Fall flu preparations in full swing

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Federal and state health officials are gearing up for a resurgence of the H1N1 flu virus this fall and winter. They say the flu strain could hit more severely than it did in the spring, and are preparing to distribute a vaccine for H1N1 when it's available in October.

MPR's Lorna Benson has just returned from two days of briefings by the Centers for Disease Control and Prevention on H1N1, and a briefing today by the Minnesota Department of Health on pandemic flu. She answers some of the most common questions about the upcoming flu season.

When will vaccine be available for H1N1 influenza?

Assuming the clinical trials show that the vaccine works and that there are no red flags regarding safety, CDC officials hope that the five U.S. flu vaccine manufacturers will have the first doses ready by mid-October.

Who will be able to get those first doses?

There are five priority groups that the CDC has identified for early vaccination. In Minnesota they make up about half of the population. The groups are:

1. Health care workers

2. Pregnant women

3. Parents, household contacts, caretakers of babies under 6 months of age

4. Children and young people between 6 months and 24 years of age

5. People 25 to 64 with underlying medical conditions such as asthma, diabetes, chronic lung or heart disease

If for some reason there is less vaccine available than expected, Minnesota officials could reduce the size of this priority group.

Priority would then go to pregnant women, healthcare workers with direct patient contact, children 6 months through age 4, people who care for infants under 6 months, and children 5 through 18 with chronic health conditions. That's approximately 718,000 Minnesotans.

Will Minnesotans who don't qualify for these priority groups be able to get vaccine?

Yes, as more vaccine becomes available, public health officials will open up the program to others. Eventually, even people 65 and older who are not on any priority list currently should be able to get vaccinated if they want it. But that could be many months from now.

At this point, how much vaccine does the government think will be ready by mid-October?

If everything goes well with production, manufacturers should have approximately 45 million doses by that time. Each week after the vaccination launch they expect to receive an additional 20 million doses. In total, the government has purchased 195 million doses.

Why didn't the government order more vaccine?

The CDC says the government can order more doses if there's demand for more going forward.

It's worth noting though that the 195 million doses won't actually cover 195 million people. That's because everyone will likely need two doses of vaccine to develop full immunity.

The dose issue is still being worked out in clinical trials, but CDC officials say they're pretty sure that most people will need two shots, because this is a totally new virus strain and most of us don't have any built up immunity to it.

Older people seem to be the exception. They haven't been hit as hard by the virus so far. Public health officials suspect that this population has at least some immunity, based on exposure to similar strains of H1N1 when they were very young.

Getting two doses of vaccine seems complicated. How will it work?

It is more complicated, because it means two trips to the vaccination clinic. So you would get your first as early as mid-October, assuming the vaccine clinical trials don't raise any red flags before then. After that initial dose, you would have to wait three weeks to get your second dose.

It would then take another two weeks or so for your body to mount a full immune response to the virus. So Thanksgiving is probably the earliest anyone would be fully protected from the new strain of H1N1 flu.

Are public health officials worried about people not getting that second dose of vaccine?

Yes they are (again, assuming that clinical trials show that two doses are necessary). They say it's very possible that most people will have zero protection from the virus if they only get one dose of the vaccine.

This is based on studies they've done on seasonal influenza vaccines in young children. The very first time any child under age 9 gets a flu vaccination, they need to get two doses to develop immunity to the virus because they typically haven't developed any natural antibodies to it.

That same concept applies to this vaccine as well. For most of us, we've never been exposed to a flu strain like this. So health officials think most of us would need two shots.

Where should people go to get their vaccination?

Minnesota health officials say the vaccine will probably be available at many of the same locations that offer seasonal flu shots. In addition, it's possible that some schools will also offer the vaccinations.

The Minesota Health Department says setting up a vaccination program in the schools is a big undertaking. They need health workers to administer the shots, and they need to get parental consent for every student getting vaccinated. So the state is leaving it up to local officials to decide whether or not to offer the shots to students.

Speaking of seasonal flu, every few years we hear that the shot is mismatched to at least one of the flu viruses that are circulating. Do we know how well the new pandemic vaccine is matched to the novel H1N1 virus?

The good news is that the CDC says so far, the virus appears to be very well matched to the vaccine. They haven't detected much genetic change in the virus during the past four months. They suspect that's because the virus hasn't had to work very hard to infect people --- meaning that most of us don't have much, if any, immunity to it.

So if it's able to easily spread itself among the population, it doesn't have much reason to mutate.

If people get vaccinated against novel H1N1 influenza, would they have immunity to a change in the virus?

It's possible. A CDC official says some people might have enough immunity from the vaccine to recognize a change in the virus, depending on the type of change. In that case, the person might still get sick but it may be a milder illness.

If someone thinks they have already had the new H1N1 influenza, should they still get vaccinated?

If you didn't have a laboratory confirm your case, it's recommended that you get vaccinated.

Should you still get a seasonal influenza shot if you are getting the H1N1 vaccine?

Health officials recommend it. In fact, they say people should get the seasonal vaccination as soon as possible. It's already available in some places.

What if you don't want either influenza vaccination. Will it be mandatory?

No. Government officials say it will be a voluntary program.

What if you can't afford to get vaccinated?

The U.S. government is paying for the new H1N1 vaccine, as well as the syringes and other supplies needed to administer the shots.

In public vaccination clinics, there will probably be no charge for the vaccination. In private clinics, doctors and nurses will be able to charge a fee for administering the shot. But it's possible that health insurance plans may cover that fee.