Widespread influenza outbreak in 47 US states

By Kate Randall
14 January 2013

The influenza outbreak has reached epidemic proportions in the United States, the Centers for Disease Control and Prevention (CDC) said Friday. Forty-seven states are reporting widespread flu activity, and the CDC reports that nine out of ten regions in the US have “elevated” flu activity.

The news comes as the Food and Drug Administration acknowledged that a form of the antiviral medication Tamiflu given to children to slow or stop flu symptoms was in short supply. The largest US flu vaccine provider Sanofi also said Thursday that it has sold out four of the six different dosages of the Fluzone seasonal flu vaccine due to unanticipated late-season demand.

There have been 28,747 confirmed laboratory cases of the flu reported nationwide, according to the CDC, but the number is likely much higher as many people do not seek treatment or are not tested. Twenty children have died from confirmed cases of the flu. The number of deaths among adults nationwide is not calculated by the CDC until the after the flu season has ended.

As of last Friday, the percentage of people seeing health care providers for influenza had increased to 5.6 percent of all visits, the fourth consecutive weekly increase. This compares to 2.2 percent in the previous flu season, which was relatively mild. The CDC estimates that more than 200,000 people in the US will be hospitalized for the flu in the year 2013.

One of the latest child victims was Tahila Johnson of Dallas, Texas. The six-year-old received a flu diagnosis from the Dallas Regional Medical Center last Monday and was sent home with a prescription for Zyrtec, an over-the-counter antihistamine. The girl was found dead by her grandmother the next day.

On Saturday, Governor Andrew Cuomo declared a state health emergency in New York, where the flu has sickened more than 19,000 people, compared to 4,404 confirmed cases for 2011-2012. Under the order, for at least the next 30 days pharmacists will be able to give flu shots to children as young as six months, overriding a state law that limits them to immunizing those 18 years and older.

Boston Mayor Thomas Menino declared a health emergency last Wednesday after health officials confirmed 700 cases of the flu in the city, 10 times last year’s figure. Massachusetts health officials have reported about 6,000 confirmed flu cases in the state and 18 flu-related deaths, all in adults. More than 6,000 people got flu shots at nearly two dozen free clinics set up across the city on Saturday.

Hospitals have been overwhelmed with patients seeking treatment for flu-like symptoms. At one point last week, a dozen Chicago-area hospitals were on “bypass status,” meaning they were so swamped with flu patients they were forced to turn people away. At Lehigh Valley Hospital-Cedar Crest in Pennsylvania a special tent was set up last Tuesday outside the emergency room to treat patients.

The Influenza A virus subtype H3N2 predominates this season, while the Influenza B strain is causing about 20 percent of cases. According to the CDC, the available flu vaccines are reportedly about 62 percent effective against contracting a severe case of the flu, which might cause hospitalization. Even if a vaccinated individual does come down with the flu, the illness is likely to be less severe.

The vaccine, though far from perfect, is still the best protection available against the flu and the CDC and local and state health officials are recommending that those who have not received the vaccine do so as soon as possible. However, as in the case of other urgent issues related to public health, prevention of the flu and treatment for those who come down with the illness are handled in a slipshod fashion, completely subordinate to the capitalist market.

There is no nationwide government program to offer and administer the flu vaccine, and no comprehensive publicity campaign to urge people to be vaccinated. Only 37 percent of Americans have received the vaccination, despite the CDC’s recommendation that everyone over the age of six months should receive it.

In a country of more than 315 million people, drug manufacturers planned to produce only 137 million doses of the vaccine this year. The majority of the vaccines are produced by Sanofi (60 million doses) and GlaxoSmithKline PLC (25 million doses). Seasonal flu vaccines in the US account for $1.6 billion in revenues, and are expected to grow to $2.2 billion by 2018.

Drug retailer Walgreens is the largest distributor of flu vaccines in the United States aside from government health authorities. The pharmacy chain has administered 5.7 million flu shots so far this flu season, up from 5.3 million a year ago.

Walgreens is reimbursed by private insurers and Medicare, and stands to make a handsome profit. “We’ve kept our reimbursement rates the same, so we are making a consistent level of profit,” Walgreens President Kermit Crawford commented following the annual shareholders meeting in Chicago.

Shortages of the vaccine are being reported. The city of Somerville, Massachusetts ran out of the vaccine last week and was only able to resume offering the shot this weekend after borrowing 100 doses from Cambridge Health Alliance in the adjoining city. In Colorado, health care provider Kaiser Permanente, with 535,000 members, had to stop giving flu shots last week and was expected to resume giving the vaccine this past weekend after receiving new supplies.

While urging the population to be vaccinated due to the outbreak, the CDC posted a banner on its web site reading: “At this point flu vaccine may be harder to find now than it was earlier in the season. You may need to contact more than one provider (pharmacy, health department, or doctor) to find available vaccine.” Individuals and families are expected to fend for themselves in the scramble for a vaccine recommended by the government agency.

And as the CDC acknowledges, vaccination provides far from perfect protection against contracting the illness. The current flu shot has little prospect of producing what is referred to as “herd immunity,” which is achieved when the community’s viral load drops after enough people are immunized with an effective vaccine, and even the unvaccinated are protected.

A vaccine that would provide lifelong protection against all flu strains—much like childhood immunizations for illnesses such as polio or measles—would be much more effective. “But there’s no appetite to fund that research,” Dr. Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told the New York Times .

“To get a vaccine across the ‘Valley of Death’ is likely to cost $1 billion,” he added. “No government has put more than $100 million into any candidate, and the private sector has no appetite for it because there’s not enough return on investment.”

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