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.

Flu Vaccine Locator (AMAZING!), Nationwide USA.

 
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.

H1N1 Influenza—Swine Flu Update

When the H1N1 flu came to my office in April and May of 2009, I had been hearing a lot about it, but with few credible statistics. In a few weeks, I saw maybe a dozen kids and parents with the right symptoms to make the diagnosis. One or two actually had confirmed diagnoses with laboratory testing. I have a tiny practice, so that seemed like a lot at the time.

Perhaps it's obvious that everybody in Washington is expecting worse to come. The mini-epidemic last spring was relatively removed from typical winter conditions in most of the country, so if it returns in mid-winter, as the flu usually does, it might be worse.

In the winter, kids generally spend more time indoors with other kids, often playing actively or in close proximity to each other in school. That's a good way to spread germs. Even at home, that closeness favors the spread of contagious diseases. In the winter, the air is drier and our respiratory secretions are thicker and stickier. That, too, is kind of like flypaper for diseases.

There is another hand to this. So far, I haven't really read much about this particular influenza being more virulent than the regular influenza that comes around every season. That's not terribly reassuring in my line of work, since the regular old flu can be a serious problem for newborns, as well as for kids with a breathing condition like asthma. That's the good news.

The reason, I think, that there's so much worry is that it seems that nearly everybody who's exposed to this H1N1 flu gets sick. Think of what that could mean—you and your whole family all sick at once, your neighbors and friends sick, the pharmacist, and so on. It's not a pretty picture.

The nice folks at the CDC have said there will be a H1N1 vaccine available, probably in October or so. I don't know what the final recommendations will be for who will be the first priority of people to get it. At the moment, it’s recommended for all children and young adults, all pregnant women, and people with other risk factors. I'll get it if I can. There's a regular seasonal flu shot too—it's available now. It's worth a shot.

Note to my patients and their parents: if you want your child to have flu shots this season, please let me know ASAP. I might still be able to order them.

The Centers for Disease Control (CDC) is one branch of the government that works superbly. They are the most authoritative source on this planet for all news of epidemics and new diseases. There is no physician or expert who knows more than they do. All the major news organizations get their information from them, and you should too. The H1N1 Flu page is where you can find the best and most up-to-date information. It's updated at least once every couple of days. Don't be sold on something from the alarmist salesperson at the alternative-medicine pharmacy. Trust yourself and get the straight story from the CDC. They have no hidden agenda and aren't trying to sell you anything.