Obama Administration Might Recommend Three Flu Shots for Americans This Fall

Two would be aimed at the swine flu circulating the globe

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HealthDay Reporter

TUESDAY, May 5, 2009 (HealthDay News) -- President Barack Obama's administration is weighing whether to craft a fall vaccination campaign that could mean three flu shots for Americans, two of those aimed straight at the swine flu virus that has been circulating around the globe in recent weeks.

The Washington Post reported late Tuesday that this would mark the first time the government has asked its citizens to get more than one flu vaccine a year.

Experts are looking at who ought to get the swine flu shots and whether vaccine makers can make both 180 million doses of seasonal flu vaccine and up to 600 million rounds of the new vaccine, the newspaper reported.

"We are moving forward with making a vaccine," Robin Robinson, a director with the Department of Health and Human Services who oversees pandemic response programs, told the Post. Robinson added that although a formal decision about the swine flu vaccine has not been made, if the government goes ahead, it would probably produce two doses for all Americans. If the threat diminishes, he said, health officials could decide to produce doses for only a portion of the population.

Meanwhile, a Texas woman who lived along the U.S.-Mexico border and had chronic health problems died this week after contracting swine flu, state health officials said Tuesday.

The death of the woman, who lived in Cameron County, the southernmost county in the state, was "the first death of a Texas resident with H1N1 flu," state health officials said. No other details were available, the Post reported.

Last week, a 23-month-old boy from Mexico, who also had underlying health problems, died from the swine flu illness in a Houston hospital. He was the first fatality in the United States from the current swine flu outbreak.

Meanwhile, U.S. health officials said Tuesday that the outbreak of swine flu appears similar to the seasonal flu in its severity, so schools across the nation should remain open and any schools that did close should reopen.

This announcement marked a change from the previous guidance, which recommended that affected schools close for at least two weeks. The U.S. Education Department has said that more than 430 schools have been closed nationwide because of flu fears, affecting about 245,000 children.

Students who are sick with flu-like symptoms should stay home for at least a week, officials cautioned.

"The good news is that while that guidance recognizes the fast transmission, the end result has been a more mild version of the disease than was originally feared and the lethality seems at a much less significant level," U.S. Health and Human Services Secretary Kathleen Sebelius said during an afternoon press conference. "So, there is new guidance being put out that will recommend that schools cease closing with affected cases."

The change in guidance does not mean that scientists know much more now than they did before about what the virus will do, Sebelius stressed. "We don't know what will happen over the course of the summer, and we certainly don't know what will happen when we get back into the [fall] flu season," she said.

"We are learning more about the H1N1 virus every day," Sebelius said. "We know there will be more cases and, unfortunately, there are likely to be more hospitalizations and more deaths. We are working as fast as we can to stay ahead of this disease."

Although the flu is milder than thought, it continues to spread throughout the country and many more cases are expected.

As of Tuesday there were 1,105 probable and confirmed cases across 44 states, Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said during a teleconference. "There are over 700 probable cases and 403 confirmed cases. The confirmed cases are in 38 states," he said.

On Monday, federal health officials said that much of the recent bump upward in cases was due to health workers catching up on a backlog of lab tests, and not a sudden rise in new infections.

Still, "we are continuing to see virus transmission and expect to continue to see virus transmission both around the United States and around the globe," Besser said. "We would expect to see cases in all states over time, and we will see more hospitalizations and it is likely we will see additional deaths."

However, a closer look at the flu in Mexico -- believed to be the source of the outbreak -- has revealed that it is really not very different from the flu seen in the United States, Besser said. "We are seeing more cases in Mexico of the milder disease," he said.

At another press conference on Monday, Besser told reporters that "we are not out of the woods," but he added that "we are seeing a lot of encouraging signs."

Among the encouraging signs: "So far the severity of illness we are seeing in this country is very similar to what we see with seasonal flu," Besser said. "And that's encouraging information."

In addition, some of the initial lab tests are heartening, Besser said. "The lack of some of the factors that have been associated with more severe disease in previous pandemics, we are not seeing those," he said.

Testing for the virus is also becoming faster, Besser said. "We have distributed test kits to every state and this will allow for more rapid diagnosis at the state level," he said.

And, he added: "The situation in Mexico is encouraging. It appears that things are leveling off in Mexico."

In fact, the Mexican government on Tuesday announced moves to revive an economy that had been leveled by the swine flu outbreak. According to the Associated Press, while annual Cinco de Mayo festivities were more or less canceled this year, car traffic was noticeably busier in Mexico City on Tuesday and fewer people were seen wearing surgical masks.

All of this followed the declaration by Mexican officials on Monday that the epidemic appeared to be waning, with no deaths linked to swine flu recorded since April 29. The country's flu alert was scaled back to allow cafes, museums and libraries to reopen this week after a five-day shutdown of nonessential businesses. Universities and high schools will reopen Thursday, and younger schoolchildren are to report back to school on May 11, the AP reported.

"The measures we have taken, and above all the public's reaction, have led to an improvement," Mexico City Mayor Marcelo Ebrard said at a news conference on Monday. "But I insist that the virus is still present, that we need to remain on alert, and the resumption of activities will be little by little, not all at once."

Still, officials from the World Health Organization said it was premature for countries to ease up on efforts to control the outbreak, but added that there were no imminent plans to raise the pandemic alert level. Currently, the WHO has labeled the outbreak a Phase 5 outbreak, meaning the disease is spreading throughout communities in at least two countries in one of the WHO's six regions -- in this case the United States and Mexico. To reach Phase 6, the geographic spread of the disease would have to occur in at least one other country in another region.

The WHO reported Tuesday that the disease continues to spread around the globe, with 21 countries reporting 1,490 cases.

What health experts don't know is whether the never-before-seen virus will return, perhaps in a more dangerous form, when the regular flu season begins again late this year. Because the pathogen is a genetic mix of pig, bird and human flu strains, health officials are worried that humans may have no natural immunity to it.

Besser said Monday that the CDC continues to work to prepare a vaccine, although "the decision doesn't need to be made now whether to manufacture a vaccine" for the next flu season.

Federal health officials will be looking for clues to what the swine flu virus -- officially designated H1N1 -- will do in the fall by monitoring what happens in the Southern Hemisphere, where the flu season there is just getting under way. "That will tell us a lot about whether the virus is changing, whether it's becoming more severe and what measures we might want to take in the fall," he said.

As with the previously tested strains of the swine flu virus, new testing has found that the pathogen remains susceptible to the two common antiviral drugs Tamiflu and Relenza, according to the CDC.

And that has led to a boom in sales of the two drugs in the United States, the AP reported Tuesday. Frightened by the prospects of the swine flu, Americans are snapping up the two antiviral medicines that treat the virus, whether they have it or not.

More than one-quarter of a million prescriptions for Tamiflu pills alone were filled at retail U.S pharmacies in the week ending last Friday. That's 34 times higher than the week before -- as the regular flu season wound down -- and more than double the peak of last winter's flu season, the news service said.

WHO officials stressed that the swine flu cannot be transmitted through the consumption of pork products.

U.S. Human Cases of H1N1 Flu Infection
(As of May 5, 2009, 11:00 AM ET)
States # of
Alabama 4  
Arizona 17  
California 49  
Colorado 6  
Connecticut 2  
Delaware 20  
Florida 5  
Georgia 1  
Idaho 1  
Illinois 82  
Indiana 3  
Iowa 1  
Kansas 2  
Kentucky* 1  
Louisiana 7  
Maine 1  
Maryland 4  
Massachusetts 6  
Michigan 2  
Minnesota 1  
Missouri 1  
Nebraska 1  
Nevada 1  
New Hampshire 1  
New Jersey 6  
New Mexico 1  
New York 90  
North Carolina 1  
Ohio 3  
Oregon 15  
Pennsylvania 1  
Rhode Island 1  
South Carolina
Utah 1  
TOTAL (38) 403 cases 1 death
*Case is resident of Ky. but currently hospitalized in Ga.
Source: U.S. Centers for Disease Control and Prevention

More information

For more on swine flu, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: May 5, 2009, teleconference with Kathleen Sebelius, secretary, U.S. Department of Health & Human Services, and Richard Besser, M.D., acting director of the U.S. Centers for Disease Control and Prevention; May 1-2, 2009, teleconferences with Anne Schuchat, M.D., interim deputy director, science and public health program, U.S. Centers for Disease Control and Prevention, and Nancy Cox, Ph.D., chief, influenza division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention; Associated Press; Washington Post

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