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Q&A: Expected flu surge raises big questions

NBC Chief Science and Health Correspondent Robert Bazell explains the latest on the  race to develop a swine flu vaccine.
/ Source: NBC News

As the government warns that hundreds of outbreaks of swine flu at summer camps around the country could predict a big surge of the virus when students return to school, advisers have set priorities for groups that should be first in line for vaccinations against the H1N1 virus.

The panel of experts said that pregnant women, health care workers, and children and young adults between 6 months and 24 years of age face a greater risk of contracting the virus and suffering complications and  that these groups should get priority for the swine flu vaccine when it's available.

NBC Chief Science and Health Correspondent Robert Bazell explains the latest on the race to develop a swine flu vaccine.

Will there be enough swine flu vaccine for everyone in the fall?
A vaccine isn’t going to come galloping to our rescue before the pandemic hits again in the fall. Viruses grow at different speeds and the virus to make the swine flu vaccine is growing about 30 percent to 50 percent of the rate of the regular influenza. This is not going well. The first tests in human beings are just beginning in Australia. There will be tests in the U.S. in August.

It’s very clear there is not going to be a vaccine before school starts.

There was a lot of discussion at the meeting yesterday about the inclusion of 18-24 year olds in the recommendations. College students would be very vulnerable. When young people are in close quarters, they are at high risk of getting the virus.

The schools are the obvious place where it looks like there’s going to be trouble again. In the height of the epidemic in May, there were about 450,000 students not going to school because of swine flu. It could be far worse in the fall.

The concern of people who do computer models of outbreaks is, what if everybody in a power plant was stricken? We might lose a critical service. Or what if a huge percentage of people in sanitation service were sickened?

There are ways in which a disease, which is relatively moderate or mild in most people, could still be very disruptive to society. But there isn’t a whole lot we can do about it at this point.

Can we expect swine flu vaccine rationing?
The federal government will initially buy all the vaccine and will give it to the states. And it will be up to the states to give it out. They're assuming the supplies will be limited for awhile.

Is there any sign the flu is getting any worse?
No. They are certainly watching it very closely for that. We’ve been very fortunate so far that the molecular biology of this virus indicates that it does not seem to be changing.

There is one thing that has happened. There have eight cases of resistance to Tamiflu, which is not a lot out of potentially millions of cases, but it’s a worrisome trend. (Tamiflu is an antiviral used to prevent infections.)

Tamiflu gets used a lot in certain situations. With all the talk about vaccinating 18-24 year olds, there hasn’t been a lot of experience of what happens on college campuses. The brunt of the epidemic earlier this year happened when most college students had gone home for summer.

When colleges come back into session, that’s when you expect it to spread. We saw a big outbreak in July at the Air Force Academy, which starts very early. About 100 cadets were diagnosed with H1N1. The way they handled it was to isolate the people who had the virus in their separate quarters. Then, they gave Tamiflu to everyone else at the Academy. And they shut the virus down.

It's not clear whether that’s a reasonable strategy for the rest of the country. I don’t know if there’s enough supply of Tamiflu and you risk  developing a resistant infection, and then you don’t have any other defenses against the virus at all.

What happens when regular flu kicks in? How will they determine what’s swine flu and regular flu?
There could be a lot of confusion. There are going to be at least two shots, the seasonal flu shot — and when it’s available — the swine flu shot. And they’re targeting different groups with the two shots, so that could make the confusion worse.

There certainly will be a lot of seasonal influenza. An important thing to look at in the southern hemisphere, swine flu has come to be the predominant strain. There still is the seasonal flu, but it’s not nearly as much as the swine flu. And this is the height of their flu season.

Recently, in some places, such as Argentina and even Canada, there have been shortages of ICU beds and ventilators. Part of what needs to be done here is for every hospital to have a plan on how to handle everybody. Because nobody’s going to know which flu is what. Every hospital is going to have a test for influenza A, which is accurate. But if you get an enormous number of cases, you don’t test everyone.

Because of all the fears about the bird flu pandemic a few years ago, every city and every state is supposed to have a pandemic preparedness plan. Because we’ve seen this potential tsunami coming for the fall, we need to have in place what we do if the schools closed. Where do the kids go? Is it OK at companies if their workers call in sick? That’s got to become part of the fabric of society.

Who is most at risk from swine flu?
Women who are pregnant; if they start to get a fever they should go to the doctor and get treated. A study showed that pregnant women, especially those in the later stage, are at greater risk for complications from swine flu.

While Tamiflu and Relenza haven’t specifically been approved for use in pregnant women, there is no indication they are harmful to them. For pregnant women, it’s important to get the medical care right away because these drugs really only work in the first 24-48 hours for it to have any effect.

And the same advice that people were saying before still holds: Don’t just go to the doctor when you have the sniffles, but if you feel so bad very quickly you should not hesitate to go.