Three years ago this week, the United States declared a public health emergency in the face of rising “swine flu cases.”
Within two months, every state had reported confirmed patients with the re-named H1N1 influenza virus. The World Health Organization raised the worldwide pandemic meter that June. The government raced to get a vaccine created.
“During H1N1, one of the biggest things to do was to get vaccine out where it was accessible to everybody and how to do that in the fastest, most efficient way throughout the state so getting vaccinated was an easy thing for Arizonans to do,” said Dr. Cara Christ, medical director for public health services for Arizona. “We did a lot of planning with stakeholders, physicians and hospitals to make sure the vaccine is out there and available and to let the public know the best way to avoid the flu was to get vaccinated.”
When the vaccine did become available to the public that fall, Maricopa County rolled out school-based immunization clinics.
Prior to the outbreak of H1N1, getting large segments of the population vaccinated for flu each year didn’t happen, said Dr. Bob England, director of the Maricopa County Department of Public Health.
“The difficulty we’ve had to do that for flu has been logistical. Every year we try to vaccinate everybody, but we never get that high of a percentage, especially in key segments,” he said.
England said Japanese data from the past shows that if “herd immunity” can occur in school children — where at least 80 percent of the children are vaccinated — “you can take more than 90 percent of the flu away from the rest of us. That’s because kids in school spread flu more than any of us.”
That “herd immunity” — where you stop the disease by giving it fewer people to grab onto — has become England’s testimony for widespread vaccinations.
“Every time any part of the country has tried to do that, we’ve fallen far short. But we’ve been doing it in the context of our crazy quilted health-care system where we track individuals, which health care insurance covered which child, what sort of out-of-pocket costs there were, deductibles. All those things that make it complex,” he said.
But with H1N1 came school-based vaccination clinics, paid for by the government, England said.
Working with ASU researchers, England and his team are trying to determine the cost benefit of doing that again in the future during a “bad” flu season, not necessarily a pandemic.
The initial report showed half a billion dollars a year could be saved in health-care costs, over-the-counter medications, missed work time, hospitalizations and more, England said. That’s with an investment of $7 million to get the vaccine to school children every year.
But the team is still trying to drill down to the tiniest details to see exactly where the savings could be, he said.
“Hopefully the data at some point in the near future is going to create the decisions to go ahead and front-end funds, doing this so everybody can benefit — the kids, the grandparents, everybody,” he said.
In the last year, not much has been heard about the H1N1 virus, likely, health officials say, because of three years of immunizations.
“It’s been a slow year this year so far for flu,” Christ said. “But this is about the time in 2009 that we got the first reports of H1N1 in the country, so we’re not going to say we’re out of the woods, yet.”
Through April 21, there have been 71 percent fewer cases of lab-confirmed flu in the state than this time last year, according to the state Department of Health Services. Of those, 84 percent have been identified as influenza A. H1N1, a strand of influenza A, has made up 66 percent of those cases.
The ups and downs of flu seasons make the disease so unpredictable, England said. One small mutation of the disease and another pandemic may take place.
“Remember the bird flu and how we were all going to get sick? The bird flu is still out there. If that mutation happens to make it easily transferable from person to person, we could see a pandemic,” he said. “Because the flu evolves. It mutates all the time. Every year there’s new strands coming around.”
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