2:00PM Thursday Jul 30, 2009

ATLANTA – Pregnant women, health care workers and children six months and older should be placed at the front of the line for swine flu vaccinations later this year, a US government panel recommended yesterday.

The panel also said those first vaccinated should include parents and other caregivers of infants; non-elderly adults who have high-risk medical conditions; and young adults ages 19 to 24.

The Advisory Committee on Immunization Practices voted to set vaccination priorities for those groups Wednesday during a meeting in Atlanta. The panel’s recommendations are usually adopted by federal health officials.

The recommendations are designed to address potential limits in vaccine availability later this year if there is heavy demand and limited supplies.

The government estimates that about 120 million swine flu vaccine doses will be available to the public by late October.

Roughly 160 million people are in the priority groups considered most vulnerable to infection or most at risk for severe disease. There are more than 300 million people in the US.

Traditionally, less than half of the people recommended to get seasonal flu shots get them. Only about 15 per cent of pregnant women get seasonal flu vaccinations.

If there is ample vaccine, vaccinations also would be recommended for all non-elderly adults, the panel also voted. And if there’s still plenty of vaccine, the swine flu shots and spray doses should be offered to people 65 and older.

Fewer illnesses have been reported in the elderly, who appear to have higher levels of immunity to the virus, health experts say.

However, the elderly should be pushed to get shots against seasonal flu, which is a significant health risk to older adults.

Panel members say they hope swine flu vaccinations will be opened up quickly.

“The only sin is vaccine left in the refrigerator,” said Dr William Schaffner, a Vanderbilt University flu expert, in a comment to the panel.

The panel also said if vaccine is scarce, the government could require that a much tighter group be at the front of the vaccination line, numbering about 40 million.

That would include pregnant women and household contacts of small children, just like in the general priority recommendation.

But the others would be children ages 6 months through 4 years, children with chronic medical conditions and only health care and emergency services workers who have direct contact with patients.

It’s a worst-case scenario that officials aren’t expecting, but they wanted to have a plan for it just in case, said officials with the US Centers for Disease Control and Prevention, the federal agency that reviews the panel’s recommendations.

The range of recommendations reflects how hard it is to plan for swine flu, officials said.

Variables with the swine flu virus can range from whether it mutates into a form that is more deadly, spreads more efficiently, or is better at fighting off current antiviral medications.

Variables with the vaccine include potential production problems. Production of the vaccine will be a prodigious feat: The government has already purchased 195 million doses for the coming autumn and winter, which far eclipses the 125 million or so doses generally produced for seasonal flu vaccine.

Four vaccine manufacturers are wrapping up seasonal flu vaccine production and have begun production of swine flu vaccine. But another company, Sanofi Pasteur, has been more delayed and may not finish seasonal vaccine production until September, a company spokeswoman said. Sanofi is among the largest producers of flu vaccine, so those delays could have a significant ripple effect.

Packaging, distribution and other steps can take a month or more. For those reasons, the government’s best guess at the moment is 40 million doses will be available in September and 120 million by around mid-October.

First identified in April, swine flu has likely infected more than one million Americans, the CDC believes, with many of those suffering mild cases never reported.

There have been 302 deaths and nearly 44,000 laboratory-identified cases, according to CDC numbers released last week.

It’s not clear whether the virus in its current form is much worse than seasonal flu in terms of overall threat to the US population, but it is causing more severe illness in some younger adults and children.

It has a dangerous genetic characteristic that allows it to infect the lower lungs, whereas seasonal flu tends to infect the upper respiratory tract, CDC officials said.

- AP

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Wheezing, sneezing, coughing, short of breath, aches, chills and a head cold and that was only the start of what was to be a miserable few days.

Feeling early symptoms late on Friday, I tossed and turned in my sweat-soaked bedsheets, begging for morning.

Come Saturday, my head throbbed, my nose was full and my body ached.

“It’s just a cold,” I said to myself. The fact I am six months pregnant meant I could not afford anything more.

Most flu medicines are out of bounds, so, left with two paracetamol tablets every six hours, I lay on the bean bag, with a hot cup of fresh lemon and honey, drifting in and out of sleep.

Later, feeling better, I attempted to make dinner.

Bad idea.

Constant nausea meant I had not eaten much that day.

I had to lean on the bench as stars came flying towards my eyes.

Back on the bean bag, next to a roaring fire and wrapped in at least five clothing layers, I felt cold.

I knew I had to get to bed and tossed with hot, cold, sweats, chills, dreams and hallucinations until Sunday dawned.

After hearing about the impact of swine flu on pregnant women and their babies, I called the Christchurch flu hotline and was given an appointment for the flu centre that day.

I entered a large, isolated and cold warehouse in the city centre where about 10 others, all wearing masks, were waiting.

The staff wore masks, hats, gloves and disposable cloaks; only their eyes were visible. I was told to wait as a “bottleneck” of extremely sick people were taken to hospital.

I was eventually seen by nurses and a doctor, who diagnosed flu and told me 80 per cent of cases were swine flu.

A scan at Christchurch Women’s Hospital reassured me the baby was fine, the heart was beating strongly.

I decided against a swine flu test after learning it required a tube up my nose that scraped down the back of my throat to take a swab.

Whatever I had, the only cure was to go home, stay home, take plenty of fluids, rest, monitor symptoms, and not let anyone near me.

It was Monday afternoon before I started to improve.

I’m glad I caught swine flu now.

I’ve been told that I have built up a basic immunity to any mutant form the virus may take. I hope so.

FOUR MUMS SENT TO INTENSIVE CARE

Four pregnant women or new mothers with swine flu have been treated in Christchurch’s intensive care unit as expectant mothers are warned to be vigilant. Christchurch intensive care specialist Geoff Shaw said his unit treated at least two women expecting babies and two new mothers.

Last weekend, a 19-year-old Australian woman lost her unborn child at 36 weeks because of swine flu complications. Shaw said it was not clear why pregnant women were more vulnerable but recommended they stay away from anyone who was coughing or unwell.

Fran McGrath, of Public Health, warned pregnant women not to take anti-viral medicine without seeing a doctor.

- with KIM THOMAS Stuff

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Influenza A (H1N1) Swine Flu
Information for pregnant women and breastfeeding mothers

Pregnant women

Pregnant women are thought to be at greater risk of complications from the new Influenza A (H1N1) than many other people. If you are pregnant and have influenza symptoms, you should consult your doctor before taking any antiviral medicine. Your doctor will assess the risks and benefits of this medicine with you, and may need to seek advice from an infectious diseases specialist.

Breastfeeding mothers

Any influenza can be very serious in young babies. However, babies who are breastfed do not get as sick, and are sick less often, than babies who are not breastfed.

Don’t stop breastfeeding if you are ill. Breastfeeding protects babies because breast milk passes on antibodies from the mother to a baby. Antibodies help fight off infection. Limit formula feeds if you can. If you are too sick to breastfeed, express milk and have someone give it to your baby.

Be careful not to cough or sneeze around your baby. You may want to wear a face mask, as long as you take the necessary precautions outlined in the World Health Organization’s advice on the use of masks in the community setting in Influenza (H1N1) outbreaks (www.who.int) to keep from spreading the virus to your baby.

You are able to keep breastfeeding while you take medicines such as Tamiflu to treat the new influenza A (H1N1) virus.

NZ Ministry of Health

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Pregnant women have been urged to consider “self-quarantining” after international reports of severe complications from swine flu.

The Sydney Morning Herald reported that up to six new mothers were seriously ill after giving birth prematurely because the virus was threatening the lives of their babies.

Dr Ted Weaver, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said that while the risk was small, pregnant women should take simple steps to avoid catching the disease.

“Pregnant women should be quite scrupulous with their hand hygiene … If they don’t have to go out and do things in the community, maybe they shouldn’t. If they do have to, maybe they should wear a mask,” he said.

“They should in some ways consider self-quarantining.”

It is thought pregnancy makes women more vulnerable to all types of influenza because of immune system and other changes. Deputy Director of Public Health Dr Darren Hunt said unborn babies might also be at increased risk from the mother’s response to infection, such as a high temperature.

Two babies of the Sydney women were reported to be in intensive care with their mothers.

Dr Weaver stressed that most pregnant women who had become severely ill internationally had other health problems, such as diabetes, asthma or heavy smoking. “If a woman does become sick with swine flu she could expect to make a full recovery without affecting her or her baby,” he said.

Waikato Hospital obstetrician Dr Alastair Haslam said his hospital had seen some probable cases of swine flu in pregnant women but no major complications.

Meanwhile, the number of confirmed deaths in New Zealand from swine flu has risen to 10 with the death of a Tairawhiti man in his 40s.

The man had serious underlying health problems.

There are no figures available on the number of pregnant women in hospital with swine flu in New Zealand.

Public health doctor Nick Wilson said flu epidemics in 1918 and 1957 were noted for the higher mortality risk among pregnant women.

They are among the groups that have preferential access to Tamiflu in New Zealand, although health authorities say they should not take it without seeing a doctor.

Dr Hunt said pregnant women with influenza symptoms should call their GP or Healthline.

They should take extra care with hand washing and stay away from crowded places.

“Pregnant women are … at greater risk of complications from the swine flu, including pneumonia, and need to be particularly watchful for signs and symptoms of the virus,” he said.

Dr Weaver said that if a pregnant women gets a disease, “there is always a risk that she, as part of management of the disease, will have to be delivered early … The baby could be affected by the prematurity or could be quite sick with a flu-like illness.”

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