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Younger Age of Severe Swine Flu Cases Worries Experts

Average age of those hospitalized in U.S. is 15, CDC says

WEDNESDAY, May 6 (HealthDay News) -- While the large majority of U.S. cases continue to be mild, those who are hospitalized due to more severe disease appear to be atypically young, health officials said Wednesday.

In fact, the median age of hospitalized individuals with swine flu is 15, which is younger than occurs in regular seasonal flu, U.S. Centers for Disease Control and Prevention acting director Dr. Richard Besser said in an afternoon news conference.

"We are seeing the same distribution in hospitalized patients as we are in milder cases in the community, and that's younger than what you would see in seasonal flu," Besser said. "In seasonal flu you tend to see a predominance of burden of disease in the elderly and in the very young and here we are seeing it more in the younger population," he said.

"That is something we are keeping our eye on. That is something that raises concern," Besser added.

Overall, the age spread for hospitalized patients ranges from eight months to 53 years of age, he said. Why the more severe cases are skewing young remains unclear, Besser said, but it could be that younger people are getting sicker sooner, or older people may have some kind of built-in immunity.

In any case, the U.S. outbreak of H1N1 swine flu is continuing and although most cases are still mild more deaths are expected, the CDC head said. "We remain concerned," Besser said. "We are seeing continued spread around the country. We are seeing increases in numbers of patients."

Tuesday's death of a woman in Texas, the first U.S. resident to die while battling the swine flu, "reminds us that influenza can be a very serious infection, and it's one we need to continue to take very seriously," Besser added.

According to the Associated Press, Texas health officials have not said that the death of 33-year-old schoolteacher Judy Trunnell was directly caused by the H1N1 flu, noting that she also had unspecified "chronic underlying conditions."

Late Tuesday, reports surfaced that the government would ask Americans to get three vaccinations for the upcoming flu season -- one for the seasonal flu and two for this new strain of H!N1. However, on Wednesday Besser said that it is premature to make that decision.

"Before a vaccine is administered there are a series of studies that need to be taken, these are under the direction of the National Institutes of Health and approved by the Food and Drug Administration," he said. "They need to do studies to determine how much the antigen needs to be in the vaccine to stimulate protection."

"They will also need to see do you get sufficient immunity from one dose, do you need more than one dose," Besser said. "With each vaccine it's different, with different age groups it's different. It's really early to say how many vaccines someone is going to need until those studies are done," he said. "Hopefully, we will be able to find a vaccine that worked with one dose."

Besser said that, as of Wednesday, the CDC is reporting 1,487 probable and confirmed cases in 44 states. "That's an increase of around 400 from yesterday. There are around 850 probable cases and 642 confirmed cases. The confirmed ceases are in 41 states," he said.

In addition, there are 35 confirmed hospitalizations from the flu and an additional 17 probably caused by flu, Besser said. Much of the increase is due to catching up on testing, but there is a real increase in disease too, he said.

Besser noted that in Mexico, the outbreak's epicenter, the flu is disappearing in some areas and popping up in others, which is what will be seen in the United States as well.

"When you see a large outbreak or epidemic it is frequently made up of a series of smaller outbreaks and epidemics. What they are seeing in Mexico is parts of the country where they are seeing increases in disease and in parts of the country they are seeing decreases in disease. When you add that all up it may show some leveling off, but it doesn't give a sense of how dynamic the situation is," he said.

The World Health Organization is now reporting about 1,500 cases in 22 countries, with Canada, Spain and the UK having the most cases outside of the U.S. and Mexico.

Looking towards the possible re-emergence of the H1N1 flu next fall, U.S. experts are pondering who ought to get the swine flu shots and whether vaccine makers can make both 180 million doses of the regular seasonal flu vaccine and up to 600 million rounds of the new vaccine, the Postreported.

"We are moving forward with making a vaccine," Robin Robinson, a director with the Department of Health and Human Services who oversees pandemic response programs, told the Post. Robinson added that although a formal decision about the swine flu vaccine has not been made, if the government goes ahead, it would probably produce two doses for all Americans. If the threat diminishes, he said, health officials could decide to produce doses for only a portion of the population.

Last week, a 23-month-old boy from Mexico, who also had underlying health problems, died from the swine flu illness in a Houston hospital. He was the first fatality in the United States from the current swine flu outbreak.

Also Tuesday, U.S. health officials said the outbreak of swine flu appears similar to the seasonal flu in its severity, so schools across the nation should remain open and any schools that did close should reopen.

This announcement marked a change from the previous guidance, which recommended that affected schools close for at least two weeks. The U.S. Education Department has said that more than 430 schools have been closed nationwide because of flu fears, affecting about 245,000 children.

Students who are sick with flu-like symptoms should stay home for at least a week, officials cautioned.

The change in guidance does not mean that scientists know much more now than they did before about what the virus will do, Heath and Human Services Secretary Katharine Sebelius stressed in a Tuesday news conference. "We don't know what will happen over the course of the summer, and we certainly don't know what will happen when we get back into the [fall] flu season," she said.

"We are learning more about the H1N1 virus every day," Sebelius said. "We know there will be more cases and, unfortunately, there are likely to be more hospitalizations and more deaths. We are working as fast as we can to stay ahead of this disease."

At another press conference on Monday, Besser told reporters that "we are not out of the woods," but he added that "we are seeing a lot of encouraging signs."

Among the encouraging signs: "So far the severity of illness we are seeing in this country is very similar to what we see with seasonal flu," Besser said. "And that's encouraging information."

In addition, some of the initial lab tests are heartening, Besser said. "The lack of some of the factors that have been associated with more severe disease in previous pandemics, we are not seeing those," he said.

Testing for the virus is also becoming faster, Besser said. "We have distributed test kits to every state and this will allow for more rapid diagnosis at the state level," he said.

And, he added: "The situation in Mexico is encouraging. It appears that things are leveling off in Mexico."

In fact, the Mexican government on Tuesday announced moves to revive an economy that had been leveled by the swine flu outbreak. According to the Associated Press, while annual Cinco de Mayo festivities were more or less canceled this year, car traffic was noticeably busier in Mexico City on Tuesday and fewer people were seen wearing surgical masks.

All of this followed the declaration by Mexican officials on Monday that the epidemic appeared to be waning, with no deaths linked to swine flu recorded since April 29. The country's flu alert was scaled back to allow cafes, museums and libraries to reopen this week after a five-day shutdown of nonessential businesses. Universities and high schools will reopen Thursday, and younger schoolchildren are to report back to school on May 11, the AP reported.

"The measures we have taken, and above all the public's reaction, have led to an improvement," Mexico City Mayor Marcelo Ebrard said at a news conference on Monday. "But I insist that the virus is still present, that we need to remain on alert, and the resumption of activities will be little by little, not all at once."

What health experts don't know is whether the never-before-seen virus will return, perhaps in a more dangerous form, when the regular flu season begins again late this year. Because the pathogen is a genetic mix of pig, bird and human flu strains, health officials are worried that humans may have no natural immunity to it.

As with the previously tested strains of the swine flu virus, new testing has found that the pathogen remains susceptible to the two common antiviral drugs Tamiflu and Relenza, according to the CDC.

And that has led to a boom in sales of the two drugs in the United States, the AP reported Tuesday. Frightened by the prospects of the swine flu, Americans are snapping up the two antiviral medicines that treat the virus, whether they have it or not.

More than one-quarter of a million prescriptions for Tamiflu pills alone were filled at retail U.S pharmacies in the week ending last Friday. That's 34 times higher than the week before -- as the regular flu season wound down -- and more than double the peak of last winter's flu season, the news service said.

WHO officials stressed that the swine flu cannot be transmitted through the consumption of pork products.

U.S. Human Cases of H1N1 Flu Infection
(As of May 6, 2009, 11:00 AM ET)
States # of
Alabama 4  
Arizona 48  
California 67  
Colorado 17  
Connecticut 4  
Delaware 33  
Florida 5  
Georgia 3  
Hawaii 3  
Idaho 1  
Illinois 122  
Indiana 15  
Iowa 1  
Kansas 2  
Kentucky* 2  
Louisiana 7  
Maine 1  
Maryland 4  
Massachusetts 45  
Michigan 8  
Minnesota 1  
Missouri 2  
Nebraska 4  
Nevada 5  
New Hampshire 2  
New Jersey 7  
New Mexico 3  
New York 97  
North Carolina 7  
Ohio 5  
Oklahoma 1  
Oregon 15  
Pennsylvania 1  
Rhode Island 2  
South Carolina
Utah 1  
TOTAL (41) 642 cases 2 deaths
*Case is resident of Ky. but currently hospitalized in Ga.
Source: U.S. Centers for Disease Control and Prevention

More information

For more on swine flu, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: May 5, 2009, teleconference with Kathleen Sebelius, secretary, U.S. Department of Health & Human Services, and Richard Besser, M.D., acting director of the U.S. Centers for Disease Control and Prevention; May 1-2, 2009, teleconferences with Anne Schuchat, M.D., interim deputy director, science and public health program, U.S. Centers for Disease Control and Prevention, and Nancy Cox, Ph.D., chief, influenza division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention; Associated Press; Washington Post

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