November 4, 2009

Swine Flu Update November 4 2009

Sometimes our government does things really right.  I think the Centers for Disease Control [CDC], year in and year out, does a great job.  And they do it for the whole world.  (At least for them, for free.)  Before any of my patients go to exotic locales, or sometimes not so exotic ones, I will check their website for up-to-the-minute news of outbreaks or cautions.  Their very best feature is a real-time Traveler's Health section, where you can find what's going on disease-wise in any place on Earth, and if your next vacation leaves you exposed to Chikungunya Fever.

Feeling this way, from years of experience, has left me particularly confused about the current H1N1 vaccine situation.  I heard from our government just months ago that there would be available 130,000,000 doses of vaccine available.  They did a fine job of publicizing the epidemic, so that many of those who never got flu vaccine before are now asking for it. 

I have a long list of children whose parents want them to get the vaccine, and many of those children have complicating risk factors.  I haven't received even 1 dose so far.  In this area, Kaiser Permanente (presumably the largest organization ordering vaccine) got theirs a couple of weeks ago.  Some other counties have had it for a while, too.  Larger medical practices are getting deliveries.  Not me, not the small practices.  When--if--I get some in my office, will it be like the seasonal flu vaccine?  I ordered it last year, received a fraction of what I ordered, and can't get more.  There is no more, and many of my patients have had to do without. 

One of the things that's so confusing is the number of doses available.  In the 3 or 4 months since the 130 million number was being mentioned to every news outlet, a large proportion of those doses failed to materialize.  I've tried to find an authoritative link on this, but haven't been able to.  A lot of sources suggest 14 million, some say a little more than that, but much will only be available in 2010.  The CDC website says that as of October 30, 2009 16,870,000 doses have been shipped.  Where did it all go?  The manufacturing cycle for vaccines is a long one.  Batches are grown, purified, prepared.  If things were going slower than expected, were they going 90% slower?  How come the government didn't know or didn't publicize that or tell us what to do instead?  Are there manufacturing plants that have broken down?  Labor unrest?  All the reasons I can think of should have been known and followed intimately by the same people and institutions that seem to have been so vigilant (and generally right, by the way) about the upcoming, now ongoing, epidemic.

I'm faced with a problem.  If I don't get enough, who do I give it to?  I know who the most vulnerable patients are, and I will be ranking them.  It's not a list you want your kid to be on top of.  But it's a list you still might want your kid to be on.  Why do I have to make this kind of choice? 

I need to point out that I am not blaming anybody for this situation.  If it were possible to deliver all the promised doses, I'm confident it would be done.  But I do feel that we all should have known long before this.  The lack of information could have serious health effects.  Next year, there will be studies of the cost of the H1N1 epidemic.  The cost of treatment, hospitalization, interventions of all kind, doctor and ER visits will be added to lost wages and time spent staying home with the sick child.  But what won't be counted is how much might have been saved--even without the vaccine--if we had been able to plan a little better with better, more timely information.

With all the above said, here's some information available this morning, as a service to my patients and their families, and to the many readers of this blog everywhere.

Questions and Answers about the H1N1 vaccine.
Is it safe?
A guide to antiviral drugs for the flu.

What to do if you or somebody close to you gets the flu.
Pregnant women and this flu.
State of California Public Health link.
City of Berkeley flu link.
FAQ for parents about H1N1

For kids, adults, and probably free:
Alameda County H1N1 vaccine clinics.
Contra Costa County H1N1 vaccine clinics.

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