Parents infuriated over wait for swine flu vaccine


Palm Beach Post Staff Writer

Saturday, October 24, 2009

When pediatrician Tommy Schechtman ran a weekend swine flu vaccination clinic recently, he was forced to deliver bad news to many parents.

Children who got the seasonal flu nasal mist at schools and in his office had to wait another 28 days before taking the swine flu nasal vaccine, all he had at the time.

The children had been vaccinated against a flu strain that was not circulating, rendering them unable to be vaccinated against the strain that actually threatened them.

Some parents screamed at him.

"'You gave my child the seasonal flu mist and now my child is not eligible to get H1N1?'" Schechtman said. "They are upset."

School health officials estimate the H1N1 pandemic "swine flu" has sickened between 150 and 300 Palm Beach County students each week since school started. More than 70 people have been hospitalized, around 30 of them in intensive care. Six county residents have died.

Meanwhile, the county health department and school district are in the midst of the most extensive school-based influenza vaccine campaign in their history. Against seasonal flu, not swine flu. That's because the agency applied for and won a major federal grant to give out free flu vaccines in schools long before the first swine flu cases emerged.

Now, health workers are distributing 30,000 doses of the triple-strain seasonal vaccine at 107 public elementary schools, paid for with the $206,000 federal grant. It has been a major undertaking, said Dr. Cathy Burns, health services specialist for Palm Beach County schools. Changing the plan now would be nearly impossible.

"The logistics of all of this takes weeks and weeks of planning," Burns said.

There were consent forms that had to be written, then translated into Spanish, Creole and Portuguese. The forms had to be duplicated, distributed, checked and entered into computerized records. Contracts had to be negotiated and signed. School schedules had to be checked and arranged.

Then on vaccination day at each school, dozens of children must be pulled from class, interviewed for contraindications such as asthma or egg allergies, then vaccinated and observed for side effects, under the watchful eyes of assistant principals and nurses.

Thirty-eight elementary schools have given the seasonal vaccine since Oct. 5. By Thanksgiving, it will be given at an additional 69 schools.

On Friday, children at Cholee Lake, Panther Run and Grassy Waters elementary schools were vaccinated. On Monday, children at Pioneer Park, Rosenwald, Gove and Marsh Pointe elementary schools will be next.

At each school, a third to half of the students are signing up to be vaccinated, some of the best results the health department has ever seen. It's more typical to see 20 percent of kids get vaccinated.

Health department Director Dr. Alina Alonso said she was delighted with the response.

"At Boca elementary the other week, 57 percent of kids had taken up the FluMist. That has gone extremely well," she said.

Unfortunately, the vaccine the children are receiving this year is likely useless against the pandemic flu strain.

Worse, it prevents the administration of the pandemic flu vaccine that's in most abundant supply locally, the FluMist H1N1 live-virus nasal spray, made by Medimmune, a subsidiary of AstraZeneca.

Giving the live virus vaccines too close together can prevent an effective immune response, doctors say. It would be a nonissue if the killed, injectable vaccine were available, because scientists believe it can be given at the same time as the FluMist without problems.

But manufacturers have run into difficulty growing the H1N1 virus, said Dr. Thomas Friedan, director of the Centers for Disease Control and Prevention, during a media briefing Friday. It's grown in fertilized hen eggs.

He quoted from a children's book, Frog and Toad Together.

"Even if you yell at them, they don't grow faster," he said. "As it happens, the FluMist has been growing well."

Bloomberg News reported Friday that the CEO of Novartis says the company will not be able to deliver much vaccine until early 2010. Novartis is to deliver about one-third of the nation's flu vaccine supply. The swine flu strain has grown at about half the rate of seasonal flu strains, he said.

Because the H1N1 vaccine supply is so uncertain, because the virus is so new, and because time is so short, it's better that children go to their doctors if they can to get vaccinated against H1N1, said Dr. Savita Kumar, the Palm Beach County Health Department's medical epidemiologist for communicable diseases.

It's not practical for the health department to cancel or convert its school FluMist campaign to a swine flu campaign, Kumar said.

"The contracts are already in place with those vendors providing the seasonal vaccine," she said. "The other planning went on over quite a few months."

When large shipments of swine flu vaccine are shipped, they go to the physicians, health department clinics, hospitals and other clinics according to the direction of local public health officials. Kumar said she wants parents to be there during vaccination, to sign consent forms and hold hands in cases where the needles are used. So for swine flu, after-school clinics or doctors' offices are better than in-school vaccinations, she said.

While the new H1N1 strain represents more than 95 percent of circulating flu nationwide, experts say there is value in having widespread vaccination against seasonal flu, too.

Dr. Peter Palese, a microbiologist and professor at Mount Sinai School of Medicine, said people should do their best to get both vaccines, to protect themselves and to lower the chances that the flu strains will swap genes in some unhappy person who gets both types at once. The seasonal flu vaccine is proving to be scarce this year, too, and so the children may be fortunate to have the chance to get the seasonal flu shot at all.

"No one knows for sure which influenza virus strains will be circulating in the upcoming season, come January, February," Palese said. "It is thus very prudent to take both vaccines."

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