From Our 2009 Archives

First Doses of Swine Flu Vaccine Coming Soon

CDC Says 3.4 Million Doses Will Be Ready in Early October

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

Sept. 18, 2009 -- The first 3.4 million doses of swine flu vaccine -- all the nasal spray vaccine -- will ship in early October, the CDC said today.

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H1N1 Swine Flu

In addition, some flu shots may be ready to ship by then, too, Jay Butler, MD, chief of the CDC's H1N1 Vaccine Task Force, said at a news conference.

"Vaccine will be going out and will be distributed to providers by the first week of October," Butler said. "Additional vaccine may be available as well, but 3.4 million doses is the hard number that we have right now. And all that vaccine is the live attenuated vaccine, which is the nasal spray."

H1N1 swine flu vaccine will be distributed to states according to population. Here's how it works:

  • Some 90,000 provider sites -- some of them retail chains with many stores -- will order vaccine from state health departments.
  • State and local health authorities will triage the orders, deciding who gets how many doses of vaccine.
  • State and local authorities will then send the orders to the CDC, which will collate them and send them to the distributors at about 5 a.m. the next morning.
  • Distributors will fill the orders within three business days and then ship the vaccine by overnight express to providers.
  • By mid-October, some 45 million vaccine doses will be available. Every week after Oct. 15, 20 million more doses of vaccine will become available until the entire U.S. allotment of 195 million doses is reached.

Unlike the more traditional flu shots, the nasal spray version of swine flu vaccine is approved only for people age 2 to 49 years. That means that very young children -- one of the priority groups for swine flu vaccination -- won't be getting these first doses. Neither will pregnant women.

Instead, these first 3.4 million vaccine doses likely will go to health care workers with direct patient contact, or to caretakers and household contacts of infants under 6 months of age.

"It's a decision that really does need to be made locally," Butler said.

Two Flu Shots for Kids

The good news from clinical trials of H1N1 swine flu vaccine is that healthy adults need only one dose of vaccine for protection.

But the package inserts being readied for the vaccine say that kids under age 10 years will need two doses of vaccine, given three weeks apart.

"We anticipate that two doses will be required for younger children," Butler said.

Do You Need Vaccine if You've Already Had a Flu-Like Illness?

Swine flu is, of course, already here and moving like wildfire. It's now widespread in 21 states, with cases in all 50 states.

"It's a very strange thing for us to see that amount of influenza at this time of year," Daniel Jernigan, MD, deputy director of the CDC's flu division, said at the news conference. "In the Southeast right now there's a considerable amount of influenza disease, very consistent with the earlier opening of schools in the Southeast. ... We may expect that increases in numbers of cases will occur in other parts of the country, where kids are now getting back together."

It's clear that a lot of people will have had the flu by the time the flu vaccine arrives.

If you've had a flu-like illness since the pandemic began, will you need a flu shot? Yes, Jernigan says.

It's true that you're immune to swine flu if you've already had it. But H1N1 swine flu isn't the only bug that causes flu-like symptoms.

Unless you've had a laboratory-confirmed case of swine flu -- not just a rapid flu test in a doctor's office, but a lab test of a nasal swab sample -- you really can't know that you've had the flu. And such tests aren't being done on people with mild cases of flu.

"There's no evidence that, even if you have immunity, getting the vaccine would cause problems or increase the chances of a reaction," Butler said. "Certainly for myself, if I had been ill in the past six months without a lab confirmation, I would definitely want to get the vaccine."

It's a Pandemic, but Not a Bad One

When swine flu first appeared, the signs were ominous: Previously healthy young people were showing up in hospitals with severe disease. Some died.

It looked as though the swine flu pandemic was going to be bad one. But that no longer seems to be the case.

Early severity estimates were based on cases that came to medical attention, while milder cases weren't at first noticed. Now it appears that -- at least so far -- we've been lucky. While lots of people have and will have swine flu, it's not as bad a pandemic as the terrible pandemic of 1918 or even the moderate pandemic of 1957.

This week, Harvard researcher Mark Lipsitch, PhD, told an Institute of Medicine meeting that on a 1 to 5 scale -- with 5 being a 1918-like pandemic -- the swine flu pandemic looks more like a 1.

Jernigan said that the CDC has been collaborating with Lipsitch, but is doing its own analysis.

"We are likely to have numbers that look very similar to what Dr. Lipsitch had," Jernigan said. "Our estimates do indicate that the amount of disease is about what we would expect for a severe influenza season and not at the levels of the pandemics from 1918 or 1957."

That said, Jernigan noted that flu viruses can change quite quickly, and that the CDC will continue to monitor the severity of the pandemic in the U.S. and elsewhere.

"There's only so much that you can do with forecasting," he said.

SOURCES: Daniel Jernigan, MD, deputy director, Influenza division, CDC. Jay Butler, MD, chief, 2009 H1N1 Vaccine Task Force, CDC.

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