ATLANTA -- Pregnant women, children and
health-care workers are among those who should be first
in line to receive a vaccine for protection against H1N1
swine flu, a U.S. vaccine-advisory panel recommended
Wednesday.
The recommendation from the Advisory Committee on
Immunization Practices, a body that counsels the federal
government on vaccine matters, includes as many as 159
million people, or more than half the U.S. population.
Those who should be offered shots first should the
government give the final go-ahead to an H1N1 swine flu
vaccination campaign are at highest risk of
complications from the new flu virus, which had caused
5,011 hospitalizations and 302 deaths as of July 24,
according to the Centers for Disease Control and
Prevention.
Aside from pregnant women, shots should be given first
to those in close contact with infants under 6 months
old, health and emergency medical services workers,
children and young adults from 6 months old through age
24, and people under 65 years old with underlying
medical conditions, the panel said. It made its
recommendations to the CDC, which will review them and
then disseminate them to state and local health
departments to help them plan for vaccination efforts.
The panel made a point of including young adults from
ages 19 to 24 in the list of those to receive vaccine
first because the rapid spread of the disease in schools
in May and summer camps and military units this summer
suggests outbreaks are likely to erupt on college
campuses this fall. Moreover, people of that age group
often hold service and entry-level jobs at which they
could easily spread the disease to the broader
population, the panel said.
The government isn't likely to have enough vaccine ready
in early fall to cover this entire priority group. U.S.
officials said they hope to have at least 120 million
doses ready in October; 40 million of those could be
ready by September should they be needed then. Robin
Robinson, a vaccine official with the Department of
Health and Human Services, said more than 20 million
doses of bulk antigen have already been produced.
The 120 million doses would be enough for about 60
million people to be vaccinated in October, given that
officials expect people will need two doses. But Anne
Schuchat, the CDC's respiratory-diseases chief, said it
was unlikely that everyone would line up for the shot,
despite the agency's urging. Between 20% and 50% of
these high-risk groups normally get the seasonal flu
vaccine, she pointed out. "The size of the population
may not be so relevant in terms of what the demand will
be," she said.
Still, the advisory panel recommended that local
officials narrow the priority list to a group of about
42 million people should vaccine supplies be tight. That
highest-priority group would limit the children who
receive the vaccine to those between 6 months and 4
years old and those with chronic medical conditions. The
number of health-care and emergency medical services
workers who get the vaccine first would also be limited,
but pregnant women and people in close contact with
infants would still be included in the highest-priority
group, the panel said.
Once there is enough vaccine for the broader priority
group, next in line would be healthy adults between ages
25 and 64, the panel said. People ages 65 and over, who
are normally among the first to get seasonal flu shots,
would be last in line for the new H1N1 shot, because
their rates of infection have been far lower. One CDC
study suggested that older people may have some immunity
to the virus because they were exposed in their early
years to H1N1 viruses that were similar to this new
virus.
Pregnant women are of particular concern to
public-health officials. In a study published Wednesday
in the medical journal the Lancet, the CDC reported that
the rates of hospitalization and death in a group of
pregnant women studied early in the outbreak were higher
than those in the general population.
Some attending the meeting in Atlanta where the panel
made its recommendations expressed concern that a
vaccination campaign targeting pregnant women and
children first may go ahead before the results of
clinical trials to test the safety and dosage of the
vaccine are ready.
Concerns were also expressed about the use of thimerosal,
a preservative that contains mercury, in the vaccine.
"We're very concerned about thimerosal," said Lyn
Redwood, vice president of the Coalition for SafeMinds,
an organization that supports research on the links
between mercury and neurological disorders such as
autism.
Dr. Schuchat said that thimerosal-free vaccine would be
available, both in the form of shots and nasal spray.
Source : The Wall Street Journal, page A3
