The Somerville Health
Department had to postpone public flu clinics after vaccine shipments
fell short of expectations. Harvard Vanguard Medical Associates, in
Davis Square, told a similar story. This vaccine shortage comes to the
distress of parents with young children, who are particularly
susceptible to the H1N1.

There have been 1555 confirmed cases
of H1N1 in Massachusetts since April, when it was first detected in the
U.S. Of those cases, 13 people have died, according to a report by the
Massachusetts Department of Public Health (MDPH). According to the
Centers for Disease Control, H1N1 is now widespread in 48 states, which
has not been the case during typical flu seasons.

People lack
immunity to H1N1 flu, according to the Paulette Renault-Caragianes,
director of the Somerville Health Department, because H1N1 is a "novel"
virus.

"Part of that newness is there's a significant part of
our population that's probably never been exposed to this type of
influenza," she said, adding that the seasonal flu changes only
slightly each year.

H1N1 also differs from seasonal flu in the populations it hits hardest.

"90
percent of deaths you see from seasonal flu are from people over 65,"
Renault-Caragianes said. "In H1N1, 90 percent of the deaths we've seen
are people under 65, and more than half of the hospitalizations have
been people under 25-years-old."

'Vast majority'of flu cases will be H1N1

Dr.
Benjamin Kruskal, pediatrician and Director of Infection Control at
Harvard Vanguard Medical Associates, described the severity of H1N1 in
Somerville as being "similar to that with seasonal flu."

"Because
we're seeing more people sick, we are expecting to see more people who
are severely ill," Kruskal added. "We're now seeing levels of flu
illness that are typical of the very peak of a typical flu season
[February]. We normally see very little flu at this time of year."

The
Weekly Influenza Report released by MDPH showed the same trend, noting
that of the 75 influenza-positive specimens tested in Massachusetts
this October, 74 were H1N1, and the other was influenza B – not
seasonal flu. Kruskal says that based on that data, doctors could
assume the "the vast majority" of flu cases this fall are H1N1.

Along
with increased numbers of flu cases has been a vaccine shortage in
Somerville and across the country. According to Renault-Cariaganes, the
city originally planned to hold H1N1 clinics in the fall, but in
October it had received only "a very small amount" of the vaccine.

MDPH
and the CDC has advised the city that it "should wait until November
(and) until the supply that everyone has is sufficient for a
larger-scale offering of H1N1 vaccine clinics," she said.

Renault-Caragianes
blames the shortage on the fact that the same pharmaceutical companies
have contracted with the federal government to produce both seasonal
and H1N1 flu vaccines in the same year. As widely reported in the
media, manufacturers have also faced technical difficulties growing
virus for the H1N1 vaccine.

Even when the Somerville Health
Department does receive vaccine, it will not be immediately available
to everyone who wants it. Instead, the department will provide the
vaccine first to priority groups and even sub-groups outlined by the
CDC.

Renault-Caragianes said the priority groups include
pregnant women, caregivers of infants under six months, people 24 and
under, people 25 to 64 with underlying health conditions and healthcare
workers. After going through each group, the city may hold clinics.

'An Odd Loophole'

On
Nov. 2, the Somerville Health Department received a shipment of 400
doses of H1N1 vaccine and began inoculating children at Somerville
schools. Most of the vaccine they received is in a formulation called
FluMist, a nasal spray that contains a live virus which triggers the
body's immune system without causing an infection.

Renault-Caragianes
said that the vaccine is "limited in its use." Two high-priority
groups, pregnant women and those with underlying health problems,
cannot use the FluMist formulation, and the vaccine has only been
approved for people aged 2 through 49.

The school flu clinics
will start by vaccinating students only, and if vaccine supplies allow,
they will move on to teachers and staff. The clinics are not open to
the general public.

On Nov. 9, Renault-Caragianes said more
vaccines had been received by the city and that pregnant women would be
allowed to make an appointment to receive doses. She said there may be
enough vaccine for more general distribution in December.

The
shortage of vaccine and triage for available doses is a familiar
problem for Somerville parents Sue and Vince, who did not give their
last names. The couple has been struggling to get H1N1 vaccinations for
themselves in order to protect their daughter. At 3 months, she is too
young to receive the H1N1 vaccine.

In Sue's words, they "fall in an odd loophole in priority."

"We're
not young children, we're not infants, we're not pregnant, but we're in
that twilight zone where we care for a very young child," she said.

The couple tried to get vaccinated at Harvard Vanguard Medical Associates, but were told they could not get it.

"They
had some, which they gave out to children under 2 who already had
doctor's appointments and pregnant women," Sue explained. "But I wasn't
considered high priority in the first round."

Somerville
resident Liz Sylvan has had similar frustrations finding the H1N1
vaccine. Like Sue and Vince, Sylvan and her husband tried "a couple of
different ways" to find an H1Ni vaccine for their 2-year-old daughter,
Misha but have been unsuccessful.

"Nobody that we interact
with has it yet," Sylvan said. " Our pediatrician's office doesn't have
it, and I am worried about it, because she's little, she's 2."

Pointing
to her son, she continued, "And he's under 6 months, so he doesn't even
get to [receive the vaccine] yet, and so I am very concerned about it."

More information about H1N1 vaccine availability can be found at www.flu.gov.