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Swine flu (Update) roundup:
Vaccine testing on track. Expected Flu Season in the Fall
  Aug 21 2009
Testing of the vaccine against the pandemic H1N1 influenza virus is on track and there have been "no red flags" for adverse effects, said Dr. Antonhy Fauci, director of the National Institute of Allergy and Infectious Diseases, at a news conference today. The only observed problems have been some redness, swelling and soreness at the injection site -- the same as observed with seasonal flu and other vaccines. The first data on the immunogenicity of a single dose of the vaccine should be available by the middle of the September and data from two doses should be available a month later, he said.
Based on the lack of adverse effects in vaccination of the elderly, tests in children age 6 months to 17 years began Wednesday and Thursday, he said. Data from those trials should be available about two weeks after data from the first trials.
The United States expects to have 45 million to 52 million doses of the vaccine available by mid-October and as many as 195 million by the end of the year, said Dr. Jay Butler, director of the Centers for Disease Control and Prevention's H1N1 vaccine test force, in the same news conference. The vaccine will be distributed to the states on the basis of population, he said, and distribution will be coordinated in the same manner as the government's Vaccines for Children program -- although the program will have to enroll many more providers to ensure adequate distribution.
Butler said that there have so far been 7,963 hospitalizations and 522 deaths from laboratory-confirmed infections of pandemic H1N1 in the United States. About 75% of those hospitalized are under the age of 49, as are 60% of those who died. The current round of infection is slowing, he added, with only sporadic cases in all states except Alaska and Maine, which have widespread activity. "Reports of widespread influenza activity in August are very unusual," Butler noted, and emphasize how little is still known about the new virus. Officials believe there have been more than 1 million cases of swine flu in the United States to date.
Worldwide, nearly 1,800 people have died from complications of the virus, with more than 1,200 of them in Latin America, according to the World Health Organization. But flu activity is decreasing in the Southern Hemisphere, Butler said, as the conventional flu season winds down. Activity is also declining in the United Kingdom, which has had a severe outbreak of the virus, but is increasing in Japan -- for reasons that are not clear. A WHO official said earlier this week in China that there could be an "explosion" of new cases this fall with cases doubling every three to four days for several months. Fauci said that the U.S. should expect an upsurge in new cases this fall as children return to school, but Butler said that an explosion of new cases is a "worst case scenario. Whether it will occur, I don't think any of us know."
Agricultural officials in Chile said this week that pandemic H1N1 virus has been found in two flocks of turkeys and that the animals were quarantined and have fully recovered. Officials have been wary about such infections because of the risk that the pandemic H1N1 virus could recombine with the H5N1 avian flu virus, which is much more deadly but not as readily transmissible in humans. Such a recombinant could theoretically possess the easy transmission of the current swine flu virus with the lethality of the bird flu. It could also recombine with seasonal flu, which is resistant to antiviral drugs such as Tamiflu -- thereby limiting options for treating and preventing swine flu infections.
Butler noted, however, that the isolation of the virus from turkey "is not that surprising" because attributes of swine flu viruses help them infect turkeys. The virus was discovered because of a drop in egg production, not because turkeys were dying, and officials have seen no evidence of recombination. "The report did not raise any great concerns among us," he concluded.
-- Thomas H. Maugh II

Employers Advised on Swine Flu; Local Colleges Making Plans
By Annys Shin and Daniel de Vise
Washington Post Staff Writers
Thursday, August 20, 2009
Bracing for a second wave of the swine flu pandemic, the federal government urged employers Wednesday to offer flexible sick-leave policies, while local colleges and universities worked on plans that included confining ill students to their rooms.
The secretaries of commerce, education and homeland security offered guidance to businesses on how to prevent the spread of the H1N1 virus and how to prepare for a major outbreak. They stressed the importance of allowing employees who exhibit flu symptoms to go home and stay home until at least 24 hours after their fevers subside. They also said that businesses should consider eliminating policies requiring a doctor's note to justify a sick day and that employers should be prepared to operate with fewer people.
"If an employee stays home sick, it is not only the best thing for that employee's health . . . but the productivity of the company," Commerce Secretary Gary Locke said at a news conference.
The resurgence of the first pandemic in more than 40 years could cause disruptions for businesses, schools and governments. This spring, the arrival of the virus in the United States led to the closure of more than 700 schools, including several in the Washington region.
With the school year about to begin, public health officials expect to see a resurgence of the virus, which is now the dominant form of influenza circulating globally. The federal government has been stockpiling flu treatments such as Tamiflu and is working with GlaxoSmithKline, Novartis and a few other drugmakers to produce 45 million doses of vaccine. The vaccines are expected to be available in mid-October.
That sense of urgency, however, is not shared by most Americans, who are either "not too" or "not at all" worried about the swine flu hitting home, according to a new Washington Post-ABC News poll. Most said they have confidence that the government and local health providers will be able to effectively deal with an outbreak. About 55 percent of Americans said they are apt to get the vaccine for themselves or someone in their household.
Most people who have become infected have experienced relatively mild illness. Scientists are watching to see whether the virus mutates into a more dangerous form.
Government officials said even if the severity of the virus does not change, it is still likely to infect more people during the autumn and winter than it did in the spring. Children and younger adults appear to be more vulnerable.
Emergency planners from several Washington area colleges met Wednesday to review flu preparations. Local colleges are generally advising students who develop flulike symptoms to call -- rather than visit -- the campus health center. Those with mild symptoms are likely to be voluntarily confined to their rooms until their symptoms pass. Schools are setting up protocols for friends or roommates to bring food to the sick, as well as procedures for healthy students to be separated from ill roommates for a few nights.
"We don't have the capability to move all the sick kids into one dorm," said James Turner, head of student health at the University of Virginia. The University of Delaware, which had 22 confirmed swine flu cases in the spring, is blanketing the campus with touch-free sanitizer stations, said Marcia Nickle, the school's emergency preparedness coordinator.
Many schools are determining the number of cases or the rate of absenteeism that would trigger class cancellations. "No one really knows what that tipping point is at this stage of the game," said John Williams, George Washington University's provost and a physician.
The H1N1 virus surfaced this spring in Mexico and spread to at least 168 countries. As of Friday, there had been more than 177,000 confirmed cases and at least 1,462 deaths, including 477 in the United States, according to the Centers for Disease Control and Prevention. As many as 2 billion people could contract the flu before the pandemic is over, the World Health Organization estimates.
To minimize H1N1's spread, the Cabinet secretaries told employers Wednesday to consider limiting face-to-face meetings and travel, to encourage telecommuting and to make alternate work arrangements for employees such as pregnant women who are at high risk for complications from the virus.
Asked whether the government would order businesses to close if the circumstances warranted it, Locke said that it would be up to businesses to decide and that each industry is so different, it is "impossible to make a sweeping statement."
The Cabinet secretaries also said employers should be flexible in the event that schools are closed and employees have to make alternate child-care arrangements.
Staff writer Jon Cohen contributed to this report.
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