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Show SpecialFeatures Monday, Aug. 24, 2009 Page 17 Massive swine flu vaccination campaign poses challenge BY ROB STEIN The Washington Post be, and how to avoid confusing “On the other hand, if this the public with an overlapping outbreak is early and severe effort to combat the regular and there isn’t enough vaccine, WASHINGTON— seasonal flu. they’ll be criticized for underGovernment health officials To prepare, more than 2,800 preparation.” are mobilizing to launch a local health departments have Officials stress that they are massive swine flu vaccination begun recruiting pediatricians, proceeding cautiously. A final campaign this fall that is obstetricians, nurses, decision to move forward will unprecedented in its scope— pharmacists, paramedics and not be made until they get and in the potential for even dentists along with a the results of clinical trials— complications. small army of volunteers from testing for safety and to The campaign aims to churches and other groups. determine dosing— and assess vaccinate at least half the They are devising strategies the virus’s threat. But officials country’s population within to reach children, teenagers, are confident the vaccine will months. While more people pregnant women and young pass muster and expect a have been inoculated against and middle-aged adults in campaign will be launched as diseases such as smallpox and inner cities, suburban enclaves soon as manufacturers deliver polio over a period of years, the and the countryside. the first vials. United States has never tried to “This is potentially the “There’s little doubt we’re immunize so many so quickly. largest mass-vaccination going to vaccinate people,” But even as scientists rush program in human history,” said Anthony Fauci of the to test the vaccine to ensure said Howard Markel, a National Institute of Allergy it is safe and effective, the professor of medical history and Infectious Diseases, who campaign is lagging. Officials at the University of Michigan is leading the government’s say only about a third as much who is advising the Centers testing of the vaccine. “Who vaccine as they had been for Disease Control and and when and exactly how we expecting by mid-October is Prevention as it spearheads the have to figure out.” graphic likely to arrive by then, when RETRANSMITS effort. The campaign is haunted by that moved Aug. 19 a new wave of infections could Public health officials memories of the government’s be peaking. describe the effort as crucial to ill-fated 1976 effort to Among the unknowns: how defend against the second wave vaccinate against swine flu. many shots people will need, of the Northern Hemisphere’s The epidemic fizzled, but the what the correct dosage should first influenza pandemic in 41 years. As schools reopen, the number of cases could jump “There’s little sharply within weeks, sparking Cases of the H1N1 virus Cases of the H1N1 virus doubt we’re going potentially far with nearly continue to grow with nearly a second wave continue to grow larger than 200,000 the outbreak last around to vaccinate 200,000 confirmed around the confirmed the spring. Although flu1,800people. world and nearly 1,800 deaths. world the andswine nearly deaths. Who and appears no more dangerous when and exactly H1N1 cases by region, H1N1 cases by region, than the typical seasonal as of August 13, 2009 as of August 13, 2009 how we have to flu, the new virus— known The Americas Americas figure out.” as H1N1— The is likely to infect 105,882 many more people because 105,882 ” most have no immunity Europe Europe Anthony Fauci more than 32,000 against it. more than 32,000 infectious disease The vaccine effort carries Western Pacific Western Pacific planner political risks for the Obama 27,111 27,111 administration. “If the Southeast Asia Southeast Asiabe outbreak fizzles, they will 13,172 13,172 susceptible to being criticized vaccine was given to 40 million Eastern Mediterranean Eastern for spending billionsMediterranean of people and blamed for causing 2,532 dollars,” said2,532 Harvey Fineberg, a rare paralyzing disorder Africa president ofAfrica the National known as Guillain-Barre Academy of Sciences’ Syndrome. 1,469 1,469 Institute of Medicine, which advises Another wild card will be SOURCE: World Health Organization AP SOURCE: Worldissues. Health Organization APvaccine will be Congress about medical whether the 5YKPG HNW 5YKPG HNW Speak Up Swine Flu Vaccination Priorities The CDC recommends that two age groups and three other categories be first in line to get the vaccine: Everyone in age group AGE 0 5 10 15 20 6 months to 24 years Those with chronic health disorders or compromised immune systems 25 30 35 40 45 50 55 60 65 Of any age if you: OR 25 - 64 years Once all priority populations have been vaccinated, everyone ages 25 – 64 should be vaccinated. (159 million people) If the vaccine is initially available in limited quantities, these groups should receive the vaccine first: for children younger than 6 months old 5 - 18 years OR 6 months through 4 years (42 million people) ª Are pregnant ª Live with or care ª Are a health care or emergency medical services worker* *If quantities are limited, only those healthcare or emergency personnel who have direct patient contact How the Vaccine Works DEAD VIRUS PROTEINS H1N1 (SWINE FLU) VIRUS 1 The virus carries two proteins on its surface called hemagglutinin (HA) and neuraminidase (NA). NA + HA 2 These proteins give flu strains their main identity, and scientists must match the HA and NA components to form the basis of a vaccine. WEAKER VIRUS 3 These components are combined with segments taken from another, weaker flu strain to make the vaccine. ANTIBODIES 4 The new vaccine is chemically inactivated (“killed”) and then injected into humans. BY ROB STEIN AND LAURA STANTON — THE WASHINGTON POST SOURCES: Centers for Disease Control and Prevention (CDC), World Health Organization delivered with an “adjuvant” to boost its effectiveness or stretch limited supplies into more doses. Adjuvants have been used in Europe, but the Food and Drug Administration has not authorized their use in the United States. “This is an overreaction,” said Barbara Loe Fisher of the National Vaccine Information Center, which opposes many vaccine policies. “There is no national security threat here. Why are we operating like this? This is not polio. This is not smallpox.” Fears and misinformation about the vaccine are already circulating, including inaccurate claims that the vaccine will be mandatory. “I’m very concerned about the dangers of vaccines,” said Janice Smith, 58, of Misawaka, Ind., who attended a public hearing Aug. 15, one of a series of meetings the CDC has sponsored to gauge public sentiment about the vaccine. Authorities are adamant that vaccination will be voluntary, and say there is no reason to think the vaccine will be any less safe than the usual flu vaccine. An adjuvant 5 The vaccine SWINE prompts the creation FLU of swarms of antibodies that recognize the proteins and can fight the swine flu virus, if it later enters the body. will be used only if necessary and proven safe, they say. To address concerns of pregnant women and parents with young children, some vaccine is being produced without a mercury additive. And because the short-term studies can only identify common, immediate side effects, the CDC will step up monitoring for rarer, serious complications such as Guillain-Barre. “We’re putting into place systems that are as good as we can have to identify problems quickly if they do occur,” CDC director Thomas Frieden said. On Friday, officials reported that no “red flags regarding safety” had emerged in the clinical trials. “We are continuing oversight on the quality and safety of the vaccine being produced, and the production process itself,” said Jesse Goodman of the FDA. “That’s going well so far, but our oversight is continuing.” In the meantime, local officials are tailoring plans to their communities. The shots in the arms and squirts up the nose will happen in schools, medical offices, hospitals, public health clinics, workplaces, drug stores and at mass vaccination events, possibly including drivethrough clinics in parking lots where people would stick their arms out their car windows for a stab. “It is clearly what we would call an all hands on deck,” said James Blumenstock of the Association of State and Territorial Health Officials. “We’re not starting from scratch, but we also don’t have everything on the shelf that we can just pull off and put in place. It’s a full-court press in moving forward to have everything in place when we’re ready to go.” Public health departments “have suffered from decades of neglect and are now facing a fiscal crisis in many places where they have had to lay staff off, or furlough staff or freeze hiring,” Frieden said. “So H1N1 has not come at a particularly good time.” Setting priorities for delivering the vaccines will bring other complications. The elderly, usually first in line for flu shots, will not be this time because they seem more resistant to the virus. 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