Report: Swine flu could infect half in U.S.

WASHINGTON — Health and Human Services Secretary Kathleen Sebelius said Tuesday that a massive school closing wouldn't stop the spread of the swine flu virus, saying vaccinations must be the defense against a menace that one report said could infect up to half of the population.

"What we know is that we have the virus right now traveling around the United States," Sebelius said in a nationally broadcast interview. "And having children in a learning situation is beneficial ... What we learned last spring is that shutting a school down sort of pre-emptively doesn't stop the virus from spreading."

Sebelius appeared on NBC's "Today" show one day after a special presidential advisory panel presented a grim report to the Obama White House, saying among other things that a "plausible scenario" for the United States later this year is wide-scale infections, possibly 30,000 to 90,000 deaths, mostly among young children and young adults, and perhaps as many as 300,000 sick enough to require intensive care unit treatment at hospitals.

Asked in the interview what people should do while awaiting the arrival of a vaccine, with first supplies likely by October but most not until the Thanksgiving season, Sebelius said: "I think it's important that people begin to anticipate that we will have a vaccine. We think it's likely that we're going to need two shots for the vaccine."

She said people should plan ahead for this, particularly those with pre-existing medical conditions, pregnant women and health care industry workers. Sebelius said federal health authorities also are recommending that people should immediately get their regular "seasonal" flu vaccine to bolster their health for the scenario yet to play out later this year regarding the swine flu virus.

"Seasonal flu vaccine is ready at the beginning of September," she said. "We want the population that is most at risk to begin their seasonal flu vaccine now."

Sebelius said on MSNBC that the government has asked drug makers to accelerate the manufacture of antiviral medication that could be administered intravenously to hospitalized swine flu victims.

A report by the President's Council of Advisors on Science and Technology, delivered Monday, said that while the impact of H1N1 was impossible to predict, a "plausible scenario" is that the epidemic could "produce infection of 30-50 percent of the U.S. population this fall and winter, with symptoms in approximately 20-40 percent of the population (60-120 million people), more than half of whom would seek medical attention."

Swine flu could lead to as many as lead to as many as 1.8 million U.S. hospital admissions during the epidemic, with up to 300,000 patients requiring care in intensive care units. In fact, those very ill patients could occupy 50-100 percent of all ICU beds in affected regions of the country at the peak of the epidemic and place "enormous stress" on ICU units.

Seasonal flue typically causes 30,000-40,000 annual deaths, mainly among people over 65.

People with certain pre-existing conditions, including pregnant women and patients with neurological disorders or respiratory impairment, diabetes, or severe obesity are at high risk, along with certain populations, such as Native Americans, the report said.

The fall resurgence in swine flu could occur as early as September, with the beginning of the school term, and the peak infection may occur in mid-October.

The report emphasized that this was a planning scenario, not a prediction. But, it added, "the scenario illustrates that an H1N1 resurgence could cause serious disruption of social and medical capacities in our country in the coming months."

Q. What are the plans for developing novel H1N1 vaccine?

A. Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a novel H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.

Q. When is it expected that the novel H1N1 vaccine will be available?

A. The novel H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials

Q. Will the seasonal flu vaccine also protect against the novel H1N1 flu?

A. The seasonal flu vaccine is not expected to protect against the novel H1N1 flu.

Q. Can the seasonal vaccine and the novel H1N1 vaccine be given at the same time?

A. It is anticipated that seasonal flu and novel H1N1 vaccines may be administered on the same day. However, we expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.

Q. Who will be recommended as priority groups to receive the novel H1N1 vaccine?

A. CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the novel H1N1 vaccine when it first becomes available. These key populations include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

We do not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions.

The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.

Q. Where will the vaccine be available?

A. Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.

Q. Are there other ways to prevent the spread of illness?

A. Take everyday actions to stay healthy.

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread that way.
* Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.

Q. What about the use of antivirals to treat novel H1N1 infection?

A. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. This fall, antivirals may be prioritized for persons with severe illness or those at higher risk for flu complications.

Q. Will vaccination against the new H1N1 influenza be mandatory?

A. CDC and ACIP (The Advisory Committee on Immunization Practices, which provides advice and guidance on the control of vaccine-preventable diseases) will make recommendations for who should receive H1N1 vaccine, and state and local health departments and institutions will determine how to implement these recommendations. If the vaccine is recommended for use, those who choose vaccination for themselves or their children will be screened for contraindications to vaccination (such as an allergy to eggs ) and will receive information sheets describing the vaccine’s risks and benefits, possible adverse events associated with vaccination, and how to report these events.

SOURCE: Centers for Disease Control and Prevention