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CDC Prepares for Swine Flu Surge in Fall

Swine Flu Still Hot in Northeast but Easing in Most of U.S.
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•         Should we really make a swine flu vaccine?

•         Should we base a vaccine on the current virus? Flu viruses change rapidly. Vaccine against the current virus might be far less effective against a changed virus.

•         Should we wait to see if the virus changes? If vaccine production doesn't start soon, swine flu vaccine won't be ready when it's needed.

•         Will people need one shot of vaccine, or two?

•         Will immune-stimulating adjuvants make the vaccine more potent -- or lead to an unacceptably high level of side effects?

•         As vaccine becomes available, who should get the vaccine first? Who should be sent to the end of the line?

Only one thing is for sure: There won't be enough information for a definitive answer to these questions. But Schuchat says the CDC is working overtime to come up with as much information as it can to make these decisions as informed as possible.

"We do try to separate the questions about the initial steps in vaccine development, later steps in vaccine production, and further steps that might involve the decision to vaccinate some or all of the population," Schuchat said. "There needs to be an evidence-based and careful deliberation for each of these steps. We don't intend to make a decision about immunization until as late as possible."

Key data will come from what swine flu does in the Southern Hemisphere this summer, as that part of the world enters its flu season.

Meanwhile, the World Health Organization (WHO) today reaffirmed its decision not to declare a world flu pandemic until swine flu clearly becomes as severe in other parts of the world as it has been in the U.S. and Mexico.

The WHO may decide to raise its caution level in ways less likely to sow the seeds of panic than a pandemic alert, Keiji Fukuda, MD, WHO interim assistant director-general for health security and environment, said today at a news conference.

"We have no specific plans to raise the alert in one region or another," Fukuda said. "But if the disease got significantly worse in one country, we would get that information out to other countries very quickly independent of 'phases' or 'alerts,'" he said.

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