

Return of swine flu: What's ahead for Americans?

The alarm sounded with two sneezy children in


swine flu has become the world's dominant strain of influenza, andit's putting a shockingly younger face on flu.

So get ready. With flu's favorite chilly weather fastapproaching, we're going to be a sick nation this fall. The bigunknown is how sick. One in five people infected or a worst case _half the population? The usual 36,000 deaths from flu or tens ofthousands more?


"What we know is, it's brand new and no one really has animmunity to this disease," Health and Human Services Secretary

Kathleen Sebelius says.

A lot depends on whether the swine flu that simmered all summererupts immediately as students crowd back into schools and colleges_ or holds off until millions of vaccine doses start arriving inmid-October.

Only this week do U.S. researchers start blood tests to answer acritical question: How many doses of swine flu vaccine does it taketo protect? The answer will determine whether many people need toline up for two flu shots--one against swine flu and one againstthe regular flu--or three.

The hopeful news: Even with no vaccine, winter is ending in theSouthern Hemisphere without as much havoc as doctors had feared, aheavy season that started early but not an overwhelming one. Thestrain that doctors call the 2009 H1N1 flu isn't any deadlier thantypical winter flu so far. Most people recover without treatment;many become only mildly ill.

Importantly, careful genetic tracking shows no sign yet that the

virus is mutating into a harsher strain.

We're used to regular flu that, sadly, kills mostlygrandparents. But the real shock of swine flu is that infectionsare 20 times more common in the 5- to 24-year-old age group than inpeople over 65. That older generation appears to have someresistance, probably because of exposure decades ago to virusessimilar to the new one.

Worldwide, swine flu is killing mostly people in their 20s, 30sand 40s, ages when influenza usually is shrugged off as a nuisance.

Especially at risk are pregnant women. So are people withchronic conditions such as asthma, diabetes, heart disease andneuromuscular diseases including muscular dystrophy. Some countriesreport more deaths among the obese.

Still, some of the people who've died didn't have obvious healthrisks.

"People who argue we're seeing the same death rates miss thepoint--they're in young adults. To me, that shouldn't happen,"said one infectious disease specialist, Dr. Richard P. Wenzel of

Virginia Commonwealth University. He spent the past few monthsvisiting South American hospitals to help gauge what the NorthernHemisphere is about to face.

Children, however, are the flu's prime spreaders. Already,elementary schools and colleges are reporting small clusters ofsick students. For parents, the big fear is how many children willdie.

Panicked crowds flooded India's hospitals in August after a14-year-old girl became that country's first death. In the U.S.,regular flu kills 80 to 100 children every winter, and the Centersfor Disease Control and Prevention has reports of about three dozenchild deaths from swine flu.

Even if the risk of death is no higher than in a normal year,the sheer volume of ill youngsters means "a greater than expectednumber of deaths in children is likely," said Dr. Anne Schuchat,director of the CDC's National Center for Immunization andRespiratory Diseases. "As a society, that's something that's muchharder for us."


Swine flu quietly sickened hundreds in Mexico before U.S.researchers stumbled across two children in San Diego who had thesame mystery illness. A world already spooked by the notoriousAsian bird flu raced to stem the spread of this surprising newvirus. Mexico closed schools and restaurants, and barred spectatorsfrom soccer games; China quarantined planeloads of tourists. Butthere was no stopping the novel H1N1--named for its influenzafamily--from becoming the first pandemic in 41 years.

Well over 1 million Americans caught swine flu in spring andsummer months when influenza hardly ever circulates; more than 500have died.

In July, England was reporting more than 100,000 infections aweek.

Argentina gave pregnant women 15 paid days off last month at theheight of its flu season, hoping that staying home would proveprotective.

In Saudi Arabia, people younger than 12 and older than 65 arebeing barred from this November's hajj, the pilgrimage to holycities that many Muslims save up their whole lives to make.

And in Australia--closely watched by the U.S. and Europe as apredictor for their own coming flu seasons--hospitals set upclinics outside the main doors to keep possible flu sufferers fromentering and infecting other patients.

"While this disease is mild for most people, it does have thatsevere edge," said Australia's health minister Nicola Roxon, whocounted over 30,000 cases in a country of nearly 22 million. That'scomparable to its last heavy flu season in 2007.

Cases are dropping fast as winter there ends. But Australiastill plans to start the world's first large-scale vaccinationsnext month in case of a rebound, inoculating about 4 millionhigh-risk people.

Most amazing to longtime flu researchers, this new H1N1 strainseems to account for about 70 percent of all flu now circulating inthe world. In Australia, eight of every 10 people who testedpositive for flu had the pandemic strain.

That begs the question: Do people still need to bother withregular flu vaccine?

Definitely, stressed CDC's Schuchat, who plans to get bothkinds. There's still enough regular flu circulating to endangerpeople, especially the 65-and-older generation.

Notably, South Africa is having a one-two punch of a flu season,hit first with a seasonal strain known as H3N2 and now seeing swineflu move in.


Wash your hands, sneeze into your elbow, stay home so you don'tspread illness when you're sick. That's the mantra until vaccinearrives.

This week brings a key milestone. Hundreds of U.S. adults whorolled up their sleeves for a first shot in studies of the swineflu vaccine return for a blood test to see if they seem protected.It will take government scientists a few weeks to analyze results,but the volunteers get a second vaccine dose right away, in casethe first wasn't enough.

The vaccine, merely a recipe change from the usual flu vaccine,seems safe. Federal authorities two weeks ago gave the go-ahead tostart children's vaccine trials.

"It's been a piece of cake," said Kate Houley of Annapolis,Md., who jumped at the chance to enroll her three sons, ensuringthat if the vaccine really works, they'll have some protection asschool gets started. Eleven-year-old Ethan was among the first tobe vaccinated by University of Maryland researchers and didn't evenreport the main side effect--a sore arm.

In the U.S., Britain and parts of Europe, vaccinations are setto begin in mid-October, assuming those studies show they work.First in line:

_Pregnant women. Despite accounting for about 1 percent of theU.S. population, they've been accounting for 6 percent of the swineflu deaths.

_Children and young adults from 6 months to 24 years. Babiesyounger than 6 months can't get flu vaccine, so their parents andother caregivers should be inoculated to protect the infant.

_Health care workers.

_Younger adults with risky health conditions.

Schools around the U.S. are preparing to inoculate children inwhat could be the largest campus vaccinations since the days ofpolio. The government has bought 195 million doses and will shipthem a bit at a time, starting with 45 million doses or so inOctober, to state health departments to dispense.

The Association of State and Territorial Health Officials isnegotiating with pharmacists to help perform those vaccinations.

Massachusetts even is deputizing dentists to help give swine fluvaccine, and passed emergency regulations to encourage more healthcare workers to get either the shot or a nasal spray version.

What if people not on the priority list show up? The idea is forpharmacists to gently encourage them to come back a few weekslater, said the association's executive director, Dr. Paul Jarris.

A concern is whether enough people are worried about swine fluto get vaccinated.

"Complacency is a big challenge," said CDC's Schuchat. "Weare trying to strike a balance between complacency and alarm."

Ten-year-old Isabella Nataro had a cousin sent home from summercamp because of an outbreak, and she readily agreed when hermother, a University of Maryland vaccine researcher, signed her andher brothers up for a study of the new shot. (The store gift cardthat participating kids receive after each blood test was a bonus.)

"I'm kind of worried about my friends if swine flu does come toour school," the suburban Baltimore girl said. "I hope everybodyelse at my school gets a chance to get it."


Associated Press writers Kristen Gelineau in Sydney and MichaelWarren in Buenos Aires, Argentina, contributed to this report.


On the Net:

CDC background on swine flu: http://www.cdc.gov/h1n1flu/

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