BETHESDA, Md. — The Obama administration warned Americans on Thursday to be ready for an aggressive return of the swine flu virus in the fall, announcing plans to begin vaccinations in October and offering states and hospitals money to help them prepare.
“The potential for a significant outbreak in the fall is looming,” President Obama said via telephone link from Italy to the White House’s H1N1 Influenza Preparedness Summit, held at the National Institutes of Health.
With good planning, he added, “we may end up averting a crisis. That’s our fervent hope.”
The summit meeting, jointly led by the secretary of Health and Human Services, Kathleen Sebelius; the secretary of Homeland Security, Janet Napolitano; and the secretary of Education, Arne Duncan, gathered health and school officials from across the country and took questions by video link from the governors of several states — most of whom wanted to know who would pay for preparations like the vaccination drive.
Vaccinations will begin in October only if tests scheduled to begin in August prove that it is safe and effective. Even then, officials expect only tens of millions of doses to be ready, so they will have to decide who gets vaccinated first. The most likely candidates, Ms. Sebelius said, are school children, health care workers, pregnant women and people with asthma or other conditions that make the flu more risky.
While health officials were careful to warn that there is no evidence that the flu has mutated into a more dangerous form, they noted that it seriously disrupted some cities, including New York, in the late spring and could do worse as the fall flu season begins.
“This flu is not over,” said Dr. Thomas Frieden, the new head of the Centers for Disease Control and Prevention, describing its continuing spread in more than 50 summer camps, the large numbers of cases seen in Chile, Argentina and Australia, which are now at the beginning of their flu season, and the initial detections of three Tamiflu-resistant cases.
At the flu’s peak in May, Mr. Duncan noted, there were 726 schools closed across the United States. Decisions on closing schools will be made locally, he said. Officials from New York and Texas described the difficulties they had in deciding which schools to shut down and how hard it was to explain why they picked those they did.
Both schools and businesses need to prepare for the possibility of several weeks of high absenteeism, Ms. Napolitano said. She also reminded governors that not only the obvious services, like hospitals and schools, would be affected.
“As a former governor, I can say: make sure your payroll continues,” she said. “Whoever processes your checks, make sure they have a backup.”
Ms. Sebelius outlined actions the federal government is taking. It will offer $260 million in “preparedness grants” to states and cities for the vaccination drive and $90 million to hospitals preparing for surges of cases. (Congress has already appropriated $1 billion for vaccine ingredients and up to $7.5 billion more for testing, buying and distributing vaccine if health officials decide it is safe and effective.)
The Health and Human Services Department is also remaking its Web site, www.flu.gov, to be the central repository of information for everyone: parents, school officials, doctors. And it will hold a contest, asking Americans to film their own public service announcements about flu.
“This is a YouTube challenge to everyone,” Ms. Sebelius said. “The best will be aired nationwide.”
Health officials said that they were aware of fears that a Tamiflu-resistant strain of the virus is already spreading silently in the United States, but that they had not seen evidence that it is a threat.
The worry stems from a single case found in a teenage girl who flew to Hong Kong from San Francisco on June 12. According to Hong Kong media reports, she was found to have a fever during a routine airport screening and was hospitalized as a precaution and tested.
She was never dangerously ill, was not treated with Tamiflu and recovered. But the sequence of her virus, released by Hong Kong authorities last week, showed that it had a mutation, known as H274Y on the neuraminidase gene, making it resistant to Tamiflu, a neuraminidase inhibitor.
The fact that she had a resistant strain without being treated suggests that she caught an already resistant virus from someone else, presumably in Northern California, said Henry L. Niman, who runs a Web site tracking flu mutations (recombinomics.com). Because sequencing in the United States is done on only the tiny fraction of flu cases serious enough to be hospitalized, Tamiflu-resistant virus could be circulating without being detected.
Dr. Frieden said the disease control centers had begun intensifying its monitoring in Northern California, “and it does not appear to be widespread.”
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said there was little reason to worry unless it becomes the dominant strain.
“But certainly you want to keep your eye on it,” he added.
Different strains of virus “compete” with each other each year, and the drug-resistant strains do not always win. But a Tamiflu-resistant strain of seasonal H1N1 flu utterly crushed its rivals during the last American flu season, rising to 99 percent of sequenced samples.
Also, Tamiflu-resistant strains can sometimes be successfully treated with Relenza, another neuraminidase inhibitor, with older flu drugs like rimantadine, or even with larger Tamiflu doses.
“It does worry me, though we know enough to expect this,” said Dr. Anne Moscona, a flu treatment expert at Cornell University’s medical school. “It strengthens the argument for more Relenza in the stockpile,” she added, referring to the national stockpile of supplies for an influenza pandemic.
No comments:
Post a Comment