H1N1 vaccine supply lags regular flu doses

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By Ann Geracimos

While the government's free H1N1 vaccination program is struggling to produce the expected doses, three times as much "regular flu" vaccine -- most of which is purchased on the open market -- already has been produced, even though that flu season hasn't yet hit.

Demand for the seasonal influenza vaccine is at "really unprecedented" levels, according to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

Speaking Tuesday at a news conference in Atlanta, he said "nearly 90 million doses have been distributed to providers," noting that the government purchases only about 10 percent of the seasonal-flu vaccine dosages.

Around 114 million doses of the seasonal vaccine are expected to be available through the market by year's end, and "it may be there is even greater demand than that by the end of the season," he said.

At the same time, the government's free vaccine for the novel H1N1 virus, commonly known as swine flu, still has not been produced in quantities that federal health officials had predicted earlier this year, with only 31.8 million doses available as of Tuesday and 10 million more expected by the end of this week.

Dr. Frieden injected a sober note into the subject of underlying medical conditions that are known to be contributory factors to serious cases of H1N1 flu. A majority of deaths from the new flu have been among people with such conditions as asthma and other respiratory ailments.

"People with asthma account for about one-third of all the people hospitalized with H1N1 influenza," he said, adding that the number probably is much higher, since telephone surveys showed only half of asthma sufferers sought care from a medical provider.

Obesity, too, is a possible factor, but Dr. Frieden hesitated to pronounce a definitive link, saying that would be "very theoretical, given the better information we have in some situations and the much higher attack rate of H1N1 influenza for people in the middle years of life, younger adults, and others."

However, he acknowledged that the country currently is "in the midst of an epidemic of obesity" - with rates doubling in adults and tripling in children in past decades - and said that "people who are very obese, having a body-mass index of 40 or above, are at increased risk of complications of flu. Most people with a body-mass index that high also have health problems, such as diabetes or heart disease, that may increase their risk of getting complications for the flu."

For those with a so-called "intermediate level of obesity," having a body-mass index in the 30 to 40 range, he said the data is more mixed. "It may be people in the range are at increased risk of complications, but that's not entirely clear at this point."

Scientists still are seeking to understand what this implies for people's health, he said, citing an "increase of susceptibility to infections" as one possibility and "reduced respiratory reserve and the ability to fight off infections" as another.

Two studies of deaths and intensive-care unit (ICU) patients in the H1N1 epidemic's earliest stages in Mexico and Canada also suggested a link between severe H1N1 cases and obesity.

Published in the Nov. 4 issue of the Journal of the American Medical Association, the Mexican survey covered 58 people in six hospitals' ICUs during the spring. Of those patients, 21 were judged obese, with a BMI greater than 30, and eight judged to be extremely obese (BMI of 40 or more).

"Obesity was the most common co-morbid condition in these patients and was more prevalent (36 percent) in this series than the general-population prevalence (30 percent) in Mexico," concluded the study, whose lead author was Dr. Guillermo Dominguez-Cherit.

The Canadian study of 168 ICU cases that were confirmed as H1N1 victims found obesity among 33 percent of the hospitalizations, a lesser rate than chronic lung disease, but greater than such traditional severe-flu risk factors as hypertension and smoking.

Latest figures from the D.C. Department of Health show five hospitalizations and no deaths have taken place from the H1N1 pandemic. Maryland reports 321 people hospitalized and a total of 13 deaths. Virginia has had 17 confirmed deaths and credits nearly 14 percent of all hospitalizations - mainly outpatient visits - to the flu.