GRAND FORKS, N.D. -- A surge in the number of H1N1 cases nationwide appears to have tapered off in recent weeks, but another surge is likely later in the flu season, according to an Indian Health Service official.
John Redd, chief of the IHS division of epidemiology and disease prevention, said it appears the flu surge peaked about two weeks ago based on his agency's data and reports to the Centers for Disease Control and Prevention.
During that peak, about 6 percent of all visits to IHS health care facilities were for influenza-like illness -- about 4,300 such visits in just one week. That decreased to around 1,400 for the latest reported week which ended Oct. 31 -- bringing flu-related visits down to around 2 percent.
Still, nearly 50 percent of those flu-related visits were for children under 10 years old, and the H1N1 strain is disproportionately affecting American Indian children just like it is for the rest of the American population.
Redd said officials are worried the current reduction in flu cases could lead to a reduction in vigilance. "That would be false reassurance to think that it's gone," he said.
A "third wave" is being planned for, he said, which could happen closer to the regular seasonal flu peak which is on average in the beginning of March. "We have to go even doubly hard on our vaccination efforts over the next few weeks," Redd said.
The spread of H1N1 has varied regionally and internationally, and Redd said by most accounts, the strain's impact on each American Indian reservation has been pretty similar to its surrounding communities.
There is one difference -- American Indians and Alaska Natives end up being hospitalized with the H1N1 strain more often. But he said evidence suggests that's because such populations have more people with diabetes or asthma, two large risk factors for flu complications.
"We don't think it's just by virtue of being American Indian or Alaska Native," he said.
Many reservations are in rural locations, which could be another factor because it limits access to medical care. Redd said evidence from Manitoba, which reported a flu surge in its aboriginal population in October, suggests people of any race living in isolated communities have a higher risk of complications because of this access problem.
But many isolated American Indian communities have nearby IHS facilities, he said, which helps prevent more problems.
Redd said the American Indian population tends to be more affected by respiratory disease in general, but that is not the case for every tribe and it varies widely across the country. "The issue of disproportionate impact of influenza is something that we have been really attuned to," he said.
Planning for flu
IHS officials have planned for years for a flu pandemic, Redd said, but obviously didn't realize that would be the spread of H1N1. Still, a pandemic of a new flu strain was inevitable, he said.
"We always knew that eventually it would happen," he said.
That planning has paid off -- officials already knew how many employees worked at each IHS site so they could plan on the number of vaccines that would be needed, and all sites developed pandemic flu plans that are now in operation.
Very little needed to be changed to those original plans, Redd said. The biggest modification was which groups of people would be priorities because the H1N1 strain has most affected children and pregnant women, while the seasonal flu usually affects senior citizens the most.
IHS started a surveillance data reporting system for the new pandemic to track illness rates and alter its response to the current situation, he said. But one big effort is something that is heard during normal flu seasons -- the importance of frequent hand washing and staying home when sick.
"That really is surprisingly important in terms of community reduction of transmission," he said.
Vaccines for kids
Amy Groom, IHS immunization program manager, said between 40 percent and 60 percent of American Indian children under the age of 2 received seasonal flu vaccines last year. Officials are hoping the number this flu season will be higher because of heightened awareness of its importance, she said.
H1N1 vaccines are distributed following a state-based model, Groom said, which gives doses to providers for both children and adults. As of Oct. 31, more than 22,000 H1N1 vaccines were administered to IHS patients and about 6,600 doses were given to health care workers.
But there is a national shortage of both H1N1 and seasonal flu vaccines, which has limited vaccine recipients to only the top priority groups so far, Groom said.
Vaccine manufacturers made the same number of seasonal vaccines as last year, but increased demand caused shortages earlier this year that might not be made up since they are now working on H1N1 vaccines, Groom said. "It's quite likely that for seasonal flu, we are not going to have enough vaccine to meet demand," she said.
She said it would take 1.6 million H1N1 doses to vaccinate the entire population that uses the IHS system, but many of those people could go to other health care providers or public health departments to get their shot. More doses will be delivered in the coming months, but "it is in very limited supply," she said.
Redd said these shortages are happening everywhere in the country, not just on reservations. "That's the situation on both IHS and non-IHS sites," he said. "The shortages are definitely not unique."
Ryan Johnson is a reporter for the Grand Forks Herald, which is owned by Forum Communication Co.