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Despite 2nd U.S. Death, CDC Says Don't Close Schools for Swine Flu

Swine Flu Milder Than Feared, but More Deaths Expected

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

May 5, 2009 -- The U.S. recorded it's second U.S. swine-flu death and the first of an American -- a Texas woman living near the Mexico border -- soon after the CDC said schools shouldn't close when students come down with H1N1 swine flu -- and schools closed because of swine flu may reopen.

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H1N1 Swine Flu

The CDC has repeatedly predicted that the U.S. would see more H1N1 swine flu deaths and hospitalization. Yet the CDC's official guidance for schools reflects a cautious easing of concern over the H1N1 swine flu pandemic.

Why the lower level of concern?

  • Initial alarm over swine flu deaths among healthy young people in Mexico has waned as investigation has turned up large numbers of relatively mild flu cases in Mexico.
  • The H1N1 swine flu has been relatively mild in the U.S. -- about as severe as seasonal flu.
  • Virus experts find that the current H1N1 swine flu lacks the virulence factors linked to severe illness in previous flu pandemics.
  • The Texas woman, from Cameron County in the extreme southern tip of the state, was in her 30s, Doug McBride, press officer for the Texas Department of State Health Services, tells WebMD. She had underlying health conditions that put her at high risk of flu complications.
  • ABC News reports that the woman lived in Harlingen, Texas, near the Mexico border. ABC reported the severely overweight woman, a schoolteacher, had recently given birth and had recently had pneumonia.

Schools Allowed to Reopen

The school-guidance announcement came earlier in the day from Health and Human Services Secretary Kathleen Sebelius, whose first official trip outside Washington D.C. was made to the CDC's Atlanta headquarters.

"The new guidance will recommend schools cease closing with recognized cases if H1N1 flu," Sebelius said at a news conference. "We hope this will alleviate some of the burdens on parents and workers. But keeping children safe and sound took the top priority until we knew more about this disease."

The change means more responsibility for parents, who now are asked to check their kids for signs of illness before sending them off to school. If their kids seem ill, parents are asked to keep them home for seven days -- even if they feel better in the meantime.

"And parents, don't turn around and send that child to the mall. This is about keeping children home until the virus can't be spread any further," Sebelius said.

Teachers, too will have more responsibility. They're asked to be on the lookout for kids with signs of illness and to send home any child who shows signs of the flu.

Ironically, the continued spread of H1N1 flu is one reason behind the softer CDC advice. If school outbreaks were the nexus of flu spread in the community, it might make sense to close them. But Richard Besser, MD, acting CDC director, said that school-related cases simply reflect H1N1 flu cases already in the community.

"We know that in communities where they had cases in schools, they already had cases in the community -- so trying to stop the spread of the virus by school closing is not effective," Besser said at the news conference.

As of today, the CDC says the U.S. has seen 1,105 probable and confirmed cases of H1N1 swine flu in 44 states. So far, there have been 35 known hospitalizations and one death in the U.S. Most cases have been in young people: The median age of cases is 16, and 62% of confirmed cases have been in people under age 18.

All 50 states can expect to see H1N1 swine flu, Besser said, and the CDC fully expects to learn of more hospitalizations and more deaths.

Besser also noted that the CDC is shipping swine-flu test kits to the states, which will allow them to catch up on a backlog of suspected cases. This means there will be a spike in case numbers as the backlog is reduced.

And Besser stressed that we aren't yet out of the woods.

"Over the last four days we saw exponential growth in our understanding of what is going on, but we still are in a period of major uncertainty," he said. "Where this is going to go is hard to say."

H1N1 Swine Flu Vaccine

Sebelius today confirmed that production of this fall's seasonal flu vaccine is already under way and will not be delayed until an H1N1 swine flu vaccine can be added. Instead, manufacturers have agreed to go full speed ahead with seasonal vaccine production.

"Part of reason we are accelerating seasonal flu vaccine production is to clear the deck, so if the decision is made to make a vaccine for H1N1 we will be ready to go," she said.

While the new swine flu is expected to simmer -- at least -- through the spring and summer, the big question is what will happen in the fall and winter. For reasons that are still unclear, flu viruses spread much more easily in the colder months.

If the H1N1 flu becomes a pandemic, and if it spreads in the Southern Hemisphere -- where it's now autumn -- there's a chance it might change. Those changes might make a vaccine against the current H1N1 swine flu strain less effective.

Such a changed virus might be more or less virulent and might affect different populations. All these factors will affect vaccine planning.

As of today, the World Health Organization (WHO) has not moved the needle from phase 5 pandemic alert to the phase 6 pandemic stage.

The WHO says that there have been 1,490 confirmed H1N1 cases in 21 countries, but that no continent outside North America yet has the sustained transmission that would mean an official pandemic is under way.

As of now, planning for an H1N1 vaccine is moving ahead.

"The goal is really to move forward," Sebelius said. "Every effort will be made to make sure that if and when the call is made by scientists, vaccine production is ready to go."

Vaccine decisions, Sebelius promised, will be based on science.

"We will turn to scientists at the NIH [National Institutes of Health] and CDC to say when we have a vaccine that can inoculate people, and who are the target groups that will receive vaccination," she said. "Those decisions will not be made until a vaccine is ready to go."

SOURCES: Kathleen Sebelius, secretary, Department of Health and Human Services. Richard Besser, MD, acting director, CDC. Kanji Fukuda, MD, assistant director-general for health security and environment, World Health Organization. CDC web site. World Health Organization web site. ABC News. Doug McBride, press officer, Texas Department of State Health Services.

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