Effect Measure

CDC’s 2009 flu wrap up presser

Yesterday CDC had its last press conference of this calendar year on the flu pandemic (.mp3 here). CDC’s Anne Schuchat did her usual competent job and was generally upbeat while trying to maintain the need for urgency in the vaccination campaign. She cited numbers of over 100 million swine flu and 100 million seasonal flu doses having been produced for consumption in the US and this is a real accomplishment. She also noted that availability of swine flu vaccine was now much greater. Indeed my medical center notified us that it was generally available regardless of previous priorities. Hence I added swine flu vaccination to my previously obtained seasonal flu vaccination. I am now as immunologically defended by vaccines as I can be. With high flu activity still in about a fifth of the states but activity ebbing in many others, there is uncertainty about what will happen during the period that is normally the worst for seasonal influenza, January to March. Her answer when asked that is exactly right: no one knows.

Here are some possibilities. Swine flu comes roaring back in a third wave in January or February. This would be a repeat of the pattern of the 1957 pandemic where H2N2 appeared in the spring ebbed at mid summer, had a major recrudescence at the start of the school year and died down about the same time as this virus, and then had a big wave 3 during the “normal” flu season. Significantly the new pandemic virus replaced the H1N1 seasonal flu that had been circulating at least since 1918. Why should this year be different? It may not be. But in 1957 we weren’t able to produce a pandemic strain vaccine as we have this year. Getting a significant portion of the population vaccinated might, at the very least, flatten out and prolong the epidemic curve and lessen its impact. Moreover this year’s pandemic virus is an H1N1 subtype and another seasonal H1N1 subtype has been co-circulating in the population since 1977. We don’t know if either or both of these factors will alter the pattern we saw in 1957.

Another possibility, besides a repeat of 1957, would be a return of the two seasonal viruses, seasonal H1N1 and seasonal H3N2. Those viruses affect the entire population but unlike swine flu, hit the elderly portion much harder. So people my age (over 65) could suffer our usual toll of serious illness and death from the previously circulating seasonal viruses. So far those viruses are very little in evidence and we don’t know if they will come back. The reason I got the seasonal vaccine was to try to get some protection in case that happens. There is some evidence that any H3N2 seasonal virus is not an especially good match for the current seasonal vaccine, so protection there might be less than ideal, but the H1N1 and influenza B components appear to be good matches, although data are very sparse. Like everyone else, I don’t know, but my gut tells me there is a good chance this will happen. That would make for an unprecedented situation, the co-circulation of three influenza A viruses and influenza B.

A good portion of Schuchat’s message was that this period of somewhat decreased flu activity combined with increased vaccine availability is an excellent window of opportunity for anyone not vaccinated to get vaccinated. With the pandemic less in the news and the distractions of the holiday competing for our time, attention and storehouse of anxieties it is likely that vaccine “uptake” (the new jargon for actually getting vaccine into people) will slow and be yields to exhortation lessened. So if you are a parent who has yet to get your child or teen vaccinated (with two doses for the kids under 10 years old), we’ll leave you with a little added incentive:

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Merry Christmas or whatever holiday you celebrate and may the New Year bring you and your family good health. Rather than leave it to chance or our good wishes, get vaccinated against influenza.

Comments

  1. #1 justamom
    December 24, 2009

    My family was vaccinated against both seasonal and H1N1, and we all ended up with confirmed flu about 3 weeks ago (this was approximately 3 weeks after our H1N1 vaccinations, including the boosters for my young children). Our doctors seemed to think it was likely seasonal influenza since the H1N1 vaccine is such a good match. I’m thankful it was relatively mild (though, still miserable) and that we’re healthy now. I will always vaccinate – while it didn’t prevent it this time, it very well may the next time (and it may have been what caused it to be “mild” for us). I just hope others take advantage of the vaccines that are available now. Happy Holidays!

  2. #2 Paula
    December 24, 2009

    Happy to say I and other old people I know of have finally able to get the vaccine, starting 2 and 3 weeks ago, here in rural Oregon. On the other hand, here in rural (wherever), then along comes the wind turbine installations to chop off one’s health (or hearth)! But on a more cheery note, one can agree with you that a good job’s been done (under the circumstances) recently–and you, reveres, have done a terrific job!–informing people re the 2009H1N1 vaccine developments, and maybe now everyone who wants the vaccine can get it.

  3. #3 raven
    December 26, 2009

    Just looking at the pediatric graph, looks like the number of swine flu deaths will be 2-4 times the usual. We are already at 2X and the flu season is only half over.

    I was going to get a swine flu vaccination, but before it became available, I came down with….swine flu. Wasn’t too bad, the seasonal I got the year before was worse.

  4. #4 caia
    December 26, 2009

    I tried to get the swine flu vaccine last week, after my state announced it was available to all, but my doctor’s office said they only had enough for the little kids. I understand them maintaining those priorities if their own supply is limited, but those I spoke to were unaware of the state’s announcement.

    I know they’re busy, but you’d think people who worked in a doctor’s office would hear about this sort of thing.

  5. #5 Paula
    December 26, 2009

    Caia, it seems they would, yes, or at least direct people to contact the local public health office.

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