Globally, Locally Public Health Officials Warn:

H1N1 Pandemic In Early Stages

By John Voket

From the offices of worldwide health officials to the desk of the Newtown Health District (NHD) director, public health and medical professionals are gearing up for the boomerang effect of the H1N1 or swine flu, which is expected to return in force this fall and winter.

While Newtown Health Director Donna Culbert tends to interactive webinars and meetings with state and regional health care workers in an effort to be better prepared locally, Keiji Fukuda, the World Health Organization’s assistant director-general for health security and environment, warned last week that the global swine flu epidemic is still in its early stages.

In an Associated Press interview August 7, Dr Fukuda said that given the size of the world’s population, the new H1N1 virus is likely to spread for some time.

The WHO earlier estimated that as many as 2 billion people could become infected over the next two years — nearly one-third of the world population.

“Even if we have hundreds of thousands of cases or a few millions of cases ... we’re relatively early in the pandemic,” Dr Fukuda said in an interview at WHO’s headquarters in Geneva.

The global health agency stopped asking governments to report new cases last week, saying the effort was too great now that the disease has become so widespread in some countries.

Authorities in Britain say there were more than 100,000 infections in England alone last week, while US health officials estimate the United States has passed the one million case mark. Those figures dwarf WHO’s tally of 130,000 confirmed cases worldwide since the start of the outbreak last spring.

“We know that the total number of laboratory-confirmed cases is really only a subset of the total number of cases,” Dr Fukuda said.

First Case Scenario

On the local level, this global trend mirrors what the Newtown Health District has been promoting since the community’s sole official diagnosis of H1N1 was made in early June. Within days of this news, local school administrators in concert with the health district closed Reed Intermediate School because several students exhibited symptoms consistent with H1N1.

In recent days, Ms Culbert has remained on top of the issue, attending a workshop with local school officials to discuss the potential resurgence of the virus, and how to deal with it going forward.

Ms Culbert said she would revisit the subject with school officials this week. On Tuesday, she was planning to sit in on an Internet webinar with the National Association of County and City Health Officials to discuss the pandemic.

The health director was also scheduled to attend a working session this week with area pharmacists to set up mutual channels of communication to help monitor both the dispensing of antivirals and over the counter medicines that customers might buy to combat flulike symptoms.

“It’s getting to the point where there’s something going on related to the likely resurgence of H1N1 every day,” Ms Culbert said.

On August 24 she plans to attend a session with the state Department of Public Health and representatives of the Yale School of Public Health at Yale to discuss the possible handling of an H1N1 outbreak in a residential campus or college setting.

“I’m also getting emails every day, barraged with emails about concerns related to the quantity of vaccines that will be made available for our district and to the state,” she said.

Is The Vaccine Safe?

On a national level, Dr Fukuda, the former chief of epidemiology at the US Centers for Disease Control and Prevention, or CDC, also said there must be no doubt over the safety of swine flu vaccines before they are given to the public.

Health officials and drug makers are looking into ways of speeding up the production of the vaccine before the northern hemisphere enters its flu season in the fall.

The first vaccines are expected in September and October, said Dr Fukuda. Other vaccines will take until December or January before they are released onto the market — well into flu season when a further dramatic rise in swine flu cases is predicted.

“Everybody involved with the vaccine work, from manufacturers up to the regulatory agencies, are looking at what steps can be taken to make the process as streamlined as possible,” Dr Fukuda said. “One of the things which cannot be compromised is the safety of vaccines.”

The search for an effective inoculation has taken on a new urgency as WHO announced that almost 800 people have died from the disease in the past four months. This is more than the H5N1 bird flu strain has killed in six years.

The CDC said August 7 that — based on the experience of the 1957 flu pandemic — the number of Americans dying from swine flu over the next two years could range from 90,000 to several hundred thousand. That projection would drop if the vaccine campaign and other measures are successful, US health officials said.

Responding to concerns locally, Ms Culbert said she knows that a great deal of work is being done at the national level to develop and distribute a vaccine.

“It is likely that the Newtown Health District, along with the community’s health care providers like the VNA and our area hospitals, will be looking to vaccinate the residents for both the seasonal flu as well as the H1N1 virus,” she said. “The planning work for this effort is under development, but when we know more about the vaccine, the timing of its release, the mode of its distribution, the priority placed on the individuals that are recommended to get it, etc, we will be sharing that with [the public].”

Ms Culbert said she cannot reiterate more strongly that vaccinations are not forced. 

“We will be educating people about the value of vaccination to help prevent the occurrence and the spread of disease,” she said. “Individuals make their own decision — and parents make them for their children — about receiving a vaccination.”

One question that scientists and health officials disagree on globally is whether pregnant women should be among the first to receive a vaccine — after health workers, who make up about one to two percent of the world population and are considered indispensable.

A report by WHO experts found that pregnant women appear to be “at increased risk for severe disease, potentially resulting in spontaneous abortion and/or death, especially during the second and third trimesters of pregnancy.”

Several women and their unborn children have died in recent weeks, though obesity may have played a role in some of the deaths, the report says.

“Pregnant women have emerged as one of the groups that we are concerned about as being at higher risk than other people in terms of having the possibility of developing severe illness,” said Dr Fukuda.

Could H1N1 Mutate?

But right now, WHO is holding back on recommending that pregnant women receive priority vaccinations. And the agency is not commenting on the contentious suggestion by British and Swiss health officials that women should consider delaying pregnancy if they can.

“WHO certainly has no recommendations on whether women should try to have children” now, Dr Fukuda said.

The agency has been working hard to ensure that poor countries receive vaccines, too, despite rich nations having preordered most of the available stock. A WHO spokesman said August 7 that two drug makers have pledged to donate 150 million doses of vaccine to poorer countries by the end of October.

“We’re working with a range of partners to secure more vaccine for developing countries,” WHO’s Gregory Hartl said.

Dr Fukuda, who is effectively in charge of WHO’s pandemic response until mid-August while the agency’s Hong Kong-born Director-General Margaret Chan is on home leave, also addressed the possibility that the virus might mutate and become resistant to antiviral drugs such as Tamiflu.

Four separate Tamiflu-resistant cases have been reported recently from Denmark, Japan, Hong Kong, and Canada.

“We haven’t seen widespread emergence of resistance to the drug right now,” Dr Fukuda said, but added, “this is something we’re watching very carefully.”

It is inevitable that over a long enough period of time the swine flu virus will mutate, he said, adding, “Unfortunately we can’t predict in what direction.”