Nature Medicine | Spoonful of Medicine

It ain’t over till it’s over

Swine flu seems to be ebbing in much of the Northern Hemisphere, according to the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC). But health officials maintain that the pandemic is far from over, and they are continuing to urge people to get vaccinated.

In the US, health experts convened a press conference before the holidays at the National Press Building in Washington, DC, warning that the virus could resurge and that there’s still plenty of swine flu going around. According to the latest CDC report, ending the week of December 19, only seven states still suffer from widespread influenza, compared to the outbreaks that hit most of the country earlier in the fall.

At the press conference FDA head Margaret Hamburg defended the decision not to use adjuvants, which could have meant more vaccine delivered sooner. She said that regulatory agencies were not prepared to go outside of the regular review process to approve them on an emergency basis given that the vaccine worked fine without the additive. She also cited potential safety concerns and a public that remains jittery about vaccines in general.

CDC director Thomas Frieden noted that in some previous pandemics, infection rates have declined temporarily only to increase again. He speculated that if the virus does resurface, it could come back in specific regions. (New York, for instance had an early spike in the spring but, relative to the rest of the country, experienced a late flu season in the fall.) According to the WHO, some countries, such as Georgia and Turkey, are experiencing a resurgence of infections.

Meanwhile, two studies in the New England Journal of Medicine last week highlight the susceptibility of certain populations to the virus. One study chronicled the terrible course of disease in pregnant women, and noted that the flu season will probably affect the overall rate of maternal mortality in the US in 2009. A second study examined death rates in children during Argentina’s flu season earlier this year, and compared them to deaths from influenza in previous years. Children were ten times more likely to die from the swine flu; the overall rate of death was 1.1 per 100,000 children.

So far, 47 million Americans have been infected with H1N1, according to CDC estimates. Nearly 10,000 have been killed by the virus and more than 200,000 hospitalized.

The CDC is urging that adults get vaccinated, now that more than 100 million doses of vaccine have become available. National Influenza Vaccination Week kicks off on 10 January.

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image: CDC


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