CDC's Media Briefing Update on 2009 H1N1 Flu

I'm beginning what may prove to be an irregular but -- I hope to make -- semi-frequent series of postings related to the pandemic H1N1 (AH1N1) flu virus. Its resurgence has been expected with the traditional flu season and, in reality, it never disappeared despite less popular media attention to it.

To be clear, I am no medical or public health expert but I am trained in allied areas.

So, I hope to help sift what's important from a sure-to-be increasing tide of often complex information. See for the Federal homepage on 'the flu'.

One reason I've thought to do this is because the pandemic AH1N1 strain behaves differently from what most think of as the 'common' or even 'seasonal flu'.

Another concern I have is of the readiness of our largely private health care system for unexpected numbers of seriously ill patients.

Every year, health authorities track flu cases in an attempt to pick the best bets from among strains circulating in world populations for which is most likely to threaten us during the 'typical flu season'. The three best-bet strains are then used to prepare the annual seasonal flu vaccine to help protect against what is usually the greater risk to people who are pregnant, may be infirm from other disorders, are elderly, or are very young.

The novel H1N1 strain behaves differently in a number of ways. But one concern is with the number of healthy young and young adults who have no known risk factors but end up hospitalized, on respirators, and worse.

Now it's possible that the problem is in identifying hidden underlying conditions. But, according to the CDC discussion of deaths among school children, one-third apparently had no discernible underlying condition.

Today's briefing discusses that recent reports don't show increased virulence of the strain among current cases, nor greater resistance to antiviral medications. I was happy to hear this as it addresses other concerns I have. Whew!

Today's example of my MO may prove to be common, a simple pointer to sources such as the current media briefing by the CDC. You'll find select excerpts of that below but I recommend reading the original in order to catch some of the important nuances raised during the question and answer period.

Excerpt from CDC briefing, September 3, 2009, 12:00 p.m.

NOTE: This is a rough, unedited transcript and transcription errors may appear.

Thomas Frieden:...The first point to make is that H1N1 influenza is here, it is spreading in parts of the U.S., particularly in the southeast, and in fact, it never went away. We had H1N1 influenza throughout the summer in summer camps, and now with colleges and schools coming back into session, we're seeing more cases. The good news is that so far, everything that we've seen, both in this country and abroad, shows that the virus has not changed to become more deadly. That means that although it may affect lots of people, most people will not be severely ill.

However, the H1N1 influenza and influenza generally is unpredictable, and that means two things. First, we have to vigorously monitor to see whether it's changing, who it's affecting and what's happening with it. And second, we have to be ready and prepared to change our approach depending on what the virus does. Today, CDC is releasing additional data on some tragic pediatric fatalities that occurred in the spring, and I'll provide you with more information on that, in addition, on, you can see a report that outlines the experience with H1N1 influenza in five countries in the southern hemisphere. And the experience in those five countries is very similar to what happened in this country in the spring. Large numbers of people, particularly school kids, became ill.

In some locations, hospitals had challenges to keep up with the number of people coming in, but overall, no increase in the level of severity, no increase in the death rate. In these countries, some possibility that indigenous populations were more severely affected by H1N1 influenza, that you had a greater likelihood of having severe illness from H1N1 if you were a member of a tribal or indigenous population. That's not proven, but it's a possibility. This information, as well as the child information that I'll be presenting shortly, emphasizes what we should do to prepare and what are the groups that are at highest risk, and therefore, we need to reach out to the most.

The MMWR study being released today outlines 36 deaths that were among the first deaths among children in this country. In two-thirds of those, the child had at least one severe underlying illness or underlying disability, actually, rather than illness, in most of the cases -- cerebral palsy, muscular dystrophy, long-standing respiratory or cardiac problems. So, most of the children who had fatal H1N1 infection this past spring had an underlying condition. There were some children who didn't have an underlying condition and who did become severely ill, and they were generally infected also by bacteria. When you get the flu, your immune system can be a little weakened, you can be more susceptible to other infections.

That's an important message for doctors to know that if someone has the flu, they get better, then they get worse again with high fever, that's a clue that maybe they should be treated with antibiotics, things that will help them. Most people with flu don't need treatment, and I'll discuss that more in a bit. The review of the several dozen children who died this past spring emphasizes that flu can be very severe, and it's important that we do everything we can to protect people from the flu, and I'm going to outline some of those things that we're doing. It also identifies groups that are particularly important to address.

...We continue to anticipate that vaccine will be available by the middle of October. The vaccine itself will be free. The administration may be charged by individual providers, although in the public health system, all vaccination will be free, we anticipate. It will not be easy to get vaccine uptick. We have the possibility or even likelihood that it will be a two-dose series for children, at least, and perhaps for others. We are going to be trying to reach out to children in large number and parents to get kids' vaccines, because we know that so many kids can get the flu, and the vaccine is likely to be quite effective. My kids will get the flu vaccine when it becomes available, and I would recommend that all school children get vaccinated. We also are recommending that all people with underlying conditions get vaccinated, people who have asthma, diabetes, lung disease, heart disease, neuromuscular conditions, neurological conditions that increase their risk factors and women who are pregnant....

...we do expect to see more cases. We're seeing it now. We expect that will continue. How long? No one can predict with certainty. Influenza is unpredictable. That means we need to monitor closely and be willing and ready to adapt to different approaches.

One of the challenges is preparing our health care system for the likely increase in the number of people who will seek care. We know that there are lots of things that can be done to reduce the spread of flu, and that needs to occur. But for most people with the flu, there's no reason to see a doctor or go to the emergency department unless you're severely ill. For example, you have trouble breathing or you have an underlying condition, such as diabetes, pregnancy, heart disease, lung disease. For people who do have an underlying condition, it's important to be seen promptly if you get a fever. That could make the difference between being severely ill and recovering well. Treatment in the first 48 hours can make a big difference in hastening your recovery....

The bottomline, is that the

Flu is unpredictable. Flu season is just beginning. It is very unusual to see flu continue through the summer, as it did in the U.S. this year. It is very unusual to see this many cases this early in the year, but only time will tell what this flu season brings...

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