Children and teenagers are two of the population groups most at risk from an expected resurgence of novel influenza A (H1N1) virus infection this fall. Because of this risk, the federal government is making plans to distribute through schools and daycare centers vaccine against the virus as soon as it becomes available, according to health care experts and Obama administration officials, who spoke during a July H1N1 Influenza Preparedness summit at NIH headquarters here.
The federal government expects to have a limited supply of H1N1 flu vaccine ready by mid-October. According to HHS Secretary Kathleen Sebelius, the government is looking at different kinds of sites for vaccine distribution, including daycare centers and schools.
"There will be some access through traditional doctors' offices and community health centers," said Sebelius in a response to a question posed by AAFP News Now. "But we may look at more communitywide vaccination programs to try and get this in the arms of the targeted populations as quickly as possible."
The Obama administration has released $350 million in H1N1 preparedness grants to all states and territories; $260 million will go directly to state health departments to prepare for a vaccination campaign, and $90 million will go to help hospitals handle an expected surge in patients if an outbreak occurs in their community.
The administration also has upgraded and expanded its flu information Web site(www.pandemicflu.gov). In addition, administration officials are issuing public service announcements to alert the public about the H1N1 virus, Sebelius said.
President Obama called into the flu summit from an economic summit in Italy and told participants at the conference that state and local officials need to prepare now to implement a vaccination program in the fall.
"In conversations with world leaders about this issue, it is clear we are way ahead in terms of planning," Obama said.
However, the emergence of the H1NI virus has underscored inherent deficiencies in the U.S. health care system, deficiencies that make it more difficult for the federal government to achieve the concurrent goals of reducing illnesses and deaths while minimizing social disruptions caused by the virus, according to health care officials.
"We have a very erratic and inappropriate delivery system," said Sebelius. "There are literally millions of folks whose only access to health care is through the doors of emergency rooms, and we need hospitals to be prepared to deal with folks who are truly in desperate shape and who need to be hospitalized."
The H1N1 virus has "put a spotlight on the fact that we currently don't have a system where every American has access to preventive care, doesn't have a health home and doesn't have a doctor to call," said Sebelius.
Health officials also are battling complacency among the general public and even the press that threatens to derail preparatory efforts. There is a misperception that the virus is gone and the threat has disappeared.
"It is not gone," stressed Sebelius. "It is continuing to spread. … We have it in every state in this country. We know (H1N1) spreads very quickly."
Although infection rates have declined in many parts of the United States, outbreaks are continuing, said CDC Director Thomas Frieden, M.D., M.P.H.
As with seasonal flu, the vast majority of Americans infected with H1N1 have recovered without hospitalization. Public health officials have expressed concern that people are not regarding the H1N1 flu as a serious disease.
But it is important to recognize that the seasonal flu kills an average of 36,000 people every year in the United States -- not a very reassuring statistic, Frieden said. As of July 31, the H1N1 outbreak has led to more than 5,500 hospitalizations and more than 350 deaths in the United States, according to CDC figures(www.cdc.gov).
Moreover, influenza viruses change from season to season, and H1N1 could become more severe in the fall, prompting changes in the nation's immunization efforts, said Freiden.
Health officials, meanwhile, are closely monitoring H1N1 in the Southern Hemisphere, which is now in the midst of its flu season. There are substantial infection rates in Argentina, Chile, Australia, and much of Asia and Africa, according to Frieden. Investigators also have detected antiviral resistance to two commonly used antivirals in three parts of the world.
"None of those detections has represented a wide-scale change that would result in (variations) in our treatment recommendations," said Frieden. "But it is still something that needs to be watched carefully."