Swine flu: No crisis ... but still a threat

Last March, a mysterious virus surfaced in California. Spreading like wildfire, it was reported in all 50 states by May. In June, the World Health Organization announced a global H1N1/swine flu pandemic, and in late October, President Obama declared H1N1 a national emergency.

Amid reports of school closures, hospitalizations and deaths, an anxious public awaited the H1N1 vaccine, but severe shortages and unexplained delays hindered the government plan to keep the deadly virus at bay. Finally, in late December, large quantities of the government-ordered vaccines began arriving at clinics, doctors’ offices and large drug and retail stores.

By then, though, flu cases had waned and many people had lost interest in H1N1 protection. As of early January, about 20 percent of Americans — about 61 million adults — and 29 percent of children ages 6 months to 18 years had been immunized, according to the Centers for Disease Control and Prevention.

So far, the predicted crisis has not materialized.

But the flu comes in waves. Although winter is almost over, H1N1 is not, according to health officials. While the seasonal flu typically runs its course by late spring, experts say that H1N1 can endure through summer and beyond, which means there’s plenty of time to get sick.

“H1N1 is an unpredictable virus with potentially serious and life-threatening consequences,” warned Dr. Henry Bernstein, a professor of pediatrics at Dartmouth Medical School and a member of the Committee on Infectious Diseases for the American Academy of Pediatrics. “But the good news is, H1N1 is preventable and helped measurably by immunization.”

Bernstein notes there have been two waves of H1N1 so far, and he believes there could be another one that could be worse.

From mid-April 2009 to mid-January 2010, the CDC reported about 84 million cases of H1N1, 378,000 hospitalizations and between 8,330 and 17,160 deaths.

Currently, the state of Georgia is reporting 792 hospitalizations and 43 deaths from swine flu, according to the Georgia Health Public Laboratory.

In Georgia’s North Central Health District, which encompasses 13 area counties, including Bibb and Houston, district spokeswoman Jennifer Jones said there have been 33 hospitalizations and three deaths since the H1N1 outbreak last spring. The deaths include a 41-year-old in Bibb County, a 59-year-old in Monroe, and a 63-year-old in Putnam. All had pre-existing medical conditions.

A false sense of security

H1N1 packed a wallop last spring, summer and fall, hitting hard among children, young adults, pregnant women and people with chronic health conditions.

Fears began after a rash of illness in a parochial prep school in Queens, N.Y. Some schools closed to prevent the flu from spreading.

Schools and summer camp organizations crafted plans to combat the illness, minimize the spread and strategize about potential future outbreaks. By late fall, health professionals were urging people to get immunized for the seasonal flu as well as H1N1 when the vaccine for that flu became available.

But what a difference a few months can make.

Dr. David Harvey, medical director of the North Central Health District, said the past two months have been quiet.

“This was a very complicated year. H1N1 didn’t turn out to be as severe as feared,” he acknowledged, “but it was one of the best exercises in mass preparation for whatever is coming next. We’re likely to see H1N1 year-round.”

Harvey and other midstate physicians are concerned that, because the seasonal flu has been minimal this winter, people have fallen into a false sense of security about H1N1. With vaccine supplies now plentiful, the CDC and medical professionals are promoting immunization.

The lack of an H1N1 crisis may be only part of the reason more people aren’t getting immunized.

Dr. Brad Stevens of Internal Medicine Associates in Macon says about 80 percent of his patients feared getting the vaccine. “Although we’ve administered a lot of vaccines since receiving our supply in the fall, people were more afraid about this particular shot for various reasons,” he said.

Stevens says some patients were afraid of getting the flu — or worse — from the vaccine. “They expressed fears about paralysis and Guillain-Barre Syndrome,” a disorder in which the body’s immune system attacks part of the peripheral nervous system.

Even some health-care professionals have shunned the shot. The CDC estimates that only about half of all U.S. health-care workers are immunized.

H1N1 injections can produce soreness at the site for a couple of days and mild, flulike symptoms. But all of the doctors interviewed for this article say the vaccine is safe, and that they took it themselves.

Stevens says he did considerable research before he took it and administered it to patients, adding, “The vaccines from decades ago have been improved measurably and are safe.”

Harvey, a pediatrician for nearly 40 years in Warner Robins before joining the North Central Health District two years ago, said fears about the H1N1 vaccine are unfounded. “In fact,” he said, “We’ve been told that elements of this year’s H1N1 will be included in next year’s seasonal flu vaccine.”

For their part, national pharmacy chains are conducting advertising blitzes in hopes of utilizing their now abundant supplies of the H1N1 vaccine.

But for some pharmacists, the early vaccine shortage became a case of missed opportunity.

“We typically give lots of shots each season in my pharmacies,’ said Dr. Wade Scott, who owns pharmacies on Pio Nono Avenue and Gray Highway. But while his drug rep repeatedly promised he’d have the seasonal flu vaccine in October and November, he said, “this year I couldn’t get the H1N1 vaccine at all and the seasonal flu vaccine until mid-December, when it no longer made sense to buy it because so many people had been immunized. At that point, I made a business decision.

As Scott noted, “Once (the vaccine’s) received, there are no returns. It’s always a gamble how much to order.”

Another pharmacist who works for a national chain in north Macon, but who isn’t permitted to speak directly with the media, said, “I’ve given about 900 seasonal flu shots since the fall, but haven’t given 100 of the H1N1 shots. If we had received the H1N1 vaccine in October when the stories of illness and death were in the news, we would have given a lot more shots.”

The case for immunization

Generally, doctors say, getting the H1N1 flu shot in addition to the seasonal flu vaccine is a no-brainer. Influenza is the eighth leading cause of death among people of all ages, and it is believed to be responsible for about 20,000 hospitalizations annually.

On average, about 36,000 people die from the seasonal flu in the United States any given year, and the swine flu has been responsible for about 16,000 deaths since this past April.

The H1N1 vaccine reduces the likelihood of falling ill by 70 percent to 90 percent, and for people who get the flu despite being immunized, it’s usually less severe, according to the CDC’s Web site.

Swine flu has been especially problematic for several groups, such as young children, pregnant women and people whose health already is compromised. Lung and respiratory diseases, heart disease and diabetes increase the risk of flu-related hospitalizations. Bernstein points out that pediatric deaths from flu are up dramatically in the past year.

Ideally, people should get immunized as soon as the vaccine becomes available, usually in early fall, but medical personnel say getting the vaccine now still provides protection.

Of particular concern are children 10 and under, who should get two doses of the H1N1 vaccine. Although there are no national statistics on second doses for children, USA Today surveyed 14 states, including Georgia, that require recorded registries for all H1N1 doses. The USA Today report, published in January, said 83 percent of Georgia’s children are missing their second dose of the vaccine, which translates to 168,497 children.

To underscore the need for children to be immunized, the North Central Health District offered the H1N1 vaccine to all public and private school children in the region, and they offered it during the school day to make it convenient. Eleven of the 13 counties and some private schools participated in the immunization program.

Jones, the health district’s public information officer, said the two doses of H1N1 vaccine for younger children must be given at least 28 days apart, and permission slips are needed for each dose.

“We’re still in talks with the school boards about the follow-up vaccine and are appreciative of their cooperation. We could never have immunized so many children without their help.”

Bernstein, meanwhile, cautioned the public to be vigilant. “There’s an assumption that the flu is gone, but it’s not. We’ve probably not seen the last of H1N1. It’s a moving target. That’s why it’s important to be immunized annually.”

Harvey, who served on Houston County’s Board of Health for nearly three decades added, “It’s hard to sell everyone on immunization, but education is our best defense.”