From The Wall Street Journal
A woman living near the Mexican border in south Texas became the second person in the U.S. to die of a new strain of flu, as the virus causing it continued to spread around the globe.
U.S. health officials have warned that the number of deaths is likely to grow as the new H1N1 virus spreads across the country, even though they now believe the new flu isn't as severe as they initially feared.
The woman, who was a U.S. citizen in her early 30s, had "chronic underlying health conditions," according to Texas authorities. She had been hospitalized for about three weeks, after falling ill around April 14. None of her immediate family is ill, they said. They declined to elaborate further.
Texas has been hit hard by the H1N1 virus. The state has had 61 confirmed cases overall, including the only two fatalities in the U.S. Last month, a Mexican toddler who had crossed into Texas with his family to visit relatives succumbed to H1N1 in a Houston hospital. He, too, was described by state officials as being weakened by unrelated health conditions.
The virus continued to spread Tuesday, with 1,490 laboratory-confirmed cases in 23 countries, according to the World Health Organization. Mexico had 822 confirmed cases and 29 deaths. U.S. cases rose to 403, with 700 more probable cases, according to the Centers for Disease Control and Prevention, which also said 62% of the confirmed cases are under age 18. While most cases are mild, 35 people were hospitalized and some have been sick enough to need ventilators to breathe.
The U.S. Navy, meanwhile, said it canceled the deployment of a ship and ordered its entire crew to be treated with antiviral drugs after a crew member's illness was confirmed as swine flu, according to the Associated Press.
Navy spokesman Lt. Sean Robertson said there are also about 50 suspected cases of the virus from crew members on board the USS Dubuque, which is based in San Diego, the AP reported. The ship was scheduled to leave June 1 on a humanitarian mission to the South Pacific.
The Wall Street Journal, page A3
By BETSY MCKAY and STEPHANIE SIMON
U.S. May Add Shots for Swine Flu to Fall Regimen
From the Washington Post
The Obama administration is considering an unprecedented fall
vaccination campaign that could entail giving Americans three flu shots
-- one to combat annual seasonal influenza and two targeted at the new
swine flu virus spreading across the globe.
If enacted, the multibillion-dollar effort would represent the first
time that top federal health officials have asked Americans to get more
than one flu vaccine in a year, raising serious challenges concerning
production, distribution and the ability to track potentially severe
side effects.
Another option, said Dale Morse, chairman of the advisory committee on
immunization practices at the Centers for Disease Control and
Prevention, is adding to the seasonal flu shot an ingredient targeted at
the new virus.
Experts in and out of the administration are evaluating a raft of
complicated issues, including who ought to receive an inoculation
against the swine flu and whether private vaccine makers can
simultaneously manufacture the standard 180 million doses as well as up
to 600 million rounds of a new vaccine.
"We are moving forward with making a vaccine," said Robin Robinson, a
director with the Department of Health and Human Services who oversees
pandemic response programs. Robinson said 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.
Vaccine and pandemic experts are working with the administration to
determine how to produce, test, track and educate the public about two
different influenza vaccines in the same flu season.
"They have never tried this before, and there is going to be a great
deal of confusion," said William Schaffner, chairman of the Department
of Preventive Medicine at Vanderbilt University School of Medicine.
Memories of the nation's earlier experience with a swine flu vaccine
present another challenge. In 1976, hundreds of Americans developed
neurological disorders after they were vaccinated for a swine flu
strain. The public was asked to receive one of two vaccines developed to
combat the strain.
Health officials have asked manufacturers to ramp up production of the
seasonal vaccine scheduled for rollout this fall to make way for the
possible mass production of a swine flu vaccine.
A decision on whether to produce such a vaccine will have to be made
soon, because it typically takes five months to produce a new vaccine
and authorities would want it available for the next flu season.
Some medical experts said rolling out two vaccines would present
additional challenges in terms of testing and tracking adverse
reactions. Health officials and manufacturers will need to know what the
negative reactions might be for each vaccine on its own and in
combination with the other. Initial tests would be done on animals, and
then clinical trials would be conducted with people to determine side
effects before either vaccine is rolled out.
Harvey Fineberg, president of the Institute of Medicine, part of the
National Academy of Sciences, said officials will have to weigh the
risks of the time spent on testing.
"All this takes time, money and organization," said Fineberg, who led an
investigation into the government's handling of the 1976 swine flu
vaccinations.
The greater challenge will be tracking any adverse reactions as millions
of Americans get multiple vaccinations in a matter of months this fall
and winter.
"There will be adverse effects to any vaccine. That's just science,"
said Michael Hattwick, who ran the CDC's vaccine-tracking system during
the last swine flu scare.
Hattwick said a "real-time" tracking system would need to be established
to provide constant updates to the CDC about adverse reactions. That
information, he said, should include lot numbers for the vaccines so
health officials can trace each side effect to the manufacturer and the
date of production. Routine flu vaccinations are not traced with such
precision because reporting is voluntary and often delayed, Hattwick
said.
Anthony S. Fauci, director of the National Institute of Allergy and
Infectious Diseases, said he does not expect additional adverse
reactions with two vaccinations. The traditional flu vaccine is designed
to attack the three flu strains health officials believe to be the
greatest threats in a regular season, he said.
"In a regular seasonal flu, you get three vaccines. Adding an additional
one should not present a problem," Fauci said.
A record-keeping system would also need to be devised to track which
doses patients have received, health experts said.
Without such a system, patients could lose track of which of the three
shots they have received or could fail to get the second swine flu
inoculation at the proper time.
"We will have to keep them straight and separate," Vanderbilt's
Schaffner said. "This will be an enormous challenge, and we haven't
figured out how to do it yet. That's one of the things we are trying to
sort out."
By Kimberly Kindy and Ceci Connolly
Washington Post Staff Writers
Wednesday, May 6, 2009
Posted by Scott W. Yates, MD, MBA, MS, FACP
