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CDC Chief: H1N1 Poses More Risk for Kids, Young Adults

October 20, 2009 at 12:00 AM EST
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Health officials warn that young people are expected to be hit the hardest this year by the H1N1 virus. Margaret Warner speaks with the director of the Centers for Disease Control and Prevention for more.
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MARGARET WARNER: If anyone doubted public health warnings earlier this year that swine flu would hit young people hardest, new figures out today should end that.

Of the nearly 5,000 hospitalizations connected with H1N1 between September 1 through October 10, more than half were among people 24 and under. Children and young people aren’t dying in the same proportions, however. They accounted for just 24 percent of the 292 deaths during that period.

The figures are based on reporting from just over half the states. The news comes amid delays in distributing as much H1N1 vaccine as had been predicted by now.

For more on all this, we’re joined from Atlanta by Dr. Thomas Frieden, the director of the Centers for Disease Control, or CDC.

And, Dr. Frieden, thank you for joining us.

Just to drive this point home, children, teenagers and young adults are far more at risk from this flu than they are from seasonal flu.

DR. THOMAS FRIEDEN, director, Centers for Disease Control and Prevention: Absolutely.

What we see is that, the older you are, the more protected you are against this particular strain of flu, H1N1 influenza. And we have seen explosive spread in many school, camp and college settings.

MARGARET WARNER: And then, of those who died, the young people who died, were they — did they have underlying health problems, or were these healthy young people?

DR. THOMAS FRIEDEN: More than two-thirds of all the children who have died from H1N1 flu have had underlying health conditions, but others have not.

And flu can be serious. Even an average case of flu can knock you on your back. It’s no picnic. You can lose a few days of work or school, and, in serious or severe cases, can send you to the hospital, or, tragically, can result in death.

MARGARET WARNER: Now, the briefing your agency held today, another message from that briefing was, if your child or you gets a serious case of flu, don’t wait for the test to confirm it. Go ahead and get the antiviral?

DR. THOMAS FRIEDEN: If you’re having trouble breathing, you should see the doctor or go to the hospital immediately.

For most people with flu — there have been millions and millions cases of H1N1 influenza this season. And most people recovered without any specific treatment and without any specific testing. Most people don’t need to be tested and don’t need to be treated, except in two situations, first, if you’re severely ill, having trouble breathing, having difficulty keeping food, water down, particularly for children, or if you have got an underlying health condition.

That includes women who are pregnant, people who have asthma, heart disease, diabetes, or other conditions that would make it more likely that they would become severely ill with the flu.

MARGARET WARNER: Now, why is it, what’s the latest thinking on why the pattern that we usually see in seasonal flu, which is more older people getting it and more of them dying, is completely reversed here?

DR. THOMAS FRIEDEN: It seems that, the longer you have been around, the more protection you have against certain new types of flu or newly circulating types of flu.

There are lots of theories. We’re not certain of the real reason. But, whatever the reason, the younger you are, the more likely you are to get this particular strain of flu.

Race to produce vaccines

MARGARET WARNER: All right, let's talk about the vaccination now.

Theoretically, if you wanted to vaccinate every American 24 and under, how many doses would you need?

DR. THOMAS FRIEDEN: More than we have.

The good news about vaccine is that there are already about 10 million doses out in the community. We're shipping out hundreds of thousands more every day. And, within two to three weeks, if there are no further manufacturing delays, there will be ample quantities of vaccine around, not enough right away for everyone, but, within the next few months, there should be enough vaccine for everyone who wants to get vaccinated to get vaccinated.

MARGARET WARNER: But just to give us a sense of the proportion here -- I mean, I could have looked up the numbers, but I didn't -- how many Americans are there 24 and under?

DR. THOMAS FRIEDEN: I can't give you the exact number.

MARGARET WARNER: OK.

DR. THOMAS FRIEDEN: There are about 42 million people in the five highest-priority groups.

In addition, the five groups that we have emphasized the most are pregnant women, who are at much higher risk of hospitalization or death, everyone between age six months and 24 years of age, anyone of any age who has an underlying health problem -- and, as you noted in your introduction, many of the people who have died have been young adults or people in their middle age who have health problems -- as well as people who care for infants under the age of six months, because we don't vaccinate young children.

So, those five key priority groups are the most important for vaccine.

Deciding on vaccination

MARGARET WARNER: Now, we read about and hear about parents who have qualms about vaccines, who are reluctant to have their children vaccinated, and also, just anecdotally, of some doctors who are saying to parents, you know, it's usually fairly mild, and you don't have to get your child vaccinated.

Are you saying, basically, they're wrong, that, if you have a child, you better go get him or her vaccinated?

DR. THOMAS FRIEDEN: We're not going to force anyone to get vaccinated. We're going to give the information.

The information is that the vaccine is an excellent match with the strains of flu that are spreading, that the vaccine is made in the same way, by the same companies, in the same factories, with the same safeguards as the seasonal flu vaccine that's been used for hundreds of millions of doses, and which has an excellent safety record.

And the risk of getting sick, missing school and work, and, if you're unlucky or you have an underlying condition and more likely to get sick, getting severely ill and possibly dying, is far higher than any potential risk of the vaccine.

MARGARET WARNER: But parents of young children tell me they're a bit confused about what to do. I mean, on the one hand, they're seeing these and hearing these dire, fairly dire statistics, or alarming ones, and, yet, your agency is also telling people not to panic.

I mean, what really is a parent to do?

DR. THOMAS FRIEDEN: When there's vaccine around, get vaccinated. It's the best thing you can do to reduce the spread of flu and to protect yourself, your family and your community.

MARGARET WARNER: And the other question I have been asked to ask you, which is, what is the real difference between the shot and the mist?

DR. THOMAS FRIEDEN: The mist can only be used for people who are age 2 to 49 and who don't have any underlying health problems. So, it can't be used for pregnant women or people with underlying conditions. It can be used for schoolchildren, college kids, other people who need to be vaccinated. And it can be used for health care workers who don't have underlying conditions.

So, some people prefer the mist. Some people prefer the shot. They're both expected to be highly effective.

MARGARET WARNER: And is there any discernible difference in either effectiveness or risk between the two?

DR. THOMAS FRIEDEN: Not really.

There has been some data on mist. There are some subtle differences between the two, in terms of effectiveness in past years. What that means for this year, we really won't know. They're both made against this particular flu strain. Each year, when flu comes around, we look at the strains that are circulating around the world, and vaccine is made that matches those strains.

H1N1 came too late to be included in this year's flu vaccine. That's why we have a separate H1N1 vaccine. And both the mist and the shot are used against that specific strain.

MARGARET WARNER: Dr. Thomas Frieden, director of the Centers for Disease Control, thank you so much.

DR. THOMAS FRIEDEN: Thank you.