In the face of a rising number of pediatric deaths from pandemic influenza A(H1N1) virus, the federal government has drained the Strategic National Stockpile of its remaining 234,000 doses of pediatric-strength oseltamivir, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at a press briefing.
He reported that 19 children died of laboratory-confirmed influenza during the 1-week period between Oct. 23 and Oct. 30, bringing the total of pediatric deaths to 114. More than two-thirds of those cases were in children with underlying conditions, but the remainder were in healthy children, Dr. Frieden said.
Serious H1N1-related illness and deaths also are rising in young and middle-aged adults, following the unusual pattern of illness of this influenza strain. Adults over age 65 represent just 10% of deaths from H1N1 influenza, compared with 90% of deaths in an outbreak of seasonal influenza.
Children and young adults have been particularly hard-hit in the early weeks of the autumn H1N1 surge.
“There is a certain rhythm of flu spread in a community where we see first an increase in the number of cases, generally first in children and then in older people, then an increase in hospitalizations … and then, tragically, deaths. We are expecting, sadly, to see an increasing number of deaths [in the coming weeks and months],” Dr. Frieden said.
Several urgent steps are being taken to increase the supply of antiviral medication available to treat children who show serious signs of illness, he said.
The emergency release of stockpiled pediatric oseltamivir (Tamiflu) follows an initial transfer of 300,000 doses on Oct. 1.
Additionally, the government is working closely with commercial pharmacy chains to supplement reserves by compounding adult doses into liquid, pediatric-strength oseltamivir.
“Please don't try this at home. This is something that should be done by a professional pharmacist,” Dr. Frieden said at the briefing.
He also called attention to new survey data showing that among people with underlying medical conditions such as asthma, heart or lung disease, and pregnancy, just half with flu symptoms have sought medical care.
He stressed that people with such conditions should see their health care providers right away.
At the other end of the spectrum, a large number of otherwise healthy people with mild flu symptoms may be crowding emergency rooms unnecessarily. In most individuals who do not fall into high-risk categories, H1N1 influenza produces a mild illness that can be treated at home.
People at high risk should also be prioritized to receive the 26.6 million doses of vaccine currently available, said Dr. Frieden, who released a chart explaining which type of vaccine can be received by which group.
He went on to debunk the belief that health care workers should not receive the intranasal form of the H1N1 vaccine, emphasizing that it is an attenuated, cold-adapted vaccine that is safe and will not promote the spread of influenza to patients.
“In contrast, an unvaccinated health care worker does present a risk to patients,” he said.
Dr. Frieden briefly commented on the release of a new estimate of the number of probable H1N1 cases in the United States between April and July that was generated by a probability multiplier mathematical model taking into account patients without laboratory-confirmed influenza.
That estimate of 1.8 million to 5.7 million cases was 140 times greater than the number of laboratory-confirmed cases during the period (43,677). The estimate was published online in the CDC's journal Emerging Infectious Diseases.
Federal officials are currently working on a better estimate, he said.
Another unanswered question is whether new findings from the World Health Organization might impact the current U.S. government position that children need two doses of H1N1 vaccine for adequate protection.
On Oct. 30, WHO officials stated that based on evidence reviewed by its Scientific Advisory Group of Experts, one dose of any of the current H1N1 vaccines produces a sufficient immune response to protect populations older than 6 months of age.
The position of the U.S. government has been to “look at the data and follow the data,” and for the time being, the two-dose schedule is still recommended, Dr. Frieden said.