Priority List for Swine Flu Vaccine recipients revealed. Causing great Anxiety to some.

[Mira]

NPR Health Blog
Aug 2.2009

CDC Advisors Reveal Priority List for Swine Flu Vaccine
by Deborah Franklin

Health officials aren't certain that a swine flu vaccine will be ready by early fall. Nonetheless, a government-appointed panel of vaccine experts met Wednesday to vote on a priority list of who should get the first batch.

The tentative list that the CDC advisory committee came up with was -- in no particular order:

Pregnant women, for two reasons. First, because the evidence suggests they're more likely than other adults to develop serious complications or die when infected with swine flu (or seasonal flu). And second, because they pass their immunity on to the fetus, which health officials hope will also help protect the infants after birth.

-- Household contacts and caregivers of children under six months. Infants that young can't be vaccinated, so immunizing their family members and others who care for them is the best way to keep the babies under six-months-old safe.

-- The 14 million health care and emergency service workers in the United States. That's because they could spread the illness to vulnerable populations, and also because high absenteeism among health care workers could bring down the health care system.

-- All children, adolescents, and young adults age six months to 24 years. A number of reasons for this. Epidemiological data gathered so far suggest that the youngest in this group have a higher-than-average risk of getting so sick with the new H1N1 flu that they need hospitalization. And older kids, teens and young adults tend to quickly spread flu through schools. Plus, there's a domino effect through the economy when parents have to stay home to care for sick kids.

-- Adults age 25 through 64 who have underlying medical conditions, such as heart or respiratory illness, diabetes, or other conditions that suppress their immune systems. Swine flu is likely to hit them harder than healthy adults.
(Read past the jump to find out who's at the back of the line and why.)
Beyond those targeted groups, healthy people through the ages of 25 and 64 are next up -- if there is enough vaccine left.
Last on the list are people 65 and older, said the members of the CDC's Advisory Committee on Immunization Practices. This sounds cold-hearted, but the committee says its reasoning is based on the science of the pandemic so far. There have been far fewer cases of swine flu in this elderly group. Researchers think that's because older people have higher levels of immunity to this strain of flu.

Some more here:

http://www.npr.org/blogs/health/2009/07/cdc_advisors_reveal_priority_l.html

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I hope this is not a duplication, I could not find it, anyway.

I have a friend who is 65 and has COPD. The community she blogs with, people with distressed immune systems and lung problems and on oxygen are often over 64. They are terrified at this news.
I don't have their background on those illnesses, and all I can say is that I cannot imagine their doctors would not administer the vaccine if asked to do so.

Also, I tell them, President Obama would have to tell me to my face people with those problems over 64, who wanted it, would be denied the vaccine.

Any thoughts? Does anyone know anything to calm these scared people?

[kestrel91316]

1. I betcha they don't include veterinarians in with the health care people.

They will conveniently forget about our vital role in public health issues such as food safety and zoonoses. They will let us die.

[nadinbrzezinski]

5. I think they will include you in the list

call me silly, but I suspect they will.

By the way for the reasons you noted.

[kestrel91316]

20. We tend to get overlooked. After Schwarzedollar tried to put sales tax

on veterinary medical services and NOT on such vital things as pet boarding and grooming, lol, I am pretty much convinced government types are completely clueless about our role in public health.

[LeftishBrit]

22. Apart from all other arguments...

one of the big flu-related worries is interspecies transmission and recombination into more dangerous forms - which makes it IMO particularly important for vets (and others who may be around sick animals, such as farmers) to get vaccinated.

[jwirr]

2. It looks good to me and I am over 65. At the moment I sit a child under

6 months but that will not last. I like the priority because it protects my family first.

[Mira]

7. What if you, at 65 or more,

were on oxygen, and your immune system is only marginally functional?
People like that are the scared ones. I just turned 65 and I am healthy. I don't need it.

I am not saying this is an OK priority, I think they did not carefully word it, I believe it is not possible
that we deny those who want to be vaccinated, if they are past the cut-off age and sick.

I am told that Glaxo is creating it, but other drug companies are holding out for government subsidies, which is why they are not having enough available in time.
I DON"T KNOW, that's why I posted this. There are scared people out there thinking they may be left to die.
And they are not all Republicans.

The sentiment will multiply and hurt the Obama administration.
I don't like it, and I simply don't believe it, I'm looking for some help arguing my position that it is not so.

[jwirr]

9. Actually they were covered under the people with disabilities, weren't they?

Edit to see that they are not covered. Okay that scares me but I am in the diabetes group and I still want my family protected first.

[nadinbrzezinski]

10. Bingo, my dad is in that list

he will get it because of the diabetes, COPD and the rest..

CHRONIC condition.

People need to learn how to read

[Mira]

12. Please - if you would - send me or post a link to your source. I am trying very hard to get

good news out to these people. Since I do not for a single heart beat believe their worries are founded in truth.
I am extremely concerned about the damage worrying about being left to die helplessly can do to them personally and the country politically.

[nadinbrzezinski]

13. They are not at the top of the list and this is the reason why

Adults Aged <65 Years

One dose of TIV is highly immunogenic in healthy adults aged <65 years. Limited or no increase in antibody response is reported among adults when a second dose is administered during the same season (135--139). When the vaccine and circulating viruses are antigenically similar, TIV prevents laboratory-confirmed influenza illness among approximately 70%--90% of healthy adults aged <65 years in randomized controlled trials (139--142). Vaccination of healthy adults also has resulted in decreased work absenteeism and decreased use of health-care resources, including use of antibiotics, when the vaccine and circulating viruses are well-matched (139--141,143--145). Efficacy or effectiveness against laboratory-confirmed influenza illness was 50%--77% in studies conducted during different influenza seasons when the vaccine strains were antigenically dissimilar to the majority of circulating strains (139,141,145--147). However, effectiveness among healthy adults against influenza-related hospitalization, measured in the most recent of these studies, was 90% (147).

In certain studies, persons with certain chronic diseases have lower serum antibody responses after vaccination compared with healthy young adults and can remain susceptible to influenza virus infection and influenza-related upper respiratory tract illness (148--150). Vaccine effectiveness among adults aged <65 years who are at higher risk for influenza complications is typically lower than that reported for healthy adults. In a case-control study conducted during 2003--2004, when the vaccine was a suboptimal antigenic match to many circulating virus strains, effectiveness for prevention of laboratory-confirmed influenza illness among adults aged 50--64 years with high risk conditions was 48%, compared with 60% for healthy adults (147). Effectiveness against hospitalization among adults aged 50--64 years with high-risk conditions was 36%, compared with 90% effectiveness among healthy adults in that age range (147). A randomized controlled trial among adults in Thailand with chronic obstructive pulmonary disease (median age: 68 years) indicated a vaccine effectiveness of 76% in preventing laboratory-confirmed influenza during a season when viruses were well-matched to vaccine viruses. Effectiveness did not decrease with increasing severity of underlying lung disease (151).

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5707a1.htm

Translation from the medical goopey doo

Adults over 65 have a lower response to the vaccine anyway, in other words they don't develop antibodies as fast. They also have antibodies to a slew of them from a lifetime of exposure.

They will get the vax as chronic patients... when available, but nobody expects the same results in them as they do in me or you... or my nephews.

I understand the fear, but the reality is that the higher risk groups are ahead of them, this is standard triage. Hell, I even told hubby, if it gets REALLY bad, and I get REALLY sick, I expect to be triaged out of a major fight. I was a medical provider, so I accept it, and it does not scare me.

But the summary of the CDC standards is simple... if and when they have the vax the real chronic patients will be in the middle of the pack, not at the top. It used to be, ten years ago, that small kids were not even in the triage list... these days they are.

So if we have a good enough coverage that will also have a protective effect on the herd...

[Mira]

15. Thank you for responding, nadinbrzezinski, I will pass it on. Good information for certain.

[nadinbrzezinski]

18. In this case I go to the source, the CDC

and you welcome

[pinto]

19. Thanks for the info.

:thumbsup:

[Joanne98]

3. Well the teabaggers are refusing to get them so they'll be more for us.

[nadinbrzezinski]

4. Funny, this is the TRIAGE list I came up with myself

we will have a short supply of the vaccine, there is no way, no how, they can produce enough.

At least the ... they will make it mandatory shtick, should stop by now.

[MercutioATC]

6. It's not a matter of denying them the vaccine.

Early supplies are limited, so they have to be rationed. The over-65 age group is the last in line for statistical reasons. As more vaccine becomes available, they'll be vaccinated too.

I would HOPE that a doctor wouldn't use a limited supply of vaccine to vaccinate those who are statistically less likely to be harmed.

[wroberts189]

8. Some countries have enough and I will let someone else take mine.

If that helps.

[dana_b]

11. the reverse of the yearly flu vaccine

I understand their reasoning since the young are especially hard hit by H1N1 however if someone of any age is immune compromised, I cannot believe that they would be denied the vaccine.

I'll be working as a flu vaccination nurse this season and it will be interesting to see what rules they give us, once the vaccine is available.

[Mira]

14. If at any time you hear something let it trigger two memories:

A: that I asked about it and
B: my name.

Please let me know. I am in daily contact with someone who runs a COPD Message board, which is why I know they are so up in arms about it.
Thank you!

[dana_b]

16. I will Mira!

I'll bookmark this thread too. I hope your friend (and others) get better news and what they need to protect their health.

[Mira]

17. Thanks : )

[FirstLight]

21. Well, there's four more you all can have

Not for me or my kids, thanks...

I have an autoimmune disease, and will NOT trigger it further by being vaxed
...and neither will my kids, never have never will

so you can tell the govt that we said thanks but no thanks

[Hekate]

23. My daughter is pregnant... and operates a pre-school... damn. No good choices for her. nt

[madfloridian]

24. Before now seems like seniors were given good priority on vaccines

In fact seniors usually get lectured if they don't go along with it.

I don't like the many mentions of rationing care to the elderly.

Someone in our party needs to get off their asses and explain this stuff.

[gleaner]

25. I have read in articles....

from credible sources that this particular flu hits young people much harder than older people. No one knows why. I am not, not, not comparing it to the flu that was pandemic around 1917, (Spanish Flu I believe they called it) but it acted the same way. Young people were more likely to get sicker and die. This flu seems to target the same population. Older people get milder cases and are less likely to develop serious secondary infections.

I was talking to my Internist about the vaccine last week and he has issues with giving it out to his patients based on information he has received so far about its effects and the way it was prepared. He strongly recommends getting your regular flu shots, a pneumonia shot if appropriate and to take Tamiflu or other flu specific medications when you first start feeling any kind of flu like symptoms. You still go through the illness with the oral medication, but the flu is much milder and does not last as long. They are available with a doctor's prescription, and you should see a doctor anyway if you think you have the flu. It always bears watching.

I would tell the elderly that the scientists are working very hard on a viable vaccination for Swine Flu and that there will most likely be enough to go around. If they should get sick with flu they should promptly obtain one of the oral medications available and take it under a doctor's care. In the meantime no one should panic. Practice good hand sanitation either by washing your hands often with any good hand soap, and carrying a bottle of hand sanitizer with you when you are out and about. You can buy hand sanitizer at any market or pharmacy. Purell makes it, and so do a bunch of other companies. The nurses use it in hospitals when they go from room to room or patient to patient. Most flus and colds are passed from hand to hand contact with a sick person or something they have handled recently, so keeping your hands clean and sanitized is one of the best protections against getting sick.