A flu shot for safety

Diana Del Mauro | For The New Mexican

9/25/2009 - 9/24/09

Working at a “feverish” pace, New Mexico Department of Health officials are gearing up for the largest vaccination blitz ever, which will start in October with an attempt to inoculate 265,000 of the most vulnerable people against swine flu. By December, the new vaccine should be available to every New Mexican who wants it, even those already infected with the global pandemic flu.

“The assumption is eventually we’ll have enough vaccine for everybody,” Maggie Gallagher, medical director for the Public Health Division, said in an interview Monday.

“It’s just that we won’t have that initially, so we need to target our efforts to those who are most at risk.”

The first batch of H1N1 vaccine is due to arrive in early October. It’s earmarked for health care and emergency workers, family members and caregivers for babies younger than 6 months of age, pregnant women, children from 6 months to 4 years of age, and children ages 5 to 18 with chronic medical conditions. Examples of underlying health disorders include asthma, chronic lung disease, significant heart disease, diabetes and neurodevelopmental conditions, such as cerebral palsy.

“The biggest shift — or difference from seasonal flu vaccine — is people over 65 are not in the priority group for H1N1 vaccine,” Gallagher said. “That’s been kind of a hard idea to get across to some people. Fewer (senior citizens) are coming down with that flu.”

Older Americans are still a priority for the seasonal flu vaccine, however.

Oct. 4 is the official start of flu season. But across the United States, patients are showing up at doctors’ offices with flu-like symptoms, and the number of cases has climbed for five straight weeks. Most patients are being diagnosed with swine flu, a new virus identified last April.

So far the swine flu acts much like run-of-the-mill seasonal flu: fever, cough, sore throat — at times with the added intensity of vomiting and diarrhea. Most cases are mild, although some of those afflicted have been hospitalized or died.

Scientists at the Centers for Disease Control and Prevention warn that the nature of the disease could change rapidly, paralyzing communities that don’t take protective measures.

“So far we find that the virus that’s circulating right now is a good match to the new vaccine that’s being developed and being manufactured and distributed,” Dr. Daniel Jernigan, the CDC’s deputy director of influenza, said. “We also find that the virus still maintains a high level of susceptibility to Tamiflu, or oseltamavir, the anti-viral drugs used to treat it (within 48 hours of illness onset). We’re also encouraged that we don’t find any changes in this virus that would suggest that there might be increased virulence, that is, increased severity of disease because of changes in the virus that might occur. I think we certainly do expect to see a whole lot more illness in the coming weeks. We expect that if the H1N1 remains the predominant strain that more younger people will be affected than we might think — or might see in the past.”

The CDC is rolling out two different influenza vaccines — one that addresses the pandemic virus and the other that guards against seasonal flu. Even though the two viruses produce similar symptoms, there wasn’t enough time to develop one shot that would cover both strains. “Simple reason is the virus didn’t exist at the time that the seasonal flu vaccine was being formulated,” Dr. Jay Butler, a CDC medical epidemiologist, said.

Eventually, most Americans will be offered two flu shots this year, whereas children under age 10 may require two doses of H1N1 vaccine, spaced 21 - 28 days apart, to get the same degree of protection.

“It’s absolutely voluntary,” Gallagher said. “We’re not going to force anybody to be vaccinated.”

Seasonal flu vaccine is already available at some locations in New Mexico, and health authorities are urging people to get a shot right away. For public schools and health care providers that obtain their doses through the New Mexico Department of Health, the supply of seasonal flu vaccine won’t arrive for a few more weeks.

The swine flu vaccine, also known as H1N1, is supposed to trickle in starting in early October. All health care providers must get their doses through the state Health Department.

“Every time, CDC will tell us how many doses of what kind of vaccine (we’re getting), and then we’ll allocate it out by county (based on each county’s risk group population),” Gallagher said.

Nasal spray vaccine will make up the bulk of the first delivery. If injectible doses aren’t included in the first shipment (that’s still being worked out), children under 2 years old, pregnant women, and people with asthma or chronic respiratory illnesses will have to wait because the nasal spray version is made with live virus.

“If we only get the FluMist as the first option, we need to pick the risk groups that can use the FluMist. You can’t give it to a kid with a chronic health condition, if they have any underlying lung disease,” Gallagher said.

Also, the Health Department has decided not to vaccinate pregnant women against swine flu until New Mexico receives multidose vials that are free of mercury.
New Mexico will get the proportion of the national vaccine supply equal to its population.

“We’ve been told that we can put in our first order for H1N1 within the next couple of weeks,” Gallagher said. “It’s not going to be a tsunami. I think it’s going to come in little bits at a time — pulses of doses rather than hundreds of thousands of doses at one time.”

Early illness in New Mexico

New Mexico is one of 21 states with “widespread” influenza activity. “Any reports of widespread influenza activity in September are very unusual,” according to the CDC.
No children have died in New Mexico from swine-flu complications, but at least 26 children have been hospitalized.

Four adults from four different counties have died. The youngest is a 21-year-old woman from Los Alamos County who did not have chronic health conditions; all the other adults did. A total of 70 people have been hospitalized because of the disease, including four from Santa Fe County.

These numbers paint an incomplete picture of the swine flu’s hold on New Mexico, cautions Dr. Chad Smelser, a medical epidemiologist with the state Health Department. Many cases go undetected, he said.

“There are people being hospitalized for H1N1 infection in New Mexico,” he said, “and people in the high-risk groups should take precautions to prevent getting the illness.”
If the virus, which has been simmering all summer, peaks this fall, hospitalizations and deaths could rise quickly. “Most Americans don’t have any protection against this virus,” Smelser said.

Even if the disease remains mild, the “burden on society” could be more pronounced, Smelser said, because more workers and people caring for children could fall ill. Also, the increased volume of sick people could place stress on the health care system.

The Centers for Disease Control and Prevention’s Advisory Committee on
Immunization Practices drew up a priority list for who should get the vaccine first, and then narrowed that list down should the vaccine be available in limited quantities. The New Mexico Department of Health has decided to start with the smaller target group.

“The top priority group — the big one — is 925,000 (people) statewide,” Gallagher said, who estimates that would cover nearly half the state’s population. “For the more limited, it’s about 265,000. That seems much more doable.”

The Health Department’s strategy is to offer the first shipment of H1N1 vaccine to the smaller target group of 265,000, then branch out to other high-priority segments of society.

After demand is met for the first group, adults from 25 to 64 with chronic health conditions — about 190,000 people — will be targeted, Gallagher said.
Next will be children and young adults up through age 24.

After that will be healthy adults 25 to 64.

Then when that demand is met, the swine flu vaccine will be available to people older than 65.

Approximately 55,000 Santa Fe County residents meet the federal criteria for the larger high-risk group, but those first in line for the swine flu vaccine will be closer to 15,000 people. Chris Minnick, a spokesman for the Health Department, said those figures are for planning purposes only and may not correlate with how much vaccine is allotted for Santa Fe County.

The virus can come in waves

Given the mild symptoms of H1N1 flu so far, people must make sense of this climate of urgency.

There’s the issue of timing. Gallagher said people who don’t get the vaccine before the swine flu peaks should still get the shot this year, because often the virus will come in waves every few months.

“It may wind down after Christmas, but then peak again in the spring. So we’ll continue
to offer vaccination,” she said.
There’s the issue of safety with a new vaccine.

“We have a lot of data around vaccines for seasonal flu in the past. The reason we’re calling one seasonal flu and one H1N1 is to distinguish the two vaccines. Our season is really going to be dominated by H1N1 flu,” Gallagher said. “This H1N1 flu is being made the same way that the season flu vaccine is made. They’re not using new processes. There’s nothing new and magical about it.”

Dr. Bob Sears, author of The Vaccine Book, describes the ingredients of each H1N1 vaccine formulation and highlights options that don’t contain mercury on his Web site, www.askdrsears.com. He also notes that the process is much like how flu vaccine has been developed for decades.

He expressed one caveat: “Although I don’t think this new vaccine has an increased risk, what I do worry about is that infants will be getting four count them, four flu vaccines this year — two doses of the regular one, and two doses of the swine flu vaccine. That’s unprecedented,” writes Sears on his Web site. “We’ve never given anyone four doses of a flu vaccine in one year. There is no way to predict what the side effects might be.”

The CDC says it’s safe to get both flu vaccines at once; however, the nasal-spray versions of the two flu vaccines should not be administered on the same day. Sears’ advice is to play it safe: Give the swine flu vaccine to children as far apart from other shots, including the seasonal flu shot.

Those who opt not to get the swine flu vaccine can take other measures — such as staying home until they clock 24 hours without fever, without Tylenol — to keep the disease from spreading and also reduce their chances of getting gravely ill. “This is a worldwide problem, and I would hope it would capture their attention,” said Dr. Henry Bernstein, a professor of pediatrics at Dartmouth Medical School who sits on the Committee of Infectious Diseases for the American Academy of Pediatrics.

SWINE FLU: SIGNS OF DANGER

Most people recover quickly from the swine flu on their own or with Tamiflu prescribed by their physician. Still, the virus can be deadly, so it's important to know the warning signs.

Head to the emergency room if the flu produces the following symptoms, as described on the Centers for Disease Control and Prevention Web site.

What are the emergency warning signs?

In children

• Fast breathing or trouble breathing

• Bluish skin color

• Not drinking enough fluids

• Not waking up or not interacting

• Being so irritable that the child does not want to be held

• Flu-like symptoms improve but then return with fever and worse cough

• Fever with a rash

In adults

• Difficulty breathing or shortness of breath

• Pain or pressure in the chest or abdomen

• Sudden dizziness

• Confusion

• Severe or persistent vomiting