The Swine Flu Virus

(Dr. H. M. Behl - exclusive to Veria.com)

According to WHO there is a global increase in H1N1 cases. Till date there were 2371 laboratory-confirmed cases in 24 countries worldwide, with 42 deaths reported from Mexico. There are 896 laboratory confirmed human cases, including two deaths in the United States. Younger people, of either sex, appear to be more prone to infection.

Pigs are known to have viral diseases and influenza, however the current swine flu influenza in humans was not known earlier. This influenza is caused by swine origin virus called H1N1. This strain of the virus is new and was not detected earlier till date, hence it has been named as A(H1N1). The correct nomenclature is Swine-origin Influenza A (H1N1) Virus (S-OIV). This is a serious and confirmed threat that will change priorities for many people and for many countries. World Health Organization (WHO), US government and other agencies are working overtime to find solutions and avoid spread of the disease. It does call for a caution yet it is not a potential threat to global public health.

How potential is the risk of animal viruses infecting humans?

We know of several animal viruses trespassing to humans and being fatal, though the contamination can be controlled since there is very little human to human transmission.

In September 1994, in Hendra, Brisbane Australia one racehorse developed a strange disease. This horse died in two days. It was contagious since other mares and horses too fell sick. They developed fever, respiratory distress, facial swelling and clumsiness. Later, 12 more animals died of failed kidneys and breathlessness. Even the trainer died after some days. The disease was due to a virus, never reported earlier, initially named equine morbillivirus (horse virus), later known as Hendra virus. How, why and from where this deadly virus came all of a sudden and spread in just 12 hours and left the horses dead thrashing and gasping desperately? Scientists discovered that the culprit was a fig tree where bats assembled; and the horse strayed down the tree and caught virus. The bats carried the virus. The virus did not affect the bats but was fatal for horses and human beings. Bats carry virus for SARS and Nipah.

Pathogens like this virus are natural components of an ecosystem. They have their favored targets. Occasionally, the pathogen may also shift to a new target due to accidents, aberrations, circumstances, opportunities or exigencies. When a pathogen leaps from non human animal to a person and succeeds there in making trouble, the result is zoonosis, a science of animal-human disease relationship.

Many animals like bats carry pathogens (such as virus) and may never have any adverse effect but when the pathogen changes the host, it may be deadly to the new host. We are aware of bird flu and HIV. Ebola, bubonic plague, yellow fever, monkey pox, Lyme disease, West Nile fever, strains of swine influenza, rabies, hantavirus, and many strange afflictions may be due to pathogens transferred from animals. 60 % of human infectious diseases are shared with animals. Some like rabies are lethal even with a clear scientific understanding about them. Others are new and sporadic.

SARS came from northeast China in 2003, and spread in nine countries killing 774. Initially it was thought to be carried by small mammal but later found that the horseshoe bat carries it. Rabies is very lethal and has 100 % mortality. The disease is caused by virus that rests in vampire bats.

It is difficult to eradicate a disease when its pathogen escapes to the host animal. Smallpox could be eradicated with WHO efforts since it infects humans or primates but not horses and bats. The virus had no way to hide. On the other hand, yellow fever is also infectious to both monkeys and humans, but virus can hide in several species of mosquitoes so it can never be eradicated.

Virus are the most dangerous since they evolve quickly, are unaffected by antibiotics, can be elusive, are very versatile, inflict high rate of mortality and are simply very mean. They cannot run, walk, swim, crawl but they ride. SARS, monkey pox, rabies, Ebola, West Nile, Machpo, dengue, yellow fever, Junin, Nipah, Hendra, influenza, HIV are all caused by viruses.

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Bats are mammals, breed slowly, live long, are nocturnal so remain hidden, can travel horizontally as well as vertically, can reach tree tops and come in contact with bees, monkeys, snakes, insects, fruits, fauna and flora at top of tree to bottom of tree. Bats move all over the word except Antarctica. They are quite successful mammals but scary since they innocently carry many vectors of disease. Bats are known reservoir hosts of an increasing number of zoonotic viruses, but they rarely display clinical signs of infection.

There was an outbreak of swine flu in humans in 1918 when Spanish influenza pandemic affected one third of the world's population (an estimated 500 million people) and caused approximately 50 million deaths. We did not know much about avian and swine flu at that time and were not equipped to face such a disaster. However, in 1930s the influenza viruses (now known as H1N1 viruses) were isolated from pigs and then humans13. None of the earlier cases (nearly 12 reported in the USA) in the past were fatal except for a solitary case where death occurred due to secondary complications. In 1976, there was an outbreak of swine influenza in New Jersey with more than 200 reported cases but there was again a single death. Approximately 40 million people received the swine flu vaccination (the A/New Jersey/1976/H1N1 vaccine) at that time. However, the immunization initiative was halted because of side effects of the vaccine.

Pigs are prone not only to the swine flu, but also influenza from birds and influenza from humans. Swine influenza is a highly contagious respiratory disease in pigs caused by one of several swine influenza A viruses. In addition, influenza C viruses may also cause illness in swine. Animals typically are given commercially available bivalent swine influenza virus vaccines.

Transmission of swine influenza viruses to humans is uncommon. However, the swine influenza virus can be transmitted to humans via contact with infected pigs or environments contaminated with swine influenza viruses. Once a human becomes infected, he or she can then spread the virus to other humans, presumably in the same way as seasonal influenza is spread. However, the current virus is a novel influenza A (H1N1) virus not previously identified in humans, and it appears to be spread by human-to-human transmission.

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Is it endemic or pandemic?

The swine flu epidemic can become pandemic. WHO has not declared it as pandemic at this stage. The WHO has raised its pandemic alert level for swine influenza to phase 5, which is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. It will have very detrimental effects on global health, economies and overall quality of life. It is a very scary situation.

The first influenza like illness was first reported in Mexico on March 18 which later turned out to be caused by H1N1 virus now identified as Swine-origin Influenza A (H1N1) Virus (S-OIV). About 97 of the Mexican cases have been laboratory-confirmed as Swine Influenza A/H1N1. 12 of these are genetically identical to Swine Influenza A/H1N1 viruses from California. There are reports of approximately 1,600 cases and over 150 deaths have been attributed to swine influenza in Mexico3. According to the WHO, laboratory-confirmed cases have been reported in 13 countries: the United States, Mexico, Austria (1 case), Canada (19 cases), Germany (3 cases), Israel (2 cases), the Netherlands (1 case), New Zealand (3 cases), Spain (13 cases), Switzerland (1 case), and the United Kingdom (8 cases). Cases are also suspected in Brazil, India (not yet confirmed by laboratory tests).

On April 26, 2009, the US Department of Health and Human Services declared a national public health emergency involving swine influenza A, citing its significant potential to affect national security. In the United States, 91 confirmed cases of swine flu have been reported as of May 3, 2009, Alabama (1 case), Arizona (18 cases), California (26 cases), Colorado (4 cases), Connecticut (2 cases), Delaware (10 cases), Florida (3 cases), Illinois (3 cases), Indiana (3 case), Iowa (1 case), Kansas (2 cases), Kentucky (1 case), Massachusetts (7 cases), Michigan (2 cases), Minnesota (1 case), Missouri (1 case), Nebraska (1 case), Nevada (1 case), New Hampshire (1 case), New Jersey (7 cases), New Mexico (1 case), New York (63 cases), Ohio (3 case), Rhode Island (1 case), South Carolina (15 cases), Tennessee (1 case), Texas (40 cases), Utah (1 case), Virginia (3 cases) and Wisconsin (3 cases) with a total of 226 cases and one death11 . All affected patients have had mild influenza like illness, with only two requiring brief hospitalization. As of May 3, 2009, only one death attributed to swine flu has been reported in the United States, involving a 23-month-old child. There are 149 deaths have been attributed to swine influenza in Mexico, with 9 of those deaths confirmed as resulting from the infection.

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Swine influenza tends to cause high morbidity but low mortality rates (1%-4%). Unlike typical influenza, most cases of swine influenza have occurred in previously healthy young adults.

Levels of WHO alerts

Phase 1 to 3: Predominantly animal infections: very few human infections
Phase 4: Sustained human to human infection
Phase 5/6/Pandemic: Widespread human infection. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

WHO has issued Phase 5 alert for the current swine flu.

Centers for Disease Control and Prevention (CDC), World Health Organization (WHO)

Symptoms of current swine flu

Most of the symptoms are similar to those of seasonal influenza. One should be careful if two or more than two of the following symptoms are observed. Consult health care provider immediately since the antiviral drug if prescribed should ideally begin within 48 hours from the onset of symptoms

• Fever
• Cough
• Rhinorrhea or nasal congestion;
• Sore throat
• Body aches
• Headache
• Chills and fatigue
• In addition, persons with swine flu may have other typical symptoms of influenza, including body aches, headache, chills, fatigue, and possibly diarrhea and vomiting.
• In children, signs of severe disease include dehydration, altered mental status and extreme irritability.

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In children emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

How long can viruses live outside the body

• Some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent hand washing or using an alcohol based hand gel will help you reduce the chances of becoming ill after touching these surfaces.
• People with novel flu are potentially contagious as long as they have symptoms and possibly for up to 7 days after they become ill. Children, especially younger children, might be contagious for longer than 7 days.
• The duration of influenza is typically 7days.

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Possibility of swine influenza virus infections

Centers for Disease Control and Prevention (CDC) has suggested the following criteria for suspected swine influenza :

• Onset of acute febrile respiratory illness within 7 days of close contact with a person who has a confirmed case of swine influenza A (H1N1) virus infection, or
• Onset of acute febrile respiratory illness within 7 days of travel to a community (within the United States or internationally) where one or more swine influenza A (H1N1) cases have been confirmed, or
• Acute febrile respiratory illness in a person who resides in a community where at least one swine influenza case has been confirmed.
  

How prone are you to catch infection?

Unless you come in contact with infected person, there is no risk. The influenza season is just ending in the northern hemisphere, it is now beginning in the southern hemisphere. In the northern hemisphere, influenza season runs from October to March, while in the southern hemisphere, the season covers the remaining months, April to September. Influenza virus circulates year round in climates like Southern hemisphere or the tropics. Those in this risk zone should be immunized to avoid influenza illness, according to advice from the Centers for Disease Control and Prevention.

A confirmed caseof S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests:

1. real-time RT-PCR
2. viral culture

You are also at risk:

• If you traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in areas of the United States with confirmed swine influenza cases or Mexico in the 7 days preceding illness onset.
• Live in areas in the United States with confirmed human cases of swine influenza A (H1N1) virus infection. (To find the most up-to-date information on areas with confirmed swine influenza cases, go to http://www.cdc.gov/swineflu/index.htm)
• If you have an acute respiratory illness and have a recent history of contact with an animal with confirmed swine influenza (http://www.cdc.gov/swineflu/recommendations.htm).

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Is there a risk from drinking water?

Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of the novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What is expected of the doctor attending the suspected patients?

A respiratory swab is obtained for swine influenza if there is a suspicion. (If these specimens cannot be collected, a combined nasal swab with an oropharyngeal swab is also acceptable and will be feasible in most settings). Swabs with cotton tips and wooden shafts are not recommended. Specimens collected with swabs made of calcium alginate are not acceptable. The swabs are placed in 4°C refrigerator (not a freezer). This is then transported and timely diagnosis at a state public health laboratory by the state or local health department. The laboratories should send all influenza A specimens that they are unable to subtype to the Viral Surveillance and Diagnostic Branch of the CDC's Influenza Division as soon as possible for further diagnostic testing.

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How are these swabs tested?

Real-time RT-PCR for influenza A, B, H1, H3 is conducted at a State Health Department Laboratory. Currently, swine influenza A (H1N1) virus will test positive for influenza A and negative for H1 and H3 by real-time RT-PCR. If reactivity of real-time RT-PCR for influenza A is strong, it is suggestive of a novel influenza A virus. Confirmation as swine influenza A (H1N1) virus is now performed at the CDC.

Rapid tests can distinguish between influenza A and B viruses. A patient with a positive rapid test for influenza A may meet criteria for a probable case of swine flu, but again, a negative rapid test could be a false negative and should not be assumed a final diagnostic test for swine influenza infection.

Immunofluorescence (DFA or IFA) tests can distinguish between influenza A and B viruses. A patient who is positive for influenza A by immunofluorescence may meet criteria for a probable case of swine influenza. However, a negative immunofluorescence could be a false negative and should not be assumed a final diagnostic test for swine influenza infection.

Isolation of swine influenza A (H1N1) virus by viral culture is also diagnostic of infection but may not yield timely results for clinical management. A negative viral culture does not exclude infection with swine influenza A (H1N1) virus.

Recommendations for treatment

If there is a suspicion of swine influenza infection, one must report it to local medical authorities and there are no short cuts.

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Recommendations from traditional Ayurvedic medicine

There are several herbs that give you protective and preventive capability. These may not provide a cure once you have influenza but their regular use provides you enough protection from cold, cough and fever.

• Ashwagandha is considered a rasayana (rejuvenation) herb. This herb is also considered an adaptogen which means it works to normalize physiological function. The fresh roots are boiled in milk prior to drying, in order to leach out undesirable constituents.
• Root extracts of Glycyrrhiza glabra is a preferred ingredient in modern cough syrups. It also improves body immunity.
• Ocimum (Tulsee tea) particularly with fresh lemon improves body immunity and provides protection from cold and cough.
• Regular use of Emblica officinalis (amla) fruits (dried, powdered, pickled or in syrup) provide excellent immunity from cold and cough.

Recommendations from traditional Chinese medicine

Prevention is the best medicine. Herbs are commonly prescribed during a change of season to help a person adapt to the changing weather. By planning ahead and taking herbs accordingly, one can drastically reduce the frequency and severity of catching the common cold or the flu.

• Astragalus (huang qi) and Ganoderma (ling zhi) are recommended for enhancing immunity.
• Astragalus (huang qi) indirectly protects against external pathogenic factors. Astragalus is being used by biotechnology companies for extracting active ingredients for modern medicine. Astragalus is known to increases both specific and non-specific immunity by increasing the white blood cell (WBC) count. It may also have mild antiviral activity and help with the prevention of colds. The part of the plant used medicinally is the root.
• Ganoderma (ling zhi) are wood-decaying fungi wood-decaying fungi that have been traditionally used to tonify blood and enhance immunity. Ganoderma also increases the number of white blood cells and inhibits the growth of various viruses and bacteria associated with the flu.

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Suggested Homeopathy medicines

Aconite
Usually given in fever, congestion and chill preceding inflammatory fever. Other symptoms are redness of face, anxiety, restlessness, dislike to music, dry skin, high fever, cough and violent thirst. This is recommended if the fever caused by exposure to dry cold air.
If there is no anxiety, Aconite is not recommended.

Gelsemium
When the patient is in warm weather and the fever is accompanied by laziness, muscular weakness and a desire for absolute rest and is unaccompanied by thirst, Gelsemium is recommended. The patient remains dizzy and drowsy, lacks courage and does not like to go in hot or sunny surroundings. Usually the patient will like to be left alone and does not wish to speak
Sulphur
Sulphur is recommended in fever when the skin is dry and hot and there is no sweat.
Belladonna
Belladonna is a good medicine when the fever is accompanied with headache, the eyes are red and skin has a hot and burning sensation. There is little or no thirst. The fever is worse at night. Minor cough and throat irritation can be treated with Belladonna potency 30. In case of pain in the throat and/or inflamed tonsils, this remedy can be alternated with Mercurius solubilis.
Bryonia
Bryonia is good for fever when accompanied by sharp pains over the eyes, dry mouth, cold, chilly sensation.
Kali Mur, Natrum Mur, Kali sulph, Natum sulph
These medicines are good for cough and cold. These are also recommended when patient suffering from bronchitis.

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General advice for suspected influenza patients

This is not a treatment but a supportive advice.

• Complete bed rest, remain home at the earliest sign of illness.
• Minimize contact in the community to the extent possible.
• Increased fluid consumption
• Take cough suppressants
• Patients should be encouraged to stay home if they become ill
• Avoid close contact with people who are sick
• Wash hands often
• Avoid frequent touching eyes, nose, and mouth.
• Local authorities will decide on school dismissals but parents and children should avoid gatherings and avoid congregating outside of the school if school is canceled.

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When swine flu is confirmed

• Patients who develop fever with either cough or sore throat should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer.
• They should seek medical care, patient should contact their health care providers to report illness before seeking care at a hospital.
• Patients who have difficulty breathing or shortness of breath or who are believed to be severely ill should seek immediate medical attention.
• If the patient must go out in public, he or she should wear a face mask to reduce the risk of spreading the virus in the community when coughing, sneezing, talking, or breathing. If a face mask is unavailable, ill persons who need to go into the community should use tissues to cover their mouth and nose while coughing.
• While in home isolation, patients and other household members should be given infection control instructions, including frequent hand washing with soap and water. Use alcohol-based hand gels (containing at least 60% alcohol) when soap and water are not available and hands are not visibly dirty. Patients with swine influenza should wear a face mask when within 6 feet of others at home.

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Preventive measures

Recommended measures (by CDC) for care of patients with suspected or confirmed swine influenza include the following:

• Place patients in a single-patient room with the door kept closed.
• An airborne-infection isolation room with negative-pressure air handling can be used, if available. Air can be exhausted directly outside or can be recirculated after filtration by a high efficiency particulate air (HEPA) filter.
• Patients should wear a surgical mask when outside their room.
• Encourage patients to wash their hands frequently and to follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons.
• Routine cleaning and disinfection strategies used during influenza seasons can be applied.
• Standard, droplet, and contact precautions should be used for all patient care activities and maintained for 7 days after illness onset or until symptoms have resolved.
• Health care personnel should wash their hands with soap and water or use hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions.
• Personnel providing care to or collecting clinical specimens from patients should wear disposable non sterile gloves, gowns, and eye protection (e.g., goggles) to prevent conjunctival exposure.
• Pending clarification of transmission patterns for the 2009 swine influenza A (H1N1) virus, personnel providing direct patient care for suspected or confirmed cases should wear a fit-tested disposable N95 respirator when entering the patient's room.

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Vaccines

In fact, there is no vaccine available that is specific to A(H1Ni) influenza, however vaccines used for seasonal influenza have been used and the new virus has been found to be susceptible to some of these. Some of the current vaccines are being administered to persons suffering from Influenza A (H1N1) Virus (S-OIV) yet we need specific vaccines for this disease; and it may take four to six months to develop a Influenza A (H1N1) Virus (S-OIV) specific vaccine.

Seasonal influenza vaccine is likely to have no effect on the swine-origin influenza A (H1N1) strain, the World Health Organization (WHO) said, and a new vaccine will take about 4 to 6 months to make.

We need to have vaccines against this new strain rapidly and sufficient enough for all Americans and if possible for the whole world wherever there is a potential risk. The developing world will need low-cost drugs to protect their population as this new influenza is a serious and global threat.

All currently approved vaccines use eggs for producing vaccine. The supply of eggs may be an issue for large scale production of vaccine for all Americans. Modern science has developed cell-based vaccines that don't require eggs. This is a faster mode but not yet approved for use.

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Oseltamivir (Tamiflu) and Zanamivir (Relenza) as antiviral agents

Oseltamivir (Tamiflu) and Zanamivir (Relenza) have been found to be effective against Influenza A (H1N1) Virus (S-OIV). However, no off the counter drugs may be taken even if you have a doubt of catching infection. Medical advice should invariably be taken in such cases.

Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir, and the CDC has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses. The usual vaccine for influenza administered at the beginning of the flu season is not effective for this viral strain. Also, other antiviral agents (e.g., amantadine, rimantadine) are not recommended because of recent resistance to other influenza strains documented over the past several years.

Oseltamivir and Zanamivir inhibit the glycoprotein on the surface of influenza virus that destroys an infected cell's receptor. By inhibiting viral glycoprotein, these agents decrease the release of viruses from infected cells and, thus, viral spread. Both are effective in the treatment of influenza A or B (and also for swine flu) and must be administered within 48 hours of symptom onset. These agents reduce the severity of symptoms and reduce the length of illness by an average of 1.5 days. Always take these medicines after consulting your doctor.

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CDC recommendations are as follows:

• Suspected cases: Treat with zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine as soon as possible after the onset of symptoms and for a duration of 5 days.
• Confirmed cases: Zanamivir or oseltamivir should be administered for 5 days.
• Pregnant women: Antiviral medications are in Pregnancy Category C, so they should be used during pregnancy only if the potential benefit outweighs the potential risk to the embryo or fetus.
• Children younger than 1 year: Because infants typically have high rates of morbidity and mortality from influenza, infants with swine influenza A (H1N1) infections may benefit from treatment with oseltamivir.

Detailed guidance on antiviral treatment for swine flu may be found here: http://www.cdc.gov/swineflu/recommendations.htm

Other supportive care

Basic supportive care (i.e., hydration, analgesics, cough suppressants) should be prescribed. Empiric antiviral treatment should be considered for confirmed, probable, or suspected cases of swine influenza. Initiation of antiviral agents within 48 hours of symptom onset is imperative for providing treatment efficacy against influenza virus.

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Prophylaxis with antiviral agents should also be considered for those in close household contacts of a confirmed or suspected case who are at high risk for complications such as chronic medical conditions, persons above 65 years or less than 5 years and pregnant women. Those in contact with travelers to Mexico and health care providers or public health workers who were not using appropriate personal protective equipment during close contact with a confirmed or suspected case must take proper medicine as per doctor's advice.

Aspirin or aspirin-containing products (e.g., bismuth subsalicylate [Pepto Bismol]) should not be included in the treatment of confirmed or suspected viral infection in persons aged 18 years or younger because of the associated risks.

Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications in pregnant women. Because zanamivir is an inhaled medication and has less systemic absorption, some experts prefer zanamivir over oseltamivir for use in pregnant women.

Proposed flu prevention legislation

Senator Tom Harkin (D-IA) today introduced legislation to prevent future flu outbreaks in response to the current H1N1 flu outbreak. The Seasonal Influenza and Pandemic Preparation Act of 2009 would establish a nationwide voluntary influenza vaccination program under which any individual may receive an annual influenza vaccine, free of charge.

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“The harsh reality is that we have repeatedly experienced devastating flu pandemics. Strictly as a matter of prudent prevention, it is desirable to maximize the number of Americans who are vaccinated each year. And by offering the vaccinations for free and making them conveniently available, we would remove major barriers to more widespread participation,” said Harkin.

According to the Centers for Disease Control and Prevention, an average of more than 40,000 Americans die each year from flu-related causes. Seasonal flu is responsible for more than 31 million outpatient visits and more than 3 million days in the hospital. Seasonal flu costs the U.S. economy nearly $90 billion annually, including $10 billion in medical costs.

The Seasonal Influenza and Pandemic Preparation Act will help to build up our vaccine-manufacturing capacity and prevent production capacity from becoming idle or underutilized. By offering annual free vaccines to all 304 million people in the United States, our vaccine-production capacity will be up and running and ready to shift, when necessary, to mass production of vaccines to fight a future outbreak or pandemic.

The Act was introduced as a stand-alone bill, but Harkin intends to incorporate it into the Prevention and Public Health title of the comprehensive health reform legislation.

“A program offering annual free flu shots to every American is exactly the kind of smart, cost-effective, prevention-focused public health that must be at the center of a reformed health care system,” Harkin continued.

As chairman of the Appropriations subcommittee that funds health programs, Harkin has taken the lead in providing funding to prepare for a future flu pandemic. Since Fiscal Year 2006, the subcommittee has provided more than $6 billion for these activities. President Obama has requested $1.5 billion to respond to the current influenza and Harkin is working to include funding in the supplemental spending bill currently moving through Congress that will continue to invest in vaccine development, the stockpiling of antivirals and other medical equipment and local and public health preparedness.

http://www.idph.state.ia.us/h1n1/default.asp