Last modified: Friday, November 6, 2009 12:02 PM CST

Flu deaths 18; vaccine supply up

By LIZ SWITZER, The Daily News, lswitzer@bgdailynews.com/783-3240

As the H1N1-related death toll in Kentucky - now in the eighth week of widespread influenza activity - climbed to 18 people this week, state public health officials said Thursday they expect to see a flurry of flu activity for the foreseeable future while the state’s allotment of vaccine has again been substantially increased by the Centers for Disease Control and Prevention.

“None of us has a crystal ball, so we will just have to wait and see how long we will continue to see this widespread activity,” said Dr. Kraig Humbaugh, Kentucky Department for Public Health state epidemiologist. “But we don’t expect to see any change in the level of activity at least for the foreseeable future. We are experiencing this pandemic in wide waves and we expect to see that continue as well with activity that started in the western part of the state a few weeks ago. We are now seeing more activity in the central and eastern parts of Kentucky, not to say there is not significant activity in the western part of the state.”

The Barren River Area Health Department will continue to distribute its allotment through local providers like Graves-Gilbert Clinic in Bowling Green and administer the H1N1 vaccine by appointment through its office to target populations. There are no plans currently to conduct vaccination clinics in any area schools, as has been done in some school systems across the state, according to BRAHD Director Dennis Cheney.

“We will continue to give the vaccine to target groups in our clinic by appointment and not have mass chaos,” he said.

Graves-Gilbert ordered 3,000 doses of the vaccine in total but has received only 200 doses over the last three weeks in addition to the initial shipment of 500 nasal spray doses the clinic received, said Marsha Clayton, clinical operations manager.

“We have not had enough to even vaccinate all of our health care workers here yet. We have received no injections and have given all but 130 nasal doses,” she said.

Clayton said the clinic has not received any information as to when it may get more vaccines.

This week, Kentucky’s allocation of the vaccine was increased to 442,000 doses, of which 372,000 have been shipped out to 1,200 providers to administer; of those, approximately 30 percent are in nasal spray format.

“We still have a limited supply of vaccine, enough for about 10 percent of the population, so the focus continues to be on high-risk target populations (such as children, health care workers and adults with underlying health issues),” Humbaugh said. “There is more vaccine on the way and that is good news but we still continue to receive amounts relative to state population. Demand is exceeding supply at the present but we are taking as much vaccine as we can get.”

Orders for 95 percent of Kentucky’s current allocation this week have been placed. Humbaugh also advised that those individuals who need to be vaccinated take the nasal form of the immunization if it is available, even if they are not familiar with that application as it is just as effective and safe as the injectable form.

Almost all flu activity, or 99 percent of the specimens the state has tested since August, have been the H1N1 strain, according to Humbaugh. Most infected individuals with mild symptoms are recovering without treatment while a small percentage of the population becomes seriously ill with the virus and require hospitalization, he said.

Four additional deaths were also reported this week and officials are investigating a number of others. The dead include two women from Kenton County, one in her 50s and one in her 60s, as well as two Jefferson County women. One woman was 54 and the other woman was 42.

Three of the four dead women had underlying medical conditions and 13 of the 18 deaths that have been reported in Kentucky fell into target groups for the vaccine, Humbaugh said.

“It is especially important that those in target groups seek the vaccine when it becomes available to them,” he added. “If a person shows specific symptoms such as shortness of breath and high fever that is difficult to control with anti-fever medicine, they should be in touch with their medical care provider sooner rather than later.”

In an effort to minimize contagion in Bowling Green and Warren County schools, Greenview Regional Hospital this week donated more than 350 wall and liquid hand sanitizers to area schools, said Alan W. Palmer, the hospital’s director of marketing. The sanitizers are part of a health campaign for youth called “Clean Hands are Cool Hands.”

“Young people are being hit the hardest, so this was one method we could address concern in the schools and encourage kids to wash their hands,” Palmer said.

Pandemic patterns in Kentucky are reflective of what is taking place in the rest of the nation, which is still reporting almost no seasonal flu yet, CDC Director Tom Frieden said in a weekly media teleconference.

Frieden stressed that for people with asthma and other underlying conditions, it’s particularly important to get vaccinated when vaccine becomes available.

“People with asthma account for about one-third of all of the people hospitalized with H1N1 influenza,” he said. “So if you have asthma or another underlying condition seek care promptly when you have fever with cough.”

Different states are taking different approaches to vaccinations, Frieden added. Because there are different vaccine forms, the nasal spray is being used primarily for health care workers and healthy children and the CDC is continuing to unprecedented demand for seasonal flu vaccine.

“This is something that, unlike the H1N1 vaccination effort, is handled by the market,” Frieden said. “Only about 10 percent of all seasonal flu vaccine is purchased by the government, and nearly 90 million doses have been distributed to providers throughout the U.S. We continue to hear that people are unable to get the vaccine. We think this year will be the highest ever uptake on seasonal flu vaccine. We anticipate there being around 114 million doses of seasonal flu vaccine available through the market by the end of the year. It may be there is even greater demand than that by the end of the season.”

Although newer methods of vaccine manufacturing are available, the CDC is using a traditional method of vaccine production.

“There are some newer methods and we hope they will be ready within the next couple of years,” he said. “The procedures used are complex and cumbersome and involve growth and testing mechanisms that are time consuming and take a long time to be done. We need to have better vaccine production methods, but they’re not ready yet.”

Each year, the CDC decides in February what strains to put into vaccines that will be given the following September, October, November and December. If the virus circulation changes between the winter and the following fall/winter, the strains that are circulating may be missed.

“So whether it’s for a pandemic such as H1N1 or for the changes in flu that happen each year, we do need better technologies,” Frieden said. “We hope in the not-too-distant future that we might have newer vaccine methods that would be able to provide vaccine at a more rapid pace to adjust to the types of strains circulating more promptly.”