CDC: School kids may have to get up to 4 flu shots in the fall

School children who have never had a flu shot may need to get vaccinated four times in the fall – twice for seasonal flu, twice for pandemic swine flu – officials at the CDC told health professionals on Wednesday.

Most everyone else should expect three shots.

Five manufacturers are now making vaccines against the pandemic H1N1 swine flu virus, said Dr. Tom T. Shimabukuro at the CDC’s Immunization Services Division, National Center for Immunization and Respiratory Diseases.

They are well on their way to having between 40 million and 160 million doses of egg-based vaccine available in the United States by October, added Dr. Pascale Wortley the U.S. Centers for Disease Control and Prevention’s pandemic vaccine coordinator.

On the high end, that would be enough vaccine for everyone in the United States who wanted it by January. But on the low end, it would require prioritizing distribution to health care workers and those at higher risk for complications – including children, pregnant women, and people with chronic diseases and asthma, Wortley said.

“This vaccine campaign will unfold quite differently than seasonal flu,” said Wortley, in a conference call with health care professionals nationwide on Wednesday. “This is a huge endeavor we’re gearing up for.”

Apparently, for good reason. The speed with which the H1N1 swine flu strain has spread globally has been documented meticulously, said the CDC’s Dr. Joseph Bresee, chief of epidemiology in the flu division.

“In a very short time we’ve gone from a couple of cases in two southern California kids to 94,000 cases in 134 countries worldwide,” he said.

And on Wednesday, the Florida Department of Health said two more people had died of swine flu in Florida, a 53-year-old Miami-Dade woman and a 55-year-old Volusia County man. The deaths brought the total number of swine flu fatalities in Florida to 12, the total number of confirmed cases statewide to 2,188.

Wortley said the pandemic flu shots will be divided among states proportionally, based on their population. And state health officials will manage their delivery, most likely through large-scale school, work and retail-based clinics managed at the county level. Protection against the pandemic strain will require two doses, an initial shot plus a follow-up booster.

Preservative-free shots will be available for children and pregnant women, about 20 percent of the lots manufactured, Wortley said. They will either come in single-dose injections or as Flu Mist, the live virus that is squirted into the nose.

Adults will most likely get their shots from multi-dose vials which contain Thimerisol, including very low levels of mercury.

It appears that health insurers will be willing to cover the new swine flu shots, Wortley said.

But there are still many unknowns, she said. Among them:

* Can the seasonal flu shot be given on the same day as the swine flu shot?

* How many days must pass between the first and second doses?

* How much of the antigen – the active ingredient – must the shot contain to be effective?

* Can a booster substance be added to stretch supplies further?

There are a number of newer vaccine technologies that are now under development, including cell-based vaccines and vaccines grown in fall armyworm cells. Those won’t be among the tier 1 vaccines used in the United States, Wortley said.

The regular seasonal flu vaccine supply will be ready much earlier than usual, possibly as soon as late August, she said. Clinicians will order those in the usual way.

Wortley said the CDC is setting up a process for tracking adverse reactions to the shots, including the rare but potentially fatal Guillain-Barré syndrome, an autoimmune disorder that can be temporarily paralyzing. In a 1976 vaccination campaign against a feared swine flu outbreak that did not materialize, 500 grew ill and 25 died from Guillain-Barre, but no one died of swine flu. It’s a different situation this time, because people have already from this flu strain.

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