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Swine flu is present 'in virtually the entire country,' CDC expert says

New figures show H1N1 in 10 more states than a week ago, up to 37 now, and a rise in pediatric deaths.

October 16, 2009|By Thomas H. Maugh II

Pandemic H1N1 influenza "is here . . . in virtually the entire country," Dr. Anne Schuchat of the Centers for Disease Control and Prevention said Friday. Swine flu is widespread in 37 states now, up from 27 states last week, she said.

The figures suggest that a leveling-off observed last week was an aberration.

Some reports have suggested that certain places hit particularly hard in the spring, such as New York City, might not suffer as severely this winter. The CDC has been looking at 50 such locations, and many are seeing significant increases in flu activity now.

"At most, 5% to 10% of people were infected then," Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said at a news conference. "The vast majority of people are still susceptible."

Nineteen more children died from Sept. 27 to Oct. 3, bringing the total to 76 deaths of children since April -- "and it is only October," Schuchat said. In the last three flu seasons, 47 to 88 children died each year.

About three-quarters of the children who died from swine flu had underlying conditions, such as asthma, chronic lung disease and, especially, muscular dystrophy and cystic fibrosis.

Many of the deaths resulted from bacterial infections after victims' immune systems were weakened by the virus. A vaccine is available to prevent such infections, but it is underused, Schuchat said.

Deaths of children peaked in April at the height of the spring outbreak. The numbers are starting to climb again, Schuchat said.

About 6.8 million doses of swine flu vaccine were available as of Thursday, most of them the nasal spray FluMist. States and cities had ordered 3.7 million doses, but the CDC expects the number of orders to rise sharply.

"All states and the District of Columbia have placed orders," Schuchat said.

Some shipments of the seasonal flu vaccine have been delayed, primarily because manufacturers have had to balance their production of the two different flu vaccines. Although more seasonal flu vaccine is now available than is normal for this time of year, the demand is also higher than normal.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at the same news conference that 21-day results from the trials of the swine flu vaccine in healthy adults and in patients who received a second dose continue to show that one dose appears sufficient to produce strong immunity.

Those studies also showed that giving doses of swine flu vaccine and seasonal vaccine simultaneously does not interfere with the ability of either to provoke an immune response, he said, and they have revealed no serious adverse effects.

Fauci's institute began a trial recently with a swine flu vaccine containing an adjuvant -- a chemical added to increase the immune response to the vaccine. Results should be available by the beginning of November, Fauci said. "We are not intending to use adjuvants, but we are continuing with clinical trials," he said.

The agency is also launching trials of the vaccine in HIV-infected pregnant women and HIV-infected children as well as in asthmatic children receiving various levels of corticosteroids. Steroids depress the immune system and thus could interfere with the immunization process.

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