H1N1 vaccine on the way for fall distribution

Physicians and other health care professionals likely will be among the first to receive a new influenza A(H1N1) vaccine, which should be ready by mid-October, said Dept. of Health and Human Services Secretary Kathleen Sebelius.

She made the announcement at a summit of local, state and federal health and school officials held July 9 at the National Institutes of Health.

President Obama urged attendees via a live link from Italy to start preparing for what could be a significant outbreak in the fall. "We may end up averting a crisis if we all work together," he said.

A final decision on the scope of the fall H1N1 vaccine campaign will be made by the National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices, Sebelius said. The latter committee will meet on July 29 to discuss which groups are at highest risk and should receive the vaccine first. The vaccine is being tested for safety and efficacy.

In addition to physicians and others in health care, school-age children and pregnant women are likely to be recommended as early recipients, Sebelius said.

Manufacturers are expected to have about 100 million doses of the H1N1 vaccine ready by mid-October, with additional doses later in the fall.

The number of H1N1 doses could reach 600 million -- enough for what's expected to be two doses per person, officials said.

That dwarfs the amount of seasonal flu vaccine generally made available. This year, about 119 million doses are expected for the coming fall and winter season -- about 20 million fewer doses than last year, according to information presented at the joint American Medical Association and Centers for Disease Control and Prevention National Influenza Vaccine Summit held in Dallas June 29 through July 1.

Since the annual, or seasonal, flu vaccine will not protect against the H1N1 virus, physicians should begin immunizing patients for seasonal flu as soon as they receive the vaccine in late summer and early fall, said officials at the AMA/CDC summit.

Physicians and others in the health care field have been notoriously lax in getting the seasonal vaccine themselves and they should take steps to boost that rate, according to presenters at the summit. Results of a survey released at the meeting found that 46% of health care workers get an annual flu shot.

Uncharted territory

Influenza viruses are among the most unpredictable of infectious diseases, and the H1N1 virus is one of the more puzzling, said CDC Director Thomas Frieden, MD, MPH, who spoke at the H1N1 summit.

The virus is more likely to affect children ages 5 to 17, rather than people older than 65, the group hit hardest by seasonal flu. Pregnant women also are being affected, as are people with underlying medical conditions such as asthma. The H1N1 virus is still going strong this summer, an unusual time for the flu to circulate.

Although the new flu is, at least so far, no more severe than seasonal flu, that's not too reassuring "since seasonal flu kills 36,000 people a year," Dr. Frieden said. For now, surveillance and planning are top priorities.

Since H1N1 could cause continuing, and possibly more severe, illnesses in the fall, physicians should prepare for a surge of visits from worried patients, Sebelius said. Although antivirals have been effective in treating the disease, signs of resistance are being reported in other countries.

Sebelius said $350 million in federal grants will be sent to states and hospitals by the end of July to aid in planning for possible mass vaccinations and a possible surge in patients seeking treatment. Congress has appropriated money for the vaccine.

During the H1N1 summit, several state health officials spoke about last spring's outbreak. Among them was Marcelle Layton, MD, assistant commissioner of the New York City Dept. of Health and Mental Hygiene. With 900 hospitalizations and 47 deaths, New York City experienced one of the largest outbreaks.

Despite having a pandemic plan, some aspects of the H1N1 outbreak took the city by surprise, she said. "We thought we would have some warning that a pandemic was occurring and that it would likely be recognized overseas prior to its arrival in New York City."

That wasn't the case. An outbreak in a city school was identified in mid-April shortly after the first cases in Mexico made news.

Among the lessons learned was the importance of surveillance to track the size and severity of the outbreak. Communication was another priority. The public health department held numerous press conferences and developed fact sheets and health alerts. A 24-hour phone line was established for physicians and other health care professionals. It received 5,000 calls, Dr. Layton said.

The print version of this content appeared in the July 27, 2009 issue of American Medical News.

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