Swine Flu Frustrations: Too Little Vaccine, Too Many Scare Tactics

My daughter seems to have it, and I can't understand why there's no test and not enough vaccine.

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My daughter has swine flu—I think. She came home from school Monday with chills, headache, nausea, and, in her words, "feeling worse that I ever have in my life." By the next day, she had a fever of 102, a raging cough and a sore throat. A phone call to her doctor confirmed what I suspected. She probably has H1N1, but they're not going to test her or treat her with antiviral drugs and don't need to see her unless she develops breathing problems. Oh, but I should eventually still have her vaccinated against swine flu—just in case she doesn't have it now.

I would have gotten my daughter vaccinated two weeks ago at her annual checkup, but there wasn't any H1N1 vaccine available at that point. (The office didn't even have any seasonal flu vaccine left.) While the pediatrician does have some H1N1 vaccine in stock now, she told me it will probably be gone by the time my daughter's symptoms completely disappear and she can get the vaccine. I spoke to another frustrated mom this week who did manage to get her daughter, a classmate of my daughter, vaccinated—only to have her come down with flu symptoms 12 hours later. This is where vaccines have the potential to be wrongly blamed for causing the diseases they're meant to prevent. This girl was clearly infected with something, most likely H1N1, before she was vaccinated.

Since swine flu has been on my mind 24-7 this week, I decided to draw up a list of my frustrations, gathered from news articles, conversations with friends and family, and my own reporting.

Frustration No. 1: The vaccine is too little, too late. My 14-year-old daughter couldn't get it in time, and my elementary-school-age sons haven't gotten it yet because I don't want to take them out of school for the day to wait in line. My colleague Nancy Shute reported waiting for several hours last week in the rain with her daughter, and the Washington Post reports that more than 1,000 people were lined up Wednesday to get the vaccine at a clinic in Rockville, Md., a few miles from my house. About 160 million vaccine doses were expected to be available in October, but instead just 30 million have been produced. (I'm surprised scalpers haven't started selling shots on eBay.) Health and Human Services Secretary Kathleen Sebelius told a Senate committee this week that the vaccine shortage was due to lower than predicted yields from vaccine manufacturers and some manufacturing "glitches." Apparently, H1N1 grows more slowly in eggs than other flu virus strains. I'm guessing that health officials are beginning to understand the need to modernize this process. After all, those with egg allergies can never get a flu shot because it contains traces of, well, eggs. In fact, there's already a process available for growing flu vaccine in nonanimal cells, according to the nonprofit Project on Government Oversight, which blames the current vaccine delay on the government's contracting with overseas companies that use the old-fashioned method.

Frustration No. 2: Unlike strep, there's no widely available test for flu. That rapid flu test that everyone was getting in the spring? Well, the Centers for Disease Control and Prevention told doctors to stop using it because it missed too many H1N1 infections. There is, though, a nasal swab test that's far more reliable: It uses a process to amplify the virus's DNA sequence, says Jay Lieberman, medical director of Quest Diagnostics and a professor of pediatrics at the University of California-Irvine. Unfortunately, most labs don't yet have the capability to do this testing, so samples are being taken only from those who need to have their illness confirmed—say, a pregnant woman who's at higher risk of developing complications, a hospitalized patient, or an infected person who has a newborn or family member with asthma at home. "It's important to test individuals when the results will affect how to manage patients or their family members," Lieberman tells me. Given that my daughter had a mild case and no one in the family is at increased risk, he says, there was no reason to test her. He also told me that out of the 76,500 samples tested for swine flu by Quest from May 11 through October 11, about half tested positive. In my daughter's age group (10 to 14 year olds), 77 percent tested positive, which means the vast majority of the time docs suspect swine flu in tweens based on their symptoms, they're actually right. (That's because at the moment, the infection is running rampant through school-age kids, but it's expected to spread to their parents, grandparents and siblings.)

Frustration No. 3: It's hard to get the real story. Even as a reporter, I'm having a hard time getting the facts straight. Public-health officials are staying on message even as reports contradict some of what they're saying, making it hard to figure out what's really going on. A Purdue University study out this week, for example, predicted that outbreaks would peak during October, when most Americans won't have been able to access the vaccine. CDC folks disagree, claiming that only 5 to 10 percent of Americans have been infected so far. How they know that without testing, I have no idea. After all, my daughter and others like her who aren't getting medical care wouldn't appear on their radar screen. Federal officials also say they expect another wave of H1N1 this spring. Then again, the U.S. government spent $2 billion to purchase the vaccine, so they'd like to feel like they're getting their money's worth by actually using it. If another wave doesn't hit, officials can then attribute their good fortune to a successful immunization effort.

Frustration No. 4: The scare tactics are driving me crazy. I'm tired of talk show hosts—yes, you, Bill Maher, and you, Rush Limbaugh—telling me that the vaccine is dangerous or being forced upon me by the government. I'm also tired of CDC officials giving me the number of deaths and hospitalizations caused by H1N1 without putting those numbers into perspective. The chances of actually dying from this flu are less than those of being killed in a car accident. These officials announce at news conferences that the 28 deaths in pregnant women are "really upsetting"—which strikes fear in the hearts of all the pregnant women who may not be able to get the vaccine.

Frustration No. 5: Dealing with the unpredictable is difficult. I guess, like most people, I feel calmer when I'm in control. The H1N1 virus demands my respect because it's so unpredictable. While it doesn't seem to be causing as many deaths as seasonal flu, about 45 percent of those who wind up hospitalized with it have no underlying medical conditions. Unlike with seasonal flu, a number of folks who have died from H1N1 infections were healthy, young, and physically fit. Many were children. So, I watched my daughter like a hawk for the past three days and sent her back to high school Thursday (at her insistence) 36 hours after her fever had broken. I followed government guidelines and my pediatrician's advice, but I hope I made the right decision.

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