Pregnant Women, Kids to Get Vaccine First

By BETSY MCKAY

ATLANTA -- Pregnant women, children and health-care workers are among those who should be first in line to receive a vaccine for protection against H1N1 swine flu, a U.S. vaccine-advisory panel recommended Wednesday.
The recommendation from the Advisory Committee on Immunization Practices, a body that counsels the federal government on vaccine matters, includes as many as 159 million people, or more than half the U.S. population. Those who should be offered shots first should the government give the final go-ahead to an H1N1 swine flu vaccination campaign are at highest risk of complications from the new flu virus, which had caused 5,011 hospitalizations and 302 deaths as of July 24, according to the Centers for Disease Control and Prevention.
Aside from pregnant women, shots should be given first to those in close contact with infants under 6 months old, health and emergency medical services workers, children and young adults from 6 months old through age 24, and people under 65 years old with underlying medical conditions, the panel said. It made its recommendations to the CDC, which will review them and then disseminate them to state and local health departments to help them plan for vaccination efforts.
The panel made a point of including young adults from ages 19 to 24 in the list of those to receive vaccine first because the rapid spread of the disease in schools in May and summer camps and military units this summer suggests outbreaks are likely to erupt on college campuses this fall. Moreover, people of that age group often hold service and entry-level jobs at which they could easily spread the disease to the broader population, the panel said.
The government isn't likely to have enough vaccine ready in early fall to cover this entire priority group. U.S. officials said they hope to have at least 120 million doses ready in October; 40 million of those could be ready by September should they be needed then. Robin Robinson, a vaccine official with the Department of Health and Human Services, said more than 20 million doses of bulk antigen have already been produced.
The 120 million doses would be enough for about 60 million people to be vaccinated in October, given that officials expect people will need two doses. But Anne Schuchat, the CDC's respiratory-diseases chief, said it was unlikely that everyone would line up for the shot, despite the agency's urging. Between 20% and 50% of these high-risk groups normally get the seasonal flu vaccine, she pointed out. "The size of the population may not be so relevant in terms of what the demand will be," she said.
Still, the advisory panel recommended that local officials narrow the priority list to a group of about 42 million people should vaccine supplies be tight. That highest-priority group would limit the children who receive the vaccine to those between 6 months and 4 years old and those with chronic medical conditions. The number of health-care and emergency medical services workers who get the vaccine first would also be limited, but pregnant women and people in close contact with infants would still be included in the highest-priority group, the panel said.
Once there is enough vaccine for the broader priority group, next in line would be healthy adults between ages 25 and 64, the panel said. People ages 65 and over, who are normally among the first to get seasonal flu shots, would be last in line for the new H1N1 shot, because their rates of infection have been far lower. One CDC study suggested that older people may have some immunity to the virus because they were exposed in their early years to H1N1 viruses that were similar to this new virus.
Pregnant women are of particular concern to public-health officials. In a study published Wednesday in the medical journal the Lancet, the CDC reported that the rates of hospitalization and death in a group of pregnant women studied early in the outbreak were higher than those in the general population.
Some attending the meeting in Atlanta where the panel made its recommendations expressed concern that a vaccination campaign targeting pregnant women and children first may go ahead before the results of clinical trials to test the safety and dosage of the vaccine are ready.
Concerns were also expressed about the use of thimerosal, a preservative that contains mercury, in the vaccine. "We're very concerned about thimerosal," said Lyn Redwood, vice president of the Coalition for SafeMinds, an organization that supports research on the links between mercury and neurological disorders such as autism.
Dr. Schuchat said that thimerosal-free vaccine would be available, both in the form of shots and nasal spray.
Write to Betsy McKay at betsy.mckay@wsj.com
 
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