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Pregnant women, health care workers and children six months and older should be placed at the front of the line for swine flu vaccinations this fall, a government panel recommended Wednesday.

The panel also said those first vaccinated should include parents and other caregivers of infants; non-elderly adults who have high-risk medical conditions; and young adults ages 19 to 24.

The Advisory Committee on Immunization Practices voted to set vaccination priorities for those groups Wednesday during a meeting in Atlanta. The panel's recommendations are usually adopted by federal health officials.

The recommendations are designed to address potential limits in vaccine availability this fall if there is heavy demand and limited supplies.

The government estimates that about 120 million swine flu vaccine doses will be available to the public by late October. Roughly 160 million people are in the priority groups considered most vulnerable to infection or most at risk for severe disease.

Although the number recommended to get doses exceeds the projected supply, health officials don't think everyone will run out and get vaccinated. Traditionally, less than half of the people recommended to get seasonal flu shots get them. Only about 15 percent of pregnant women get seasonal flu vaccinations.

If there is ample vaccine, vaccinations also would be recommended for all non-elderly adults, the panel also voted. And if there's still plenty of vaccine, the swine flu shots and spray doses should be offered to people 65 and older. Fewer illnesses have been reported in the elderly, who appear to have higher levels of immunity to the virus, health experts say.

However, the elderly should be pushed to get shots against seasonal flu, which is a significant health risk to older adults.

Panel members say they hope swine flu vaccinations will be opened up quickly. "The only sin is vaccine left in the refrigerator," said Dr. William Schaffner, a Vanderbilt University flu expert, in a comment to the panel.

The panel also said if vaccine is scarce, the government could require that a much tighter group be at the front of the vaccination line, numbering about 40 million. That would include pregnant women and household contacts of small children, just like in the general priority recommendation. But the others would be children ages 6 months through 4 years, children with chronic medical conditions and only health care and emergency services workers who have direct contact with patients.

It's a worst-case scenario that officials aren't expecting, but they wanted to have a plan for it just in case, said officials with the U.S. Centers for Disease Control and Prevention, the federal agency that reviews the panel's recommendations.

The range of recommendations reflects how hard it is to plan for swine flu, officials said. Some health officials have compared the exercise to predicting a hurricane. The storm — or virus — is itself unpredictable; it could grow more dangerous or suddenly weaken. The availability of lifesaving supplies or vaccine can also affect survival.

"It's better to prepare and have the storm fizzle than to be sitting there with no way off the island when the tsunami rolls in," said Kristine Sheedy, a CDC communications specialist.

Variables with the swine flu virus can range from whether it mutates into a form that is more deadly, spreads more efficiently, or is better at fighting off current antiviral medications.

Variables with the vaccine include potential production problems. Production of the vaccine will be a prodigious feat: The government has already purchased 195 million doses for the coming fall and winter, which far eclipses the 125 million or so doses generally produced for seasonal flu vaccine.

Four vaccine manufacturers are wrapping up seasonal flu vaccine production and have begun production of swine flu vaccine. But another company, Sanofi Pasteur, has been more delayed and may not finish seasonal vaccine production until September, a company spokeswoman said. Sanofi is among the largest producers of flu vaccine, so those delays could have a significant ripple effect.

Packaging, distribution and other steps can take a month or more. For those reasons, the government's best guess at the moment is 40 million doses will be available in September and 120 million by around mid-October.

Health officials are pushing for the work to done quickly. There are also clinical trials taking place over the next few months to check the vaccine's safety and effectiveness, but it's possible the government will begin a public vaccination campaign before that work is complete, said Dr. Anne Schuchat, who oversees the CDC's flu vaccination programs.

Why the rush? Vaccines work when given to a patient before they're exposed to the vaccine-targeting virus, and cases may explode not long after kids get back in school, CDC officials said.

Another reason for not waiting for testing data: Health officials are thinking of the swine flu vaccine as a variation of seasonal flu vaccine, which comes out annually and does not undergo the kind of safety and effectiveness testing that new drugs and other new vaccines do.

First identified in April, swine flu has likely infected more than 1 million Americans, the CDCbelieves, with many of those suffering mild cases never reported. There have been 302 deaths and nearly 44,000 laboratory-identified cases, according to CDC numbers released last week.

It's not clear whether the virus in its current form is much worse than seasonal flu in terms of overall threat to the U.S. population, but it is causing more severe illness in some younger adults and children. It has a dangerous genetic characteristic that allows it to infect the lower lungs, whereas seasonal flu tends to infect the upper respiratory tract, CDC officials said.

Original Post: yahoo.com

The projection from the U.S. Centers for Disease Control and Prevention is based on the influenza pandemic in 1957, when almost 70,000 people in the United States died from the flu.

"Our planning assumptions for a severe pandemic were that up to 40 percent of the workforce might be affected and not able to work, either because they were ill or because they needed to stay home to care for an ill family member," Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases, said Friday in a press conference.

But even if the new H1N1 virus never reaches that proportion, it is expected to gain strength come fall.

"We had a 6 to 8 percent attack rate just during the spring months," Schuchat said. "We think that in a longer winter season, attack rates would be two to three times as high as that," she said.

A public health campaign and a vaccination program, which will probably begin in October, could reduce the impact of the H1N1 swine flu, she said.

"We think we can limit, somewhat, the illness and severe complications of that kind of virus circulation with updated guidance and, of course, with the efforts we are making towards the development of a vaccine," Schuchat said.

Vaccine trials, already underway in Australia, are expected to begin in the United States next week, Schuchat said.

U.S. officials hope to have 160 million doses of injectable swine flu vaccine on hand by October, with more doses coming in the form of a nasal spray -- if trials of experimental vaccines are successful.

To determine who should receive the vaccine first, the CDC's Advisory Committee on Immunization Practices will meet Wednesday.

In the Southern Hemisphere, where it is winter now, seasonal flu and the new H1N1 swine flu continue to spread, Schuchat said.

The good news is that "specimens we have collected have not changed. They are still the same strain we are seeing here, meaning that the vaccine we are working on is directed against the strain that is still active both here in the U.S. and in Southern Hemisphere countries," she said.

Also, the CDC, in this week's Morbidity and Mortality Weekly Report, cited four children in Texas who developed neurological complications from encephalitis, associated with the H1N1 flu. Two of them also had seizures, but all recovered and had no lasting neurological effects after leaving the hospital.

"This is a reminder that seizure, encephalitis and other neurologic complications can occur in the setting of influenza," she said.

Although less severe in summer, the H1N1 swine flu continues to spread, especially in summer camps and schools, Schuchat said.

Reacting to reports that some camps are giving children the antiviral drug Tamiflu in hopes of preventing the virus, Schuchat advised against this. Camps should follow the CDC's guidelines on protecting campers from the flu, she said.

Giving antiviral medications in hopes of providing a general immunity can increase the odds that the virus will become resistant to the drugs, Schuchat said. To date, five cases of the H1N1 flu have proved resistant to Tamiflu, she noted. So far, this resistant strain has not been passed on to anyone else, she said.

The CDC also reported Friday that there have been 43,771 confirmed cases of H1N1 infection and 302 deaths in the United States, although officials believe more than 1 million Americans have been stricken with swine flu. The reason for the disparity: The virus continues to produce mild symptoms and patients typically recover quickly. This was the final CDC report of case numbers, Schuchat said, noting in the future it will document swine flu trends.

Original Post: www.healthday.com

The United States could find itself short of swine flu vaccine if the virus becomes much more lethal and countries start to scramble for more of the vaccine, experts warn.

They noted that the United States makes only 20 percent of the flu vaccines it uses. The situation is even worse in Britain, which imports all its flu vaccines. Only a few countries are self-sufficient in vaccines.

"This isn't rocket science. If there is more severe disease, countries will want to hang onto the vaccine for their own citizens," Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, told the Associated Press.

Leaders of countries with adequate supplies of swine flu vaccine won't be willing to share with other nations, experts predict.

"Pandemic vaccine will be a valuable and scarce resource, like oil or food during a famine," David Fidler, an Indiana University law professor who has consulted for the World Health Organization, told the AP. "We've seen how countries behave in those situations, and it's not encouraging."

Original Post: HealthDay

The agency warned, though, that the seasonal vaccine will not guard against a fourth, potentially more dangerous, strain spreading worldwide. This virus, a novel H1N1 influenza widely known as swine flu, has caused more than 40,000 cases and 260 deaths in the USA and its territories.

Its novelty is what makes it so dangerous. Most people, particularly those younger than 50, haven't been exposed to the new virus or viruses like it, so they're relatively defenseless against infection. On June 11, the World Health Organizationissued its highest infectious-disease alert, declaring that a flu pandemic had begun.

The pandemic flu virus only compounds the already considerable threat posed by seasonal influenza, which results in about 200,000 hospitalizations and 36,000 deaths every year, says Anthony Fiore, a flu epidemiologist at the U.S. Centers for Disease Control and Prevention.

"We know these (seasonal) viruses cause a lot of deaths in older people, people with chronic disease and little babies," he says. "It seems to us that the reasonable thing to do is go full speed ahead with seasonal flu vaccinations."

Originapo Post: usatoday.com