in a young kid's life," McElhinney said.

Health officials don't disagree. But for Santa to get his wish, he needs to grant theirs:

Stick giant batches of vaccine for everyone under the Christmas trees.

Flu Shot Clinics Draw Crowds

Minneapolis-St. Paul Star Tribune

The flu pandemic may be on its way out for now, but that didn't stop thousands of kids from showing up for H1N1 immunizations Wednesday at vaccination clinics in Anoka and Hennepin counties.

Several thousand people lined up around the Schwan Center in Blaine 
for vaccinations at the flu vaccination clinic, which was 
administered by the Anoka County Health Department

 The flu pandemic may be on its way out for now, but that didn't stop thousands of kids from showing up for H1N1 immunizations Wednesday at vaccination clinics in Anoka and Hennepin counties.

Parents with children in tow began lining up at 1 p.m. for the 2:30 clinic sponsored by Anoka county at the National Sports Center in Blaine. Throughout the afternoon the line meandered through the vast parking lot before entering the Schwan Center where the parents and kids were directed to the appropriate tables for their vaccines.

The county provided sidewalk chalk for the kids to use while they waited outside.

"As a parent what I loved was the abundance of sidewalk chalk drawing outside the entrance," said Martha Weaver, spokesperson for Anoka County. "That was an indicator that we had the audience we wanted."

The clinic was scheduled to run until 8:30 p.m. or until the vaccine ran out. In Hennepin County, two clinics were scheduled to run until 7:30 and 8:30.

After weeks of shortages, the vaccine is finally becoming more widely available -- just as the flu pandemic continued to wane for the third week in a row, according to new numbers reported Wednesday by state health officials. But state officials warned that it doesn't mean you can stop washing your hands.

December is just around the corner, and that's when the first seasonal flu cases start popping up, said Dr. Ruth Lynfield, state epidemiologist for the Minnesota Department of Health. Also, if past pandemics are any guide, there could be a third wave of H1N1 flu in January or February.

"I don't want people to let up," Lynfield said.

Ukraine Pleads For Help As H1N1 Epidemic Spreads

from Russia Today

Ukrainian President Victor Yushchenko has called on the international community to help the country combat the swine flu epidemic which hit the country last week. Kiev is taking emergency measures to stop the outbreak.

The president has sent letters to the European Commission, NATO’s Secretary General, and the heads of Belarus, Hungary, Moldova, Poland, Romania, Slovakia and the US asking for humanitarian aid, said the presidential press service. Ukraine needs antiviral medicine, medical masks, lung ventilators and other equipment. Several countries have already agreed to help, while Russia offered aid on its own initiative.

Ukrainian government has made an emergency purchase of Tamiflu medicine from Switzerland. A shipment of 300 million doses, worth $2.5 million, was airlifted on Sunday night. According to the president’s press service, the seller offered a discount price for Ukraine. Given that it could be the only remedy for those infected, Prime Minister Timoshenko took a hard line on its distribution:



"These medications have been imported at a wholesale price of 67 Hryvnia (about $8 USD) per pack. And what I'm holding now in my hand now is what our Foreign Minister purchased in a pharmacy the other day for 6000 Hryvnia, and this package contains 10 packs,” she exclaimed.

“This means that 1 pack is sold at 600 Hryvnia (about $73 USD)! These swindlers in privately-owned pharmacies sell it to people at ten times the price,” she added.

The medicine will be delivered to hospitals and medical emergency service to treat flu patients. It will not be sold in drug stores to prevent speculative trade. Timoshenko added that a second purchase of a similar amount of medicine is being considered.

Meanwhile, the epidemic is spreading over the country. The Health Ministry said Monday that of the 70 victims of flu and acute respiratory diseases who died over the last two weeks, 22 have been confirmed to have had the A/H1N1 strain.

Earlier it had been estimated that almost 185,000 people were suffering in Ukraine, and more than 7,000 have been admitted to hospitals. Of those, 123 were in critical condition.

As the death toll from respiratory diseases continues to rise, panic spreads among the population. In Kiev, a city so far untouched by the virus outbreak, roughly every third citizen wears a protective mask, at times a self-made one.

Anti-flu drugs and related paraphernalia are increasingly difficult to come accross. Angry people point fingers at everyone, from drug store owners to the authorities, However, officials say that it's the people who are responsible for the problem. Denis Shevchenko, the head of Ukraine's pharmaceutical union, explained:

"The medication is ordered based on a calculation of adequate supply of treatment and preventive therapy drugs per person," he said.

"If, in a fir of panic, people buy ten times more than they require, any forcast of this process becomes useless," he concluded.

It is difficult to say how many of the people affected have A/H1N1. Ukraine has too small a number of laboratories to be able to identify the swine flu virus and has to rely on foreign services, which makes the testing process even longer. The government plans to purchase more equipment to monitor the epidemic more efficiently. A mission of the World Health Organization is to arrive in Ukraine soon to help combat the outbreak.

So far quarantine has been declared in nine regions that are most affected by the disease. Schools and universities have been closed until further notice, and people are advised to stay at home and keep away from crowds.

There are some fears that the epidemic will harm the presidential election campaign which is currently underway in Ukraine. The election is scheduled for January 17, and with restrictions on public assembly, which some politicians have suggested imposing due to the outbreak, campaigning may become difficult for candidates. However, Deputy Prime Minister Aleksandr Turchinov assured that the outbreak will not stop the election. “Despite temporary difficulties with the spread of the infection, the election will go smoothly,” he said.

Swine Flu Confirmed In Iowa Cat

AP

DES MOINES, Iowa — The swine flu virus has been confirmed in a cat treated at the Iowa State University College of Veterinary Medicine.

Officials said Wednesday it's the first known case of the virus to be diagnosed in a cat. Veterinarians say the virus has also been confirmed in two ferrets, one in Oregon and the other in Nebraska.

The 13-year-old cat was treated in Ames, Iowa, and is recovering.

The veterinarian who treated the cat, Dr. Brett Sponseller, says two of the three people in the same house had flu-like symptoms before the cat became ill.

The case was confirmed at both Iowa State and the U.S. Department of Agriculture.

Sponseller says the flu is known to spread from humans to pets, but this is the first case of swine flu to spread to a cat.

Hospitals Changing Rules Due To Swine Flu

from WVNS TV

The H1N1 virus, or the swine flu, is big news lately. Everyone is talking about it and no one wants to catch it. That's why Stonewall Jackson Memorial Hospital has changed its visitation rules. The biggest change is that no one under 18 will be allowed to visit patients.

"The influenza that's around right now is affecting children 18 and younger, more than people older than that. So what we're trying to do is cut down on the people that are getting it the most from bringing it into our hospital to our patients and our staff," said Diane Bennett, an infection control nurse at Stonewall Jackson Memorial Hospital.

The number of visitors has also been limited to two people at a time, and all visitors must wash their hands before entering and leaving patient rooms. For some, these rules make sense.

"If someone has the flu or just getting it or something, then they won't spread it out to everybody else," said Hayward Wright, a Lewis County resident.

"I think that anything that can reduce the number of germs and help our family members and you know, people coming in being sick, I think it's going to help," said Ann Marie Chidester, a Virginia resident visiting her grandfather in the hospital.

"There are also new visitation rules in the birthing unit. Only significant others and grandparents of the baby will be allowed to visit the newborn. Siblings and other relatives will have to wait until the baby is brought home.

"We understand that having a child is a really special time. But right now, at this time, our patients and our mothers and babies are our top priority," said Bennett.

Bennett said in addition to the new visitation rules, the hospital has placed swine flu masks, tissues and hand sanitizers in a variety of locations to help stop the spread of the swine flu and other illnesses.

She said anyone coming to the emergency department with flu-like symptoms will be asked to wear a mask, or disposable respirator, which is a rule UHC is also following.

Flu Death In Minnesota Raises Questions

Star-Tribune

It's a scenario that strikes terror in most any parent: A perfectly healthy first-grader dies of flu in the ambulance outside his home. How could it happen?

In the most recent H1N1 flu death in Minnesota, the Hennepin County Medical Examiner's office said that 6-year-old Nathanael Schilling of Corcoran died on Sept. 24 from an inflammation of the heart, a rare complication that can result from a flu infection.

He was a first-grader at St. John's Lutheran School in Corcoran, according to his newspaper funeral notice.

It was the seventh death from H1N1 in Minnesota, and the second time this year that an otherwise healthy child died after becoming infected with the new flu strain.

Health officials say they still expect the new virus to be no more deadly than ordinary seasonal flu, which kills 36,000 Americans in an average year. What's different this year is that children appear to be more vulnerable to the new strain than to seasonal flu.

The previous child fatality in Minnesota, which occurred in July, also involved an otherwise healthy child. That 2-year-old died because of a co-occurring bacterial infection -- pneumococcus, which causes pneumonia, said Dr. Ruth Lynfield, Minnesota state epidemiologist.

Alone, it's not usually dangerous in someone who is healthy. But the flu virus opens a door, allowing the non-threatening agent to overwhelm the body and become lethal. It's the combination of the two that often kills otherwise healthy children and adults.

If symptoms worsen, act

"That's why we tell people who get the flu that if they are getting better and then symptoms get worse with high fever and bad cough, they should seek care right away," Lynfield said.

A recent study by the Centers for Disease Control and Prevention (CDC) found that of the 36 children who died from H1N1 from April to August, six had no chronic health conditions. But all of them had a co-occurring bacterial infection.

The most common co-occurring infection that causes flu-related deaths is staphylococcus aureus, commonly known as staph, said Pat Schlievert, a microbiologist at the University of Minnesota and an expert on staph-related deaths. A third of the population carries it on their body, most in their noses or on their skin. Often it's benign or causes minor skin infections. Schlievert has studied dozens of cases of children who died unexpectedly from flu combined with staph.

"The [flu] causes upper respiratory damage, which allows the staph to get where it's not supposed to be. It makes it's way into the lungs," he said.

So far in Minnesota three of the seven deaths from H1N1 have been children and only the first, who died in June, had an underlying health problem that put her at greater risk. The other deaths were adults, one elderly, and three middle-aged, all with chronic health conditions such as asthma, obesity or suppressed immune systems.

That's a sharp contrast to the pattern of fatalities seen with seasonal influenza. Most years, 90 percent of the people who die from complications of flu are elderly, and most others have chronic health problems that make them vulnerable.

Most recover

The vast majority of people who become infected with H1N1 recover, Lynfield said, "but some do get severe disease."

The good news this week is that vaccine has arrived in Minnesota.

The first shipment of nasal spray vaccine was distributed to staff at some hospitals, including Children's Hospitals of Minneapolis and St. Paul, and some area public health agencies. The rest of the first order of 28,000 doses is expected to arrive throughout the rest of the week.

The nasal vaccine, which contains a live virus, is going to health care workers, who are third on the priority list for vaccine distribution. It's not safe for the two groups at the top of the list, young children or pregnant women, who are considered most at risk.

Health care workers are at high risk of exposure to the virus, and are in a position to infect vulnerable patients.

Injectable vaccines, which will go to those high risk groups first, are not expected to arrive in the state until mid-October.

In the meantime, however, clinics are already gearing up for the deluge of people who want the vaccine. "People are asking about it," said Dr. Ron Jankowski, medical director of the Fremont Clinics in Minneapolis.

Like many clinics across the country, Fremont now has a prompt on its phone line that leads patients to a long message about seasonal flu and H1N1 vaccine.

Federal health officials have said that more than 150 million doses of vaccine will be available nationally, meaning everyone who wants the vaccine should be able to get it.

"The question is, will [swine flu] come and go before the vaccine is available to everyone?" said Jankowski. "Who knows?'

Emergency Use Of Peramivir OK'd For H1N1

From the Wall Street Journal

The U.S. Food and Drug Administration is allowing the use of an experimental antiviral drug to treat severe cases of H1N1 or swine flu.

The drug, peramivir, is currently being developed by BioCryst Pharmaceuticals, Inc. (BCRX) and is undergoing testing required for regular FDA approval.

The FDA issued a so-called emergency use authorization late Friday that allows doctors to use peramivir, which is delivered intravenously, in certain hospitalized adult and pediatric patients with confirmed or suspected H1N1 influenza.

A handful of doctors have already treated patients with severe cases of H1N1 using peramivir obtained through the agency's expanded access rules that allow individual patients to obtain experimental drugs if certain conditions are met. The emergency-use authorization allows use of the drug without prior FDA approval.

The FDA said there's only limited clinical data about whether peramivir is safe and effective, but "based upon the totality of scientific evidence available, it is reasonable to believe that peramivir IV may be effective in certain patients."

The company said it is completing production of approximately 130,000 courses of peramivir and is prepared to make more, if required.

The FDA said peramivir should only be used in patients who have not responded to or can't take the oral antiviral drug Tamiflu, made by Roche (ROG.VX) or Relenza, which is an inhaled drug made by GlaxoSmithKline PLC (GSK, GSK.LN). Like Tamiflu and Relenza, Peramivir works by inhibiting neuraminidase, an enzyme that's involved with the spread of the influenza virus within the body.

The federal Centers for Disease Control and Prevention asked the FDA to grant peramivir emergency use to help cope with the influenza pandemic which has killed more than 1,000 people in the U.S. since April and hospitalized thousands more. The CDC will control and track distribution of peramivir to hospitals.

As of Oct. 17, 46 states were reporting "widespread" influenza activity and many doctors offices have been swamped with swine-flu patients. The CDC said more than 7% of outpatients visits in the week that ended Oct. 17 were attributed to influenza-like illnesses--a rate higher than during the peak of the last few seasonal influenza seasons. The CDC said "many millions" of Americans have been sickened with H1N1 influenza since the virus was first discovered in April.

The U.S. government has ordered enough vaccine to make up to 251 million doses if needed, but production has been slower than originally anticipated.

A total of 11.3 million doses of vaccine had been shipped to U.S. doctors, hospitals, and clinics as of Wednesday, according to the CDC, out of a total of 14.1 million doses that manufacturers had shipped to warehouses by that time. By Friday, 16.1 million doses of vaccine had been shipped to warehouses, the CDC said.

The total is far below the government's most recent estimate that by the end of this month, about 28 million to 30 million doses would be shipped to warehouses for further distribution. That estimate itself is a revision, made last week, from a prior expectation of about 40 million doses by the end of the month. In July, the government had predicted that about 100 million doses would be ready in October.

3 Minnesota Pigs Confirmed With H1N1

NY Times

Three pigs at the Minnesota State Fair tested positive in late August for H1N1, the flu virus that is causing the current pandemic, the Agriculture Department reported Friday.

The department said the test results were preliminary and would not be confirmed for a few days. But if the results are confirmed, the pigs will be the first in this country found to harbor the virus. Infected pigs have been found in eight other countries.

The virus does not seem to make pigs very sick. Of 103 pigs tested at the Minnesota fair, in St Paul, only three were found to be carrying the virus, and all appeared healthy. They probably caught the virus from infected people, researchers said.

Officials at many state fairs this year worried that people would infect pigs and that reports of infected pigs would create a scare that would harm the pork industry, even though there is no risk of infection from eating cooked meat.

It is not clear what the findings mean for public health, scientists said. The virus is already spreading widely among people, and in fact is far more common in humans than in pigs, so people seem far less likely to catch it from pigs than from one another.

“It’s not surprising to find it in pigs,” said Dr. Jeff Bender, director of animal health and food safety at the University of Minnesota, who conducted the testing along with researchers from the University of Iowa. “We do know that viruses move between species.”

One concern about animals’ harboring the virus is the possibility that viruses will change as they move back and forth between species, perhaps by mixing with other viruses.

A veterinarian for the Minnesota State Fair, Dr. Tom Hagerty, was traveling on the East Coast late Friday and said he had not heard of the test findings. Dr. Hagerty sounded surprised at the news but not alarmed, because most of the pigs, or perhaps all, that were at the state fair at the same time as a group of 4-H children who became ill were to be sent to the slaughterhouse shortly afterward.

“I would be much more bothered if I heard that these had been breeding pigs,” he said.

H1N1 Vaccination Poses Challenge To Health Community

Reuters

The U.S. government's $6.4 billion swine flu vaccination program is likely to put the American public health sector under unprecedented strain and expose serious shortcomings, experts say.

As the first mass U.S. immunization program in a generation ramps up to deliver tens of millions of doses each week, public health experts disagree about how well the country's network of state and local health departments might perform.

But many say the sector never received the money it needed for large-scale immunizations despite years of planning for pandemics after the reemergence of bird flu in Hong Kong and South Korea in 2003.

"The worst-case scenario is that there is vaccine in a particular state or locale but that state or locale hasn't sufficiently planned to distribute it," said Leonard Marcus of the Harvard School of Public Health.

Marcus, who studied the 2005 Hurricane Katrina disaster, said the H1N1 immunization program could encounter similar breakdowns in leadership and coordination wherever local public health systems are underfunded or poorly managed.

"Some bureaucrat is going to say he doesn't have authority or needs a signature and it's going to stop the system from moving. That could very well cause panic," he said in a telephone interview.

Experts give the Obama administration high marks for creating a program capable of procuring 250 million doses and distributing them to 90,000 sites nationwide so that every American who wants the vaccine can get it.

The government has ordered vaccine from five companies -- Sanofi-Aventis SA, CSL Ltd, Novartis AG, GlaxoSmithKline and the AstraZeneca unit MedImmune.

"RUSTY FAUCET"

Bob Hutchens, a vaccine distribution expert with consulting firm Booz & Co, expects overall success.

"There will be some long lines, there may need to be some late hours and people may not be able to get it the day they want it," he said. "But if we approach this soundly and rationally, I suspect we'll be just fine."

But with the United States struggling to recover from an economic recession, staffing could be an issue.

Local health departments eliminated 8,000 positions in the first half of this year, after 7,000 job cuts in 2008, according to the National Association of County and City Health Officials. Another 12,000 employees have been subjected to reduced hours or mandatory furloughs this year.

The Association of State and Territorial Health Officials says three-quarters of states have cut public health funding this year, while 61 percent expect smaller budgets in 2010. Seven states have cut back specifically on immunization.

Layoffs have targeted people needed for the H1N1 program -- nurses, nurse's aides and switchboard operators and receptionists who would help field public queries.

"The problem is that there's a big rusty faucet at the end of the vaccine pipeline," said the University of Minnesota's Michael Osterholm, who warns public fears could flare quickly if H1N1 overwhelms hospitals and their intensive care units.

A poll by the American College of Emergency Physicians says almost 90 percent of emergency room doctors worry hospitals could have a hard time responding to a surge in H1N1 flu.

"Public health is the life raft," Osterholm said. "But are they big enough to get everybody on board and how will they navigate those rough waters?"

Experts were careful not to criticize the caliber of public health staff, widely respected for their energy and devotion.

But they said meager resources, combined with the scale and speed of the national immunization program, will bring unprecedented strains.

FRAYED NERVES

That could mean bad news for 46 million Americans with no health insurance, who could flood public health offices where vaccinations will be free.

"It could overload some systems in terms of staffing and frayed nerves," Hutchens said.

The Obama administration has sought to smooth the program's path by giving health departments and hospitals $1.4 billion to help plan and implement the vaccination effort, including the hiring of additional staff and contractors.

"We can't do this ourselves," said Fran Phillips, deputy secretary of Maryland's public health services, whose staff has assembled 3,000 private vaccinators to supplement two-dozen local public health departments. Maryland has received $24 million in federal grants to help with the effort.

Preparations appear to be less uniform in states like Michigan, where much of the authority rests with local health departments. Michigan received $34 million in federal money.

"They're really in the process right now of utilizing the funds, hiring folks or contracting with vaccinators," said Dr. Eden Wells of the Michigan Department of Community Health.

"It's too early to make a judgment about whether the (federal) money is enough."

H1N1 Questions Receiving Answers

Story from CNN Health

For 13-year-old Brandon Marti, the intranasal vaccine felt "good," "cold" and "watery" at the Children's Hospital at Montefiore in the Bronx, New York, on Tuesday.

Marti, among the first to get vaccinated against the novel H1N1 influenza virus this week, said he would tell his friends and classmates that "the swine flu vaccine is good, and protects me from getting the swine flu."

New York has received a shipment of 68,000 doses of the FluMist variety vaccine. This form was made available before the injectable kind because it was ready first, said Thomas Skinner, spokesperson for the Centers for Disease Control and Prevention.

As states across the country receive and distribute the vaccine, questions still linger about who should get it and why. Here are some guidelines:

Nathan Stein, 7, participated in a clinical trial for the H1N1 vaccine over the summer.

Where is the vaccine?

The campaign to inoculate millions of Americans against H1N1 flu began Monday. Every state is developing a vaccine delivery plan, according to the CDC.

All states in the United States have ordered vaccine, said Dr. Thomas Frieden, director of the CDC, at a briefing Tuesday. Each Friday, the CDC will provide information about how much vaccine is available to states and how much has been ordered. So far, about 2.2 million doses out of the available 2.4 million have been ordered, he said.

The vaccine is being made available as soon as it comes off the production line, Frieden said. This week the intranasal mist variety, called FluMist, became available, and next week the injectable form will made available, he said.

Frieden acknowledged that these first few weeks will be "bumpy" in terms of distributing the vaccine, and that demand is currently greater than supply. However, he expects that supply will soon outstrip demand.

"It will take some time to get the whole system, from the manufacturer through the distributor to the providers and to people who want to get vaccinated, up and running," he said.

Who should get it?

The CDC recommends that specific groups of people get vaccinated first, but there are no rankings within the priority groups, Frieden said.

The nasal spray version of the vaccine should be used only in people 2 to 49 and who do not have an underlying health problem, Frieden said. The priority groups for it include health care workers, children and people who care for infants, he said. Pregnant women should not have the FluMist version because it contains the live virus.

Health care and emergency medical services personnel should be in the priority group because vulnerable patients could potentially contract the flu from them, the CDC said. Already, infections among health care workers have been reported, and the health care system capacity could become significantly lowered if large numbers of these workers are absent, the CDC said.

Once the injectable shot becomes available, all priority groups should be vaccinated, the CDC said. These include pregnant women, because they are at higher risk of complications and may be able to provide protection to unvaccinated infants. People from 6 months to 24 years old should also receive the vaccine, and people from 25 to 64 should get it they have a chronic health disorder or a compromised immune system, the CDC said.

According to a CNN/Opinion Corp. poll in late August, two-thirds of Americans said they plan to be vaccinated against H1N1 flu.

Does anyone have to get it?

There are no formal penalties for those who do not get the vaccine, but people in the military are required to receive it, according to the American Forces Press Service. The state government of New York has said that health care workers must get the vaccine, although no law outlines penalties for noncompliance. Still, some workers fear they'll lose their jobs if they don't get vaccinated.

How many doses do you need?

For people 10 and older, the U.S. Food and Drug Administration has approved the use of one dose of the vaccine. For children 9 and younger, two doses may be required, Frieden said. The CDC recommends that three to four weeks pass between the first and second dose.

What if the virus mutates?

The virus has not changed much since the spring, Frieden said. In fact, the part of the virus that determines whether it's very deadly is different from the part that determines whether the vaccine will fight against it, he said, meaning that vaccination will still most likely offer protection even if the H1N1 flu becomes more deadly.

Why should you get it?

Frieden said the flu can range from mild to severe. It can make a person sick for one, two or three days, leading to absence from school or work, and some people may even need hospitalization. "Tragically, some people may die from it," he said. Still, it is not a disease that sends a lot of people to the hospital, he said.

The vaccine is also safe, Frieden said. The novel flu vaccine is made in the same production facilities by the same companies with the same methods as the seasonal flu vaccine, and it is the same kind of vaccine that has been given each year, he said. His own children will get it, as will the families of other public health experts, he said.
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Some people are concerned that it is too late to get vaccinated against the novel virus, but Frieden also dismissed this.

"It's too soon to say it's too late because we don't know what the rest of the season will bring," he said.

H1N1 Vaccination Program Starts At A Crawl

Reuters

Vaccination against the H1N1 swine flu is off to a slow start in the United States, but states have ordered more than 2 million doses of mostly nasal spray for the first patients, a top health official said on Tuesday.

Every state has ordered a share of the pandemic vaccine, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told a news briefing.

"This week, as of yesterday, about 2.4 million doses were available for ordering," Frieden told reporters in a telephone briefing. He said states had ordered 2.2 million of the doses -- a painstaking process because they must specify which vaccine they want and have a plan in place for delivering it.

The U.S. Food and Drug Administration must inspect each lot of vaccine as it is packaged. "Each day as more vaccine is cleared, more vaccine becomes available for ordering," Frieden added.

"I think what we are seeing now is the tap beginning to flow. We are seeing a substantial amount of vaccine beginning to get out."

The first batches available are AstraZeneca (AZN.N) (AZN.L) unit MedImmune's nasal spray vaccine, which is approved for people aged 2 to 49 without asthma or other lung conditions.

Many states are opting to vaccinate healthcare workers first, who have a high risk both of being infected and of passing infections along to vulnerable patients.

WAITING FOR SHOTS

But at least three Chicago-area hospitals that have received the nasal spray vaccine said they would not be using it to immunize hospital staff because it is made from a weakened version of a live virus, unlike shots, which are made using a killed virus, and there is a very small chance of infecting someone with a weak immune system.

Dr. John Segreti, an infectious diseases expert at Rush University Medical Center, said the hospital had received 2,000 doses of the nasal spray.

"We're going to be distributing it to clinics that see children. We're not using this for our healthcare workers. We're waiting for the inactivated vaccine for our health workers," he said.

Officials at Northwestern Memorial Hospital and the University of Chicago Medical Center said they also will be waiting for the shots to immunize hospital workers.

The U.S. government has ordered 250 million doses and, given that many Americans skip flu shots every year, the CDC believes this will be enough to fill demand.

"What we have decided to do is make vaccine available as soon as it comes off the production lines," Frieden said. "That means it is becoming available in lots. It is a little bit of a messy process and we do expect it to be a little bit bumpy in the next few weeks."

And it will be a strain to keep up with the virus. "As of today, influenza is widespread in most of the United States," Frieden said. "We are seeing it continue to increase in some areas."

Nonetheless, he noted, when H1N1 goes through a community, it infects about 5 percent of the people, leaving 95 percent vulnerable to a fresh round.

"You don't know what the rest of this long flu season is going to hold. We haven't had a flu season like this in at least 50 years," Frieden said.

Canada's Risky Swine Flu Plan

Story from the Victoria Times Colonist

Among the many concerns about swine flu, one grows larger by the day. Canada's public health managers are running considerable risks with their strategies.

When it became clear that the new H1N1 flu virus threatened a pandemic, many countries decided on an accelerated response. They chose a vaccine type that is quick and easy to develop.

But Canadian officials preferred a double-barrelled serum that both repels the virus and boosts the patient's immune system.

That was a controversial decision, because the more complex vaccine takes longer to develop. Countries that opted for the simpler approach are now ready to begin distribution. Some have already started.

But it will be at least mid-November before the Canadian vaccine is available and it could be January before everyone is treated.

That would be slow even for the regular flu cycle, which peaks in the early new year. But recent evidence suggests the H1N1 flu epidemic is accelerating faster than expected. There's a good chance that a million or more Canadians will contract the disease before the medication reaches them. Although the H1N1 virus has proved less dangerous than feared, some will die.

Swine Flu Cases - As Of May 2009

It's possible the double-barrelled vaccine will eventually save more lives than are lost. But in going this route health officials are taking a calculated chance.

Then there is the uncertainty about whether to offer regular flu shots before the swine flu vaccine is available. It's an important question. Every year around 20,000 Canadians are hospitalized with regular flu and up to 8,000 die.

On the one hand, Canada's chief public health officer insists swine flu poses no additional risk to patients who have already received regular flu shots.

Yet his colleagues in several provinces, including B.C., have concluded there could be a risk. They cite unpublished research that suggests patients who have received a regular flu shot might be more vulnerable to H1N1.

On that basis, most regular flu shots will be delayed until early next year in B.C. (People over 65 and residents of nursing homes can receive them right away.)

This is a momentous conclusion to base on limited information. Experts in other countries have been unable to confirm the research.

There's also considerable uncertainty about how priorities will be implemented when the H1N1 flu vaccine does arrive. The B.C. government has said first choice must go to pregnant women, people under 65 with chronic ailments, residents of isolated communities, pre-school children and front-line health workers.

But how is this to be done? Will people who do not meet these criteria be turned away in the early stages of the campaign? Physicians and clinics haven't received those kinds of instructions.

The question is moot if enough supplies arrive for everybody. That is what health officials are counting on.

They might be right. When the vaccination program was in the planning stages, the federal government ordered 50 million doses. At that time, it was thought each patient might need two shots. It now appears most adults will require only one dose.

But what happens if the serum comes late, or the epidemic comes sooner?

There is always a degree of trial and error in developing new vaccines. But in this instance, there is more than the usual level of confusion and uncertainty. Canadian officials have chosen a different approach than many western countries. Let's hope it turns out to be the right one.

Russia Denies Swine Flu Death

(AFP)

MOSCOW — Russia's health authorities Monday vehemently denied that the country had recorded its first fatality from the A(H1N1) virus, contradicting a top doctor's claim that a woman had recently died of swine flu.

"Not a single case that had a fatal conclusion -- in other words, death -- has been recorded on the territory of the Russian Federation," said Deputy Health Minister Veronika Skvortsova, quoted by news agencies.

She said that the woman, a 46-year-old Russian doctor who recently returned from Bulgaria, had died of pneumonia aggravated by a heart condition and not swine flu.

Earlier Dmitry Lvov, head of the Russian Academy of Sciences' Institute of Virology, said that not only had Russia recorded its first swine flu death but that the number of cases could be in the tens of thousands.

"We immediately diagnosed (the woman with) swine flu," Lvov was quoted as saying by the Interfax news agency.

"We could not take any measures because she died the very next day."

Lvov also warned that the total count of people infected with the virus could be much higher than the 381 cases that Russian health authorities had acknowledged so far.

"By my count, it can be as high as the tens of thousands. I cannot prove it yet, but in a few weeks I will be able to and will say so," Lvov said.

"The time when we could say that our border was secure is past. For the flu virus it is a sieve," he added.

The Russian authorities have been pointing out that the country remains relatively unaffected by the virus and have urged citizens to take strict precautions when travelling abroad.

The World Health Organisation announced on Friday that the global flu death toll has reached 3,486, up 281 from a week ago.

Experts have previously predicted that about one third of the world's population of more than 6.5 billion people could be affected by the A(H1N1) virus, but they stress that so far most victims are suffering only mild symptoms.