H1N1 Update

AP is reporting that “some people who aren’t at high risk for swine flu complications got the much-in-demand vaccine…healthy adults or senior citizens instead of kids, pregnant women and people with health problems.”

Should that be cause for alarm? On the one hand, public health officials and members of at-risk populations should be proactive about getting the vaccine, and others should be supportive of those efforts. But on the other, the greater the number of vaccine administrations, the lower the risk of H1N1 to the rest of the population, including at-risk groups. As the article reports:

One of the doctors who helped draw up guidelines for vaccine priority groups also isn’t surprised at how things are unfolding.

The government’s vaccine advisory panel “did not expect vaccine police to be set up around the country,” said Dr. William Schaffner, a flu specialist at Vanderbilt University Medical Center, who is on the panel.

If vaccine demand is low in some locations, it makes sense for non-priority groups to get it instead of wasting the supply.

“I don’t consider it a problem,” said Schaffner. “I consider it more of a problem if vaccine is left unused.”

That seems to make sense. Also, flu trends being reported by the CDC are scary enough this year that we can understand people’s temptation to avoid chivalrous conduct. Based on the latest data released for Week 41, which ended October 17th:

• Just about all of the reported and tested flu cases this season appear to be H1N1 (“swine flu”).
• The proportion of deaths relative to the number of hospitalizations has run between roughly 3% and 8%. Granted, this is a hospitalization-fatality rate, not a case-fatality rate. But imagine you have a severe enough case to enter the hospital, and have a 5% chance of not returning home. And while the proportion of deaths appears to be trending down since late August, the number of hospitalizations is up over 500%, so a lower percentage of fatalities out of a much larger number of hospitalizations provides little comfort — for example, the number of deaths in week 41 was up more than 200% over week 35.
• The number of flu deaths per week has been increasing exponentially since 2006, and to paraphrase George Soros, it’s gone ‘parabolic’ this year. There were 1.5 deaths per week in 2006-07, 1.7 in 2007-08, and 2.23 in 2008-09, while the current run rate for 2009-10 is 7.6! [We divided by fifty two because the flu didn't take its normal seasonal break this summer; the actual number of deaths per week during flu seasons would be higher than those figures.]
• According to this chart of expected versus actual cumulative hospitalizations and deaths, it’s not apparent that any age groups are at higher risk  than any others. In fact, one could argue that the 18-49 group should be at the front of the line! As we pointed out previously, this mimics the ‘W shaped’ global influenza pandemic of 1918 that killed many, many millions of people, and a far greater number of healthy adults than a typical influenza virus.

H1N1 is not only scary enough at the moment to excuse some people elbowing their way to the front of the line for the vaccine. You can actually make a sound argument, based on historical evidence and current data, that healthy twenty to forty year olds should be included in the target population for the vaccine. Perhaps that’s one reason why the CDC is not up in arms about the lack of ‘vaccine police’.

URLs:

http://news.yahoo.com/s/ap/20091030/ap_on_he_me/us_med_swine_flu_vaccine_cheaters

http://www.cdc.gov/flu/weekly/

http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/AHDR41.htm

http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/IPD41.htm

http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/EIP41.htm

http://www.cdc.gov/ncidod/eid/vol12no01/05-0979-G2.htm

http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm

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