Monday, October 22, 2007

Government comes up with order for pandemic flu vaccine

A government working group has come up with a preference order for vaccination if a pandemic influenza breaks out. The story is by Anita Manning "Scarce pandemic vaccine to be given in order: Group comes up with guidelines for innoculation," page 7D, Life Section, USA Today, Monday Oct. 22, link here.

The order prefers military personnel and health care workers first, then emergency workers, the pregnant women and babies. The elderly and healthy would wait.

The order would refer to any pandemic for which vaccine is scarce. The scariest is probably H5N1 avian influenza, although this would apply to any infection. Some pandemic flus (1957, 1968, and the "threat" in 1976) are milder. The Spanish flu of 1918, thought to resemble H5N1, tended to kill the young and healthy quickly by causing overdrive immune reaction.

Various scenarios for bird flu had suggested a sudden beginning of a human-human transmissible strain (with an "index case"), but that's unlikely. Spanish flu actually appeared in several locations in the world at the same time in 1918, before there was widespread air travel. Media reports from Indonesia have suggested some human transmission chains but they seem to die out. Media reports also indicate that Indonesia has a vaccine, and it is not clear why it is taking so long to develop an effective vaccine that could be manufactured and used worldwide.

It is noteworthy that aggressive vaccination for regular influenza may help protect the public in the sense that if there are fewer cases of people infected with regular influenza strains, then there is less chance that H5N1 could swap genes with them and mutate. This year the vaccine supply for regular flu came early; I got a flu shot at a Safeway in early October when there was no line (but it costs $30).

I had major discussions of public health policy for pandemics of several kinds in on August 30, 2007 on this blog.

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