CDC hopes to prevent repeat of 1958 flu mortality surge

Jan 7, 2010 (CIDRAP News) – Warning against complacency about H1N1 influenza, Dr. Anne Schuchat of the Centers for Disease Control and Prevention (CDC) said she doesn't want to see a repeat of what happened in 1957-58, when a perception that the pandemic was over was followed by a winter surge of flu- and pneumonia-related deaths.

To prevent that, Schuchat, head of the CDC National Center for Immunization and Respiratory Diseases, urged the public to get the vaccine, now widely available. "There are ample supplies of H1N1 vaccine in most of the country," she said. "The vaccine should be easily available pretty much anywhere you live."

Schuchat referred to a graph showing that deaths attributed to flu and pneumonia peaked in October of 1957, dropped back to a nearly normal level in December, but then surged again in the winter, peaking in late February. (Accounts of the pandemic say the second mortality peak, strangely, was not accompanied by widespread flu outbreaks.)

"In 1957 they essentially gave the all-clear whistle in that December-January time period," Schuchat said. "They had vaccine, but they didn't encourage its use, and they did go on to see that increase in mortality."

She cautioned that no pandemic is the same as any other, adding, "I do not know that the 1957 story is what we're looking at today, but I do know that we have vaccine and we don't have to repeat history."

"The H1N1 virus is still circulating," she said. "We have an uncertain future. We want and need to avoid complacency."

About 136 million doses of vaccine have been made available so far, Schuchat reported, up from 111 million doses reported on Dec 22. The government has ordered a total of 251 million doses.

The CDC estimated on Dec 22 that about 60 million people had received the vaccine at that time. Schuchat gave no new uptake numbers today, simply saying "more than 60 million" have been vaccinated.

She noted that next week is National Influenza Vaccination Week, when public health officials will push for vaccination of people with chronic illnesses, pregnant women, children, and seniors, as well as anyone else who wants to be immunized. "We think it's time now for seniors who have wanted to be vaccinated but have stepped aside so younger, higher-risk people could be vaccinated."

"There's been a pretty stable amount of demand from people who are sure they want to get vaccinated," she commented. "But among people who think they probably want to get the vaccine, that's slipping down. . . . Still, there are a lot of people who want to get the vaccine."

She also said the CDC isn't concerned for now that the vaccine supply will reach the end of its shelf life before it can be used. Unlike some of their European counterparts, US officials have made no decisions about canceling any vaccine orders, she said in response to a question.

Schuchat offered no new H1N1 surveillance report today, saying the weekly report will come out tomorrow. She noted last week's finding that only four states still had widespread activity and that confirmed hospitalizations and deaths continued to drop.

Some other indicators were up slightly last week, including flu and pneumonia deaths and the percentage of medical visits attributed to flu-like illness, Schuchat observed. The latter might mean that cases are increasing, or it could simply reflect a decrease in routine, non-emergency medical visits over the holidays, she said.

See also:

2009 Biosecurity and Bioterrorism report on lessons of the 1957-58 pandemic
http://www.liebertonline.com/doi/pdfplus/10.1089/bsp.2009.0729

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