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CDC: H1N1 Vaccine Efforts Not Meeting Goals

October 23, 2009 at 12:00 AM EDT
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The Center for Disease Control and Prevention said Friday that the H1N1 flu's effects have already matched those of the seasonal flu. Ray Suarez reports.

JUDY WOODRUFF: New data released today from U.S. and world health authorities show that the H1N1 virus extending its reach, and U.S. health officials admitted that vaccine production goals are falling short.

Ray Suarez has our lead story report.

DR. THOMAS FRIEDEN, director, Centers for Disease Control and Prevention: Vaccine production is much less predictable than we would wish. We’re nowhere near where we thought we would be by now. We’re not near where the vaccine manufacturers predicted we would be.

RAY SUAREZ: That acknowledgement came today from the Centers for Disease Control director’s, Thomas Frieden.

DR. THOMAS FRIEDEN: The vaccine strains of the virus grow, and that’s how we develop vaccine. Even if you yell at them, they don’t grow faster.

WOMAN: We have about 100 doses of injectable left.

RAY SUAREZ: The shortfall has caused many who wanted to get the vaccine to be turned away.

MAN: They said it was just for the younger people and the pregnant ladies.

RAY SUAREZ: The CDC said today most of those vaccinated have been children, and they are also more likely to become ill. At least 95 children have died since April.

So far, H1N1 is responsible for more than 1,000 deaths in the U.S. since the spring. Typically, about 36,000 Americans die from seasonal flu each year. H1N1 is becoming more widespread. The CDC said, 46 states are now reporting flu activity.

But Frieden downplayed a survey the Center released yesterday that found one in five children had symptoms of a flu.

DR. THOMAS FRIEDEN: That is very different from saying that they have had H1N1 influenza. And a much smaller proportion — and we don’t know how much smaller — would have had H1N1 influenza. We have seen in certain communities with lots of H1N1 influenza that the peak attack rate can be as high one in five in children at the peak of the activity.

But I don’t think that’s what those data show. Those data simply show that kids get a lot of infections.

Flu often begins with kids

RAY SUAREZ: Schools have struggled to keep the outbreak from spreading...

WOMAN: We have special cleaning products that we use.

RAY SUAREZ: ... with disinfectant and with hand-sanitizing lessons.

DR. THOMAS FRIEDEN: As happens with flu each year, it generally begins in kids, and then we see it later in young adults. We are still not seeing significant numbers of cases in the elderly. And that is a characteristic of this virus.

RAY SUAREZ: As more kids get sick, an increasing number of schools are closing, but Frieden stressed it was a local decision.

DR. THOMAS FRIEDEN: Schools should be closed when, administratively, it becomes very difficult or impossible for the school to continue operating, or if there are a large number of kids who have serious underlying conditions, such as muscular dystrophy, that would put them at greater risk for serious complications of the flu.

RAY SUAREZ: Worldwide, new numbers out today from the World Health Organization reveal 5,000 people have died from the virus.

And for more on the troubles with the vaccine and what comes next, we turn to doctor Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health.

Dr. Fauci, the vaccine has been called the more important public health tool in fighting H1N1. Any good estimate on how long it will take to close the gap between demand and supply?

DR. ANTHONY FAUCI: It's probably going to take several weeks, Ray, because, right now, we're at that point where we have, obviously, less than we had anticipated at this particular point, mid- to late October.

But starting with the next few weeks, when you talk about the -- the last week in October we're in now, the first week of November, then second, we will be averaging between eight million to 10 million doses a week that will be coming in, so that, by the end of November, we likely will have around 65 million doses.

So, I think it's going to be a matter of a couple of weeks before we get to the point where we're doing really well, and then maybe four weeks total where we actually have the equilibrium, the balance you're talking about, where the people who want it are going to be able to go to the centers where it's distributed and get it.

Ultimately, as we get into the late fall, we hope that we will have vaccine -- and I believe we will -- for everyone who needs it and wants it.

RAY SUAREZ: What has turned out to be the holdup with getting a sufficient amount of H1N1 vaccine out and distributed?

Competing demands slows production

Dr. Anthony Fauci
National Institute of Health
The companies were trying to do two things at the same time, because they had to get their seasonal flu made, and then they also had to do H1N1. So, there was competing demands.

DR. ANTHONY FAUCI: Well, the delay is predominantly related to the fact the virus that grows in eggs, from which you make a -- you make a vaccine from virus that you grow in eggs, and then you purify it, you like it, you inactivate it. Or, if you the live attenuated, you weaken it a bit.

It's all from the common source of being grown in eggs, and sometimes that process is slower than you would have anticipated it is. That's exactly what happened now with the production, that the virus itself did not grow very well, so the anticipated numbers of doses that we thought we would get, we didn't get on time.

And that's the reason why we have the shortage right now. In addition, the companies were trying to do two things at the same time, because they had to get their seasonal flu made, and then they also had to do H1N1. So, there was competing demands there. The combination of competing demands and a virus that wasn't growing as robustly as we had hoped it would grow has essentially resulted in these types of delays.

RAY SUAREZ: Is there a risk, when you put out the teaching, the public health message, urge people to get the vaccine, and when they turn up for it, they can't get it? Will some of those people turned away never get a vaccine?

DR. ANTHONY FAUCI: Well, see, that's the problem.

It is a difficult messaging situation, because you want to keep it on the people's radar screen that they should be vaccinated, particularly the people who are at the higher risks, the five categories that we have mentioned so many times. But it's a difficult message.

When you say, you need to get it, their first response is, well, I want to go get it. And, right now, at this particular time, unfortunately, but it's a reality, that the anticipated number of doses are not there at the amounts that we had anticipated. But we're going to be catching up with that, as we just mentioned, in a few weeks.

RAY SUAREZ: So, given that that is the situation, is there a triage going on? Who should be getting what vaccine there is right away?

DR. ANTHONY FAUCI: Well, the people who should be getting it are certainly young children, who -- who are the ones that are vulnerable.

If you look at the curve of people who are getting infected and the people who are in fact getting complications, people who have underlying conditions that predispose them to the complications of influenza and pregnant women should be right up there in the group that gets the highest priority for the vaccine that is available in small amounts, as it is at this particular time.

And, again, as mentioned, hopefully, we will be seeing that change pretty soon.

RAY SUAREZ: As individual schools look at their number of cases, are there stages in a public health response where, if you see you've got a low number of cases, you might stay open, but other schools might have to close?

How to prevent H1N1 infection

Dr. Anthony Fauci
National Institute of Health
You might want to have some active surveillance of kids who come in, so that when a teacher sees someone who is sick, you could then tell them put them in a holding room.

DR. ANTHONY FAUCI: Well, the situation is, as we have heard from the CDC -- and -- and they're maintaining this -- that they would like to have a situation where you don't have mass school closing, because of the disruption that that causes in so many ways.

So, what you would like to do is to reinforce to parents that, when their children are sick, not to send them to school. We would hope that people would adhere to that. If you get to the situation where you're getting more and more infections, then you might want to intensify that a bit, and you have a bigger outbreak than, for example, we had in the spring and that we're currently having right now.

You might want to have some active surveillance of kids who come in, so that when a teacher sees someone who is sick, you could then tell them put them in a holding room and call up the parents and tell them to take the children back home.

But, right now, we're relying on parents realizing that, if a child is sick, don't send them to school. And, then, all the other things we talk about, the simple hygienic things, like, for example, when you cough, cover yourself, when you sneeze, make sure you cover yourself, those are for people who are sick.

When you see there are people who are sick, try and get people to stay away from situations, if you're in an area where there's a lot of flu, crowded places where people would wind up transmitting the virus very easily. Those are the kind of simple things that you keep in mind.

Obviously, as you said, Ray, from the very beginning, the best way to do all this is to combine it with a vaccine. But between now and the time when we have enough vaccine to be giving it to everyone who needs it and wants it, those are the kind of simple hygienic things and commonsense things that we can do, such as keeping children from going to school who are sick.

Battling two types of the flu

Dr. Anthony Fauci
National Institute of Health
You're probably going to see two different populations getting struck harder than the other, depending upon what the flu is.

RAY SUAREZ: You will be seeing seasonal flu right alongside the H1N1. Is it tough fighting them both at the same time?

And given that H1N1 is more likely than seasonal flu to cause serious viral pneumonia, do we have to treat it almost as a separate disease and put separate measures in place?

DR. ANTHONY FAUCI: No, I don't think so.

The only thing that we do know and we realize that this virus, the H1N1 so-called pandemic flu, has a predisposition to infect young people, and, of those young people in this very small percentage of people who wind up getting serious complications, namely, pneumonias and hospitalizations and deaths, those are predominantly among very young people, people who have underlying conditions, and pregnant women.

Pregnant women have about a six-times greater possibility of getting a complication from the flu than people who are non-pregnant. With seasonal flu, the curve is different. The people who are the most vulnerable are the elderly, 65 years of age or over.

Ninety-plus percent of the deaths in seasonal flu, the 36,000 deaths that we see each year with seasonal flu, are in people 65 years of age or older, and mostly people who are 80 years of age or older. So, you're probably going to see two different populations getting struck harder than the other, depending upon what the flu is.

Right now, we're really not seeing any seasonal flu activity. Hopefully, with the H1N1 being around, that it might kind of push it off the radar screen a bit, but we need to anticipate that we will see seasonal flu. And that's the reason why we should not forget that the people who need it should be getting their seasonal flu vaccinations, also.

RAY SUAREZ: Dr. Fauci, thanks for joining us.

DR. ANTHONY FAUCI: Good to be here.

JUDY WOODRUFF: You can pose questions about the H1N1 vaccine in a special insider forum on our Web site,