Latest Update on H1N1 Swine Flu As of February 13, 2010

The Centers for Disease Control and Prevention has reported that since the H1N1 swine flu outbreak began last April, almost one in five Americans developed the H1N1 swine, amounting to 57 million Americans representing slightly more than 18 percent of the population. For many, the symptoms were so mild that they did not know they had the H1N1 swine flu. About 11,690 Americans, however, have died and nearly 260,000 Americans had to be hospitalized because of the H1N1 swine flu. As it turns out, adults 18 to 64 were the hardest hit, accounting for 76 percent of the deaths and 58 percent of the infections and hospitalizations. This is in contrast with the seasonal flu where typically 60 percent of the hospitalizations and 90 percent of the deaths occur among persons 65 years or older. There were two major waves of the H1N1 swine flu - one last spring and one this past fall. The good news is that unless a third outbreak occurs before the winter is over, the H1N1 swine flu seems to be abating, with only two million cases and just slightly over 500 deaths have occurred between Dec. 11th and Jan. 16, 2010. Also, an estimated 70 million Americans have been vaccinated against the H1N1 swine flu.

Seven New Pediatric Deaths Reported During Last Week From H1N1 Swine Flu

While the CDC reports a continued decline in H1N1 Swine flu activity, it nevertheless reported seven new pediatric deaths in the United States from the H1N1 swine flu for the week of January 3-9, 2010. Since the first case of the H1N1 swine flu last spring, the CDC reports a total of 300 pediatric deaths thus far in the United States. The CDC cautions that this number is likely to be an under-reporting since it is based on only laboratory confirmed pediatric deaths from the H1N1 swine flu. For this reason, for total deaths the CDC provides only a range of estimates. As of December 12, 2009 (the latest date for which information is available), the CDC's estimate of the total deaths from the H1N1 swine flu in the United States ranged from a low of 7,880 deaths to 14,460 deaths. The good news is that reported cases of both H1N1 swine flu and the regular seasonal flu are decreasing, though both types of flu are expected to continue to infect individuals for the next couple of months.

Dengue Fever Is Already A World-Wide Epidemic

While an estimated 12,500 people worldwide died in 2009 from the H1N1 Swine Flu and billions of dollars were spent on a vaccine to halt its spread, another world-wide health epidemic already currently threatens over 2.5 billion people worldwide - and is increasingly spreading from such places as Mexico into the United States. This is the mosquito-born illness known as the Dengue Fever. Originally confined to Southeast Asia, because of globalization and climate warming, it is a disease that is rapidly spreading throughout the world. What is particularly alarming about the Dengue Fever are three of its characteristics: (1) infected individuals can travel from one country or state to another, and when bitten by a mosquito, can pass the disease on to other individuals bitten by the same mosquito; (2) in some cases, the death rate from the Dengue Fever has been as high as twenty percent; and (3) one's chances of severe complications or dying from the Dengue Fever rise as one is infected more than once.

New H5N1 Avian Flu Outbreak

While most individuals are continuing to focus on the on-going H1N1 swine flu pandemic, they are generally unaware that a new H5N1 avian flu outbreak is occuring with reported cases in several countries, including 90 reported cases in Egypt alone. At this point, no one knows how severe this new flu outbreak will be. While the 2009 H1N1 swine flu has turned out to not be as severe as feared, health officials warn that at some point we could have a repeat of the 1918-19 Spanish flu -- also known as the "Great Influenza" - which caused more deaths from any single cause in human history. As many as 150 million people worldwide died from the 1918 Spanish flu, 700,000 of these in the U.S. Like the current H1N1 swine flu, what was unique about the 1918 Spanish flu was how young people were more likely to die than adults. It is still unclear what are the characteristics of the even newer H5N1 avian flu outbreak.

Latest Update on H1N1 Swine Flu Deaths and Hospitalizations

As of November 14, 2009, the CDC estimates that 34-67 million people in the U.S. had become infected with the H1N1 swine flu, with the best estimate of the likely number of cases being 47 million people. Its best estimates is that of this number 213,000 people ended up being hospitalized for the H1N1 swine flu. In one hospital, 28 of 100 pregnant women in intensive care died from the H1N1 swine flu. While most people did not get seriously ill even though they were infected with the H1N1 swine flu, what has been the greatest concern of health officials has been how in a small number of people it has infected the cells of the lungs of an individual. As the flu cells rapidly mutliply, it causes the cell walls to burst. As of November 14, CDC's best estimate of the number of deaths in the U.S. from the 2009 H1N1 swine flu has been 9,820. Of this number, 7,450 deaths were for individuals aged 18-65 while 1,090 deaths were individuals aged 17 and under. The typical pattern of those individuals who have died from the swine flu has been for them to show signs of getting better - then to suddenly get worse as they develop viral pneumonia. The good news is that since November 14, 2009, the number of H1N1 swine flu cases in the U.S. has been steadily decreasing.

Revised Estimates for H1N1 Swine Flu Deaths

While all types of the flu are notoriously unpredictable, a new study conducted by the Harvard School of Public Health for the federal government indicates that the number of deaths from the current H1N1 swine flu pandemic are likely to be lower than previously predicted. With there currently being over 80 million doses of the H1N1 swine flu vaccine distributed thus far in the U.S., it appears that the worst of the current pandemic might now be past us. This is backed up by recent statistics that show a decrease in hospitalizations from the H1N1 swine flu virus. As a consequence, researchers at the Harvard School of Public Health are predicting that the number of deaths in the U.S. from the H1N1 swine flu for the year will range anywhere from 6,000 to 45,000, with the predicted number of deaths likely being in the 10,000-15,000 range. This compares with the previous estimate of 30,000-90,000 deaths in the U.S. for the current H1N1 swine flu pandemic, 34,000 deaths from the 1967-68 flu epidemic, 70,000 deaths from the 1957-58 flu epidemic, and 500,000-750,000 deaths from the 1917 flu pandemic. Other experts caution, however, that in past flu epidemics, there has typically been a late-winter second wave. If this were to occur with the current pandemic, then death rates could be higher. For this reason, all health experts encourage individuals to get vaccinated for the H1N1 swine flu if they have not already done so. Health experts also caution that the current strain of the H1N1 swine flu could still mutate and become more deadly. Finally, even if the overall death rate for the current H1N1 swine flu pandemic is lower than previously predicted, health experts point out that it has nevertheless had an exceptionally higher percentage among young people and pregnant women. For this reason, the H1N1 swine flu pandemic continues to be a continuing health crisis.

REASONS FOR SHORTAGE OF H1N1 SWINE FLU VACCINE - AND PROBLEMS GOING FORWARD

From a policy perspective, three new events have emerged with respect to the public response to the H1N1 swine flu. One is the realization that public health officials have been under-reporting the number of infected people, hospitalizations and deaths. This has since been corrected so that it is now estimated that 22 million people have thus far contracted the H1N1 swine flu. This contracting of data has also resulted in the CDC reporting that they now people that we have had 540 pediatric deaths (i.e. youth 18 years and younger) and 4000 overall deaths from the H1N1 swine flu thus far. This is a wake-up call - since it is a significantly larger number of deaths and infected persons than had previously been reported.

The second policy event that has emerged is the realization that significantly less than the projected amount of H1N1 swine flu vaccine has been produced and distributed. Because what has been distributed as been freely distributed to almost anyone who wanted it given the assumption that there would be an ample supply, the result is that many (if not most) of the people at the highest risk of death from the H1N1 swine flu have not been able to receive the vaccine as promised. This is the opposite experience in Europe and other developed countries where the flu vaccine is being distributed through appointments so that all individuals at the highest risk of death receive the vaccine first. In the U.S., however, basically no priority has been given to those individuals at the highest risk - leaving high risk individuals to do what they can to find the vaccine given the chaotic distribution system in the U.S. and the resultant long lines where often more people are turned away than receive the vaccine.

The third policy even that has emerged is a realization that the U.S. errored in not developing U.S. manufacturing capacity, and instead relying upon foreign company suppliers. In this regard, because the U.S. had been reduced to only one licensed flu vaccine manufacturer in the United States when the H1N1 swine flu pandemic hit - the U.S. turned to overseas manufacturers to provide the additional required supply of the H1N1 swine fluvaccine. Unfortunately, signing up new manufacturers led to unexpected production problems. Also, the use of overseas manufacturers led to the unexpected problem of Canada and Australia block the shipment of the contracted for vaccines to the U.S. until such time as the total vaccine demand for their own countries could be filled. All of this led to the current crisis where the federal govenment expected to deliver 120 million doses of the H1N1 swine flu vaccine by mid-October, but was only able to deliver 28 million doses by mid-October.

Together, these new policy issues raise significant questions as to what should be done to correct this problem of not enough vaccine being available and of the fact that the highest risk individuals are not being given priority, and thus are not receiving the vaccine (which predictably will lead to a higher death rate than what otherwise would be the case). All of these new policy issues also raise the question as to how the government should respond if the high number of H1N1 swine flu hospitalizations and deaths continue - or even increase - as we get into December and January. There are also two even more frightening possibilties. One is that the H1N1 swine flu mutates, so that we need to produce a new vaccine - or that experience shows that a second shot needs to be given. But the even more frightening possibilitiy is the potential for the H1N1 swine flu to mutate and merge with the Avian flu virus, since the H1N1 swine flu actually already contains elements from the Avian flu virus. This would be a disastrous scenario since the current death rate for the Avian flu virus is that 70 percent of the people who contract it die from it.

Following are the companies currently licensed by the U.S. to produce the H1N1 swine flu vaccine for distribution in the U.S.:

(1) Sanofi Pasteur is located in the United States in Pennsylvania. It has produced 50 percent of the H1N1 swine flu vaccine thus far distributed in the U.S. It is the great success story of the vaccine suppliers for the U.S.

(2) CSL is located in Australia. It "was" expected to be one of the primary suppliers of the H1N1 swine flu vaccine to the U.S., but was blocked by the government of Austrialia from shipping any vaccine to the U.S. until all of the demand in Australia was satisfied.

(3) GlaxoSmithKline is another company contracted to supply the vaccine and is located in Canada. Unfortunately, the Canada govenment blocked it from supplying any of its H1N1 swine flu vaccine to the American market until demand in Canada was fully satisfied.

(4) Novartis Vaccines is located in Liverpool, England. It was also expected to be one of the primary supplies of the H1N1 swine flu vaccine to the U.S., but encountered production problems. It nevertheless has shipped 18 million vaccine doses to the U.S.

(5) Medimmune is the principal producer of the nasal mist form of the vaccine and has shipped all of the 42 million doses of the nasal mist vaccine it was contracted to supply - but a significant amount of the supplies shipped to the U.S. have yet to be distributed.

One additional issue that has arisen is the fact that all other industrialized countries have contracted for an "adjuvanted" version of the H1N1 swine flu vaccine. This allows for a quadruple the amount of vaccine that can be produced and has the added benefit of potentially providing for protection in case the H1N1 swine flu virus mutates. Even though the use of the adjuvant was approved for use in Europe as far back as 1999, the FDA in the U.S. has yet to license its use in the U.S. Ironically, the U.S. has purchased a large supply of the adjuvant that it is not using - but is keeping in storage in Louisville, Kentucky. Given the shortage of vaccine in the U.S. and the unexected number of people infected this early in the season with the H1N1 swine flu, many urge that the U.S. shift to the use of an adjuvant vaccine.