Swine Flu: New Wave Expected

H1N1, swine flu
A medical professional leads a volunteer to receive an experimental vaccine designed to prevent him from contracting the H1N1 swine flu virus, during early trials of the drug at the University of Maryland in Baltimore, August 10, 2009. The University of Maryland's School of Medicine is one of the eight university medical centres and clinics trialling the experimental vaccine, expected to become more widely available later in the year, designed to protect against the H1N1 influenza virus. (REUTERS/Jason Reed)
Inzune Hwang
Preparedness Medical Officer, CDC
Monday, August 10, 2009; 2:30 PM

As the first influenza pandemic in 41 years has spread during the Southern Hemisphere's winter over the past few months, the United States and other northern countries have been racing to prepare for a second wave of swine flu virus.

While flu viruses are notoriously capricious, making any firm predictions impossible, a new round could hit the Northern Hemisphere within weeks and lead to major disruptions in schools, workplaces and hospitals, according to U.S. and international health officials.

Inzune Hwang, an H1N1 preparedness medical officer with the Centers for Disease Control and Prevention, was online Monday, Aug. 10, at 2:30 p.m. ET to discuss the latest news news about the H1N1 flu virus.


Inzune Hwang: Good afternoon, everyone. Thank you for inviting me to chat with you today. I am the technical specialty unit lead for 2009 H1N1 response at CDC's Emergency Operations Center.

I am joined by Dr. Sonja Olsen, H1N1 International Response team lead.


Falls Church, Va.: Hi.

I am as prepared as I can be for the H1N1 to arrive again. But my question is: If I get sick with a fever, do I go to the doctor or emergency room, or just take cold/flu meds to lower fever? Meaning -- I could just have a cold or regular flu, and going to the doctor might actually expose me to H1N1. How do people that feel under the weather know when/if they should chance a doctor/hospital encounter over the risk that whatever illness we have could kill us if not professionally treated? If it matters...mid 30s healthy male here. Thanks.

Inzune Hwang: Excellent question. CDC has developed answers to some of the most common questions regarding 2009 H1N1 Influenza, including what you should do if you are ill. I recommend visiting our website www.cdc.gov/flu.

In short, if you are otherwise healthy, it is recommended that you stay at home while you are ill. It is preferable to have someone at home to help provide care and assist in accessing healthcare if symptoms become severe. If you have pre-existing medical conditions, including asthma or other lung disease or immune disease, it would be appropriate to seek healthcare as early as possible, to try to avoid serious outcomes. It is also recommended that pregnant women and the very young also seek medical evaluation early.


Washington, D.C.: I've read that the new vaccine will require 3 shots, with the first being available later this summer. Will it be available to everyone, and if so, where can people go to get immunized?

Inzune Hwang: The number of vaccinations required for full immunity is still being evaluated. Our experience with children who have never had seasonal influenza immunization has led to the recommendation for two doses. We anticipate this may apply to the 2009 H1N1 vaccine, but studies underway will inform us shortly.

The vaccine is being produced with the intention to make it available to all persons in the U.S. However, early on, there will be some limitations in supply. The Advisory Committee on Immunization Practices (ACIP) has just released its recommendations on who should have first priority for immunization. See their guidance at the following:

Vaccines will be distributed to states for delivery to healthcare providers. Check with your state health department to determine where it will be available in your locality.


washingtonpost.,com: H1N1 Flu (Centers for Disease Control and Prevention)


Harrisburg, Pa.: It was reported that 26 states, mostly due to state budget crises, are not purchasing their share of the H1N1 vaccine. They are gambling this will not be an epidemic. Is this true and, if so, what happens if these states gambled incorrectly? What states are these 26, and is there anything residents within those states can do?

Inzune Hwang: Initially, all 2009 H1N1 vaccine will be purchased by the federal government for distribution to states. Vaccine is being distributed to each state based on the population of that state. States may have time to place orders later in the season.


Alexandria, Va.: Is it possible for someone who contracted swine flu this summer to be reinfected later this year?

Inzune Hwang: A person who was infected with most viral diseases, including Influenza, should develop immunity. It is theoretically possible to be infected twice by the same virus, but unlikely.


Two questions: 1. My family (including two small children) rarely goes to the doctor when sick. We don't have ongoing conditions that increase our risk of complications, so if we don't feel well we tend to just stay home until we're better. This season, if we suspect H1N1 flu, should we go to the doctor to be counted or tested?

2. If you catch and recover from H1N1 flu, can you catch it again?

Inzune Hwang: I believe both of these questions were answered previously. Please refer to the above.


San Francisco, Calif.: Is this influenza more severe/lethal than others, or is it just being more widely reported?

Also, if one got the swine flu vaccine in the '70s, could this have any effect on resistance to the current strain?

Inzune Hwang: It is very difficult to compare 2009 H1N1 as we are still investigating its characteristics. We will know more as we enter the traditional influenza season. Looking at the Southern Hemisphere, their experience with 2009 H1N1 is similar to the U.S. experience in the spring.

There is some evidence that some who older than 50 appear to have some immunity to the 2009 H1N1 virus.


Centreville, Va.: I work in the Disaster Recovery field, which, indeed, specializes in panic.

Over-reacting notwithstanding, how do I convince my company's HR department to pay some attention to making a swine flu plan that is practical and not over-the-top?

I agree with the professionals in my field that the results could be devastating to businesses, though we seem to over-react to everything (better safe than sorry?), which, in turn, makes us appear to be the boy who cried "wolf."

Meanwhile, my company ignores the threat almost completely.

Is there a middle-ground way to make a plan, and a way to convince executives they should give this more than 30 seconds worth of thought?

Inzune Hwang: The CDC is currently working on a guidance document for businesses to help them prepare and respond to 2009 H1N1. Look for this guidance to be published on flu.gov in the coming weeks.

As the U.S. Government continues in its preparations, we anticipate the business sector will also.


Laurel, Md.: Do the current vaccine trials include testing on pregnant women?

Inzune Hwang: I am not fully sure. The National Institutes of Health are conducting the vaccine safety trials for the 2009 H1N1 vaccine.


Champaign, Ill.: Our county public health department has suggested families should be stocking enough food for at least 2 weeks at home to prepare for the swine flu this fall. The idea is that shipments to grocery stores may slow in rural areas during a huge outbreak. Is this crazy talk? This sounds insane to me.

Inzune Hwang: CDC recommends ensuring adequate food and water for all-hazard preparedness. It is difficult to impossible to predict accurately how the 2009 H1N1 virus will propagate across each community this fall or the effect it will have on your community.


Dover, N.H.: From the article in today's paper, normal seasonal flu sickens 200k and kills 36k people in the U.S. every year -- an 18 percent death rate. Over the past year, swine flu has sickened 162k and killed 1,100-a death rate of less than 1 percent.

What the heck is everyone so scared for?? When will all this hysteria STOP!

washingtonpost.,com: Preparing for Swine Flu's Return (Post, Aug. 10)

Inzune Hwang: Good question. It is important to note that the activity that we have seen thus far in the U.S. is during what is normally considered the 'off-season' for influenza. CDC is ensuring that our preparations for the fall consider all possible scenarios.

We are also concerned that many of those affected by the current virus are younger. We consider even 36,000 deaths a year as far too many.


San Diego, Calif.: How can people get vaccinated?

Inzune Hwang: Keep checking the www.CDC.gov/flu website as well as the website for your state's public health department for plans on how the 2009 H1N1 vaccine will be distributed in your community.


Kettering, Ohio: Good afternoon. I am an insulin-dependent diabetic. How quickly should I get in line for the swine-flu shot? Taking pyridostigm for mysthenia gravis, will this regimen have any problems with the vaccine? Thanks for any info.

Inzune Hwang: Diabetics are considered to be high-risk for complications due to 2009 H1N1 and have been identified to be in the top priority group for immunization this fall when 2009 H1N1 vaccine becomes available.

It is best to speak with your healthcare provider about whether your medications should preclude you from influenza vaccination. In general, if you are eligible for seasonal influenza vaccination, you should be eligible for 2009 H1N1 vaccination


Washington, D.C.: I will be traveling to Argentina next week. Given the impact of swine flu in the country, do I need to take special precautions?

Inzune Hwang: WHO does not currently recommend any travel restrictions to any country due to pandemic H1N1. You should speak to your healthcare provider about how best to prepare for your trip.

Frequently check http://www.state.gov/travel/ for the most current guidance from the U.S. State department for foreign travel.


washingtonpost.,com: U.S.Department of State/Travel


San Diego, Calif.: Should we be stockpiling anything at home?

Inzune Hwang: Please refer to the reply to a previous question about stockpiling food and water.


Infant Travel: Hello:

I am tentatively planning a trip to the west coast via airplane when my child will be 5 months old (October/November). Is this a terrible idea? If not, what precautions can I take to protect him as best as possible?

Inzune Hwang: There is currently no advisory to restrict travel in the U.S. It would be advisable to plan ahead for your child's health by speaking with your child's healthcare provider and ensure that you have access to healthcare while visiting the West coast.

As important as our focus on 2009 H1N1, there are numerous health conditions to prepare for.


Three shots: I think the questioner is confusing the pandemic H1N1 vaccine, which is likely to require 2 shots, and the seasonal vaccine, which is one shot (except in children, who require 2 doses if they've never had that shot before). This area is ripe for confusion, and CDC really needs to spend time clarifying exactly which shots are seasonal and which are for the pandemic virus.

Inzune Hwang: Thank you for your comment. There will be TWO influenza vaccines this fall: seasonal influenza vaccine and 2009 H1N1 (pandemic) influenza vaccine. Our communications department is working very hard to develop educational materials on this.


Silver Spring, Md.: If there is not enough vaccination for everyone is there any plan to make sure that what is available will go to U.S. citizens?

Inzune Hwang: Vaccine delivery will be ultimately managed by each state's vaccine program. Please contact your local health department to express your concerns.


Washington, D.C.: I read that pregnant women are especially at risk. I am due to give birth in late November. Am I a prime candidate for the vaccination, or am I due too soon? Also, I have never taken a flu shot before. Should I be concerned about a bad reaction to the shot that could harm my baby?

Inzune Hwang: Historically, influenza vaccination has been very safe in pregnant women. Currently, the benefits of vaccination outweigh the risks. You should be eligible for vaccination at any time during your pregnancy.

Additionally, you are correct that pregnant women appear to be at higher risk for serious outcome, even death, due to 2009 H1N1. Please ensure to spend time discussing this issue with your provider.


McLean, Va.: Hello,

Thanks for taking questions. If a person was exposed to Russian flu in 1978 ( I was told that that strain was actually a swine flu strain) as a child, would there possibly be residual immunity that could protect from this current strain?

Thank you.

Inzune Hwang: It is hard to answer your question specifically about Russian flu, but early evidence does suggest that persons over 50 do appear to have some immunity to the current 2009 H1N1 strain. By what mechanism that immunity came about remains to be determined.


Alexandria, Va.: Hi -- Thanks for doing this chat. I'm planning foreign travel this fall and will check your website for information. My question is: What happens if I'm in another country in the middle of an outbreak?

Inzune Hwang: An excellent question. Healthcare access in foreign country varies widely. It is very important to research what resources are available and plan with your healthcare provider before you go on any foreign travel. In addition, the State Department can be an additional resource while traveling abroad.


MoCo, Md.: I have a 7-month-old and a 5-year-old in preschool. The baby has never had a flu shot (the 5 y.o. gets one yearly). How many shots will the baby need? I think he needs 2 shots for the regular flu vaccine. How many H1N1 shots would he need on top of that? I am particularly worried because our preschooler is constantly picking up various viruses at school which jump to the rest of us.

Inzune Hwang: You are correct that your baby will need two doses of seasonal vaccine to get full immunity. It is still being determined if the same applies to 2009 H1N1 vaccine.


Anonymous: If I catch swine flu, can I give it to my old dog? I'd hate for him to catch it, because he is not doing well.


Inzune Hwang: Dogs and various animals can be infected with influenza and other viruses. We do not know specifically if 2009 H1N1 can infect dogs.


Dover is wrong: "Dover, N.H.: From the article in today's paper, normal seasonal flu sickens 200k and kills 36k people in the U.S. every year -- an 18 percent death rate."

No, no, no -- 200k are hospitalized and 36k die from seasonal flu. Millions are infected. The death rate from seasonal flu is nowhere near 18 percent.

Inzune Hwang: Thank you for clarifying those statistics. I had not read the previous quote accurately.

The mortality can be calculated various ways, including against the general population or among hospitalized cases.


San Francisco, Calif.: Thank you for answering my previous questions.

When you say that "some who -are] older than 50 appear to have some immunity to the 2009 H1N1 virus," does this mean that they are less likely to catch the virus, or that they will have less severe illness when they do?

Inzune Hwang: They are less likely to catch the virus. If they do become infected, they can still have severe illness.


Home Dayare and Swine Flu/San Diego, Calif.: I run an at home licensed daycare. I have 10 children ages 12 months to 3 years. This summer, we had a child contract swine flu and I was placed on Tamiflu. I did not get sick, but I worry because I do have mild asthma and I am 47. What should I do in my daycare if another child gets swine flu this fall and at what point should I close my daycare and for how long?

Inzune Hwang: The CDC is currently developing guidance specifically for childcare settings. Please check with www.cdc.gov/flu frequently to read it when it is completed.

You may also want to read the guidance for schools that just posted. Many of the principles from the childcare guidance will draw from the school guidance.

As an individual with asthma, you are at increased risk for severe disease and should consult your healthcare provider to protect yourself this season.


Inzune Hwang: Thank you for the thoughtful questions and comments. It was a privilege to chat with you today. Visit us often at www.cdc.gov/flu for the latest information.


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