Sunday, December 06, 2009
News, Health + Fitness

Doctors try to predict flu's path

Holiday travel and return to school after winter break could mean a resurgence in H1N1

Thomas Frieden, director of the Centers for Disease Control and Prevention, testifies during a hearing on Capitol Hill about the H1N1 pandemic last month.
Alex Wong/Getty Images

By Christine Foster

    All bets are off in determining whether the H1N1 virus will see a resurgence after the holidays. At present, the number of reported cases of the virus also known as the swine flu is declining, but hospitalizations for influenza in general remain higher than expected for this time of year, especially among infants and toddlers, according to the Centers for Disease Control and Prevention.

    Experts say H1N1 vaccine supplies are increasing and should be easier to find before Christmas, which is good news, since kids returning to school after the holidays may find themselves in a flu breeding ground. “May” is the key word—doctors are presently sizing up the probable flu season ahead.

    Because most people don’t go to the doctor every time they catch the flu, H1N1 is hard to track, and exact case numbers are difficult to come by. However, the CDC estimates that somewhere between 14 million and 34 million Americans have been infected with the 2009 H1N1 flu from April to October of this year. Of those who have contracted the virus, an estimated 98,000 have been hospitalized, and an estimated 3,900 have died due to complications stemming from or aggravated by the virus during that time.

    But over the past several weeks, the estimated flu activity of the H1N1 virus has been on the decline.

    On Nov. 30, the CDC released a weekly online “Key Flu Indicators Situation Update” pointing to the fact that doctor visits for “influenza-like illnesses” decreased sharply between Nov. 15 and Nov. 21, and only 32 states were reporting widespread influenza activity, compared to 43 states the week before.

    “We are beginning to see some declines in influenza activity, but there is still a lot of influenza everywhere,” says Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, who spoke during a Nov. 20 CDC media briefing on the flu.

So far, nearly all of the cases continue to be H1N1 and not the regular seasonal flu, which experts believe is on its way.

    “We can’t predict exactly what’s going to happen over the weeks or months ahead,” according to Schuchat. “Influenza season typically goes from December to May. Nothing is typical about this year’s influenza. We may have weeks and months of a lot of disease ahead of us.”

    The projections are due in part to the holidays themselves.

“There are a couple of factors that might bump up the flu case numbers again, including holiday travel,” says James Steinberg, a professor at Emory University School of Medicine and chief medical officer at Emory University Hospital Midtown, which has participated in H1N1 vaccine clinical trials. “It’s a virus that comes in waves, and there may be another wave. Not to mention that we haven’t even hit the traditional flu season yet.”  

[Editor's Note: An earlier version of this story gave Dr. Steinberg the wrong first name. We apologize for the error.]

    Since people will be traveling and spending time with family and friends, the risk of spreading germs increases, and can perpetuate the length of this ill-timed flu season.

    “Our expectation is that the next several weeks will be busy ones as people increase traveling over the holidays,” says Schuchat.

THE SCHOOL FACTOR

    Another reason we might see a resurgence of influenza? School.

“The first surge in Atlanta hit right after school started and children got back together,” says Jim Fortenberry, pediatrician-in-chief at Children’s Healthcare of Atlanta. “Often, with the winter weather and after the holidays, children are back in school together in enclosed spaces, and the flu takes off. This could happen with H1N1. Hopefully, it would be a less strong surge.”

    Fortenberry’s hopes for a lessened H1N1 and regular flu season center around the fact that countries in the Southern hemisphere found that H1N1 tended to “crowd out” the regular seasonal flu, causing the number of regular flu cases to drop.

    Any potential flu resurgence may also be dampened by the fact that so many people have already been infected with H1N1 this year, and developed a reasonable amount of antibody protection. Plus, Steinberg adds, the H1N1 strand has not yet seen much major mutation that might enable it to evolve and make another round through the population.

    To help knock out H1N1 before it is able to advance, vaccine producers are increasing the vaccine supply weekly. Four of the five licensed vaccine distributors in the U.S. were shipping by Nov. 20.

    “We’re not where we want to be, but available vaccine is being quickly ordered and shipped, and we are in better shape today than we were a couple weeks ago,” says Schuchat.

    The vaccine is currently designated for high-priority groups, but even among those, there are still some who are reluctant to get it because of its newness. With that in mind, the World Heath Organization called the safety results of clinical trials and vaccination campaigns “encouraging” in a brief on Nov. 19.

    The side effects of the vaccine are well within the normal range, including swelling, redness, or pain at the injection site, as well as the less-frequent fever, headache, fatigue and muscle aches shortly after the vaccine is administered.
“For those who are checking flu.gov to see about vaccines near you, keep an eye out, because there might be some opportunities to get vaccinated before the holidays,” says Schuchat.

    The public may also  HYPERLINK "http://www.thesundaypaper.com/More/Archives/tabid/98/articleType/ArticleView/articleId/4763/Wheres-the-H1N1-vaccine.aspx" check with local agencies for metro area vaccination information, or use the Georgia Division of Public Health’s vaccine locator: go to health.state.ga.us/h1n1flu, and then click the “H1N1 Provider Locator” tab.

    Because no one can predict whether influenza is declining for the year or if it might spike again soon, medical experts highly encourage vaccination against both types of influenza.

    “I would definitely recommend that people, especially high-priority groups, still receive the H1N1 vaccination,” Steinberg says.

    The CDC says wash your hands constantly, vaccinate and don’t travel sick. CHOA echoes that advice, with one eye toward the winter.

    “We are watchfully waiting and remaining prepared, so that we can be ready for a potential surge in H1N1 again,” says Fortenberry. SP