Rapid Emergence of Influenza A/H3N2 Variant: Now What?

Most people are reassured by reports of influenza A/H3N2 producing a mild infection, yet ignore the five-fold increase in cases now observed in states hosting agricultural fairs.  The case count now stands at 158 (that have been detected and recognized).  Most infectious disease specialists would say, "Big deal, most of the infections are mild."  The typical hospitalization rate for influenza is low, and the case fatality rate very low. 

But that isn't the primary concern with influenza.  It is community penetrance: the efficiency and pervasiveness of transmission that becomes the problem.  It is the reason why we consider influenza to be a top infectious agent disruptor due to the sheer volume of case counts and impact on the medical infrastructure at all levels of care.  It is the law of numbers that is the problem. It is the rapid evolution of co-existence with the host (i.e. habituation) that is the key issue.  For this biodefense professional and practicing pediatrician, I care about the case count "tsunami" effect more than a highly localized, relatively low case count but high case fatality rate crisis exemplified by the recent Ebola outbreak in Uganda.

We currently live in a situation of economic austerity, where both physicians and public health have been severely impacted by changed in healthcare.  Recent reports have suggest a full 1/3 of physicians are actively looking to retire within the next 10 years. 

Further, pediatric healthcare is not a prioritized subset of our healthcare infrastructure.  We spend far more money as Americans keeping the dying alive for an extra couple of weeks than we do taking care of our children.  Hence, the pediatric infrastructure is vulnerable to sudden surge in patient volume and complexity. 

Therefore, the emergence of a new strain of influenza that predominantly effects children is a serious problem from the perspective of this practicing pediatrician.  The persistent lack of education in the public about vaccination is another serious issue.  That said, we have noted in the past that those who refuse vaccination for their child often change their mind if community heresay produces report of children in the hospital- especially if that child winds up on a ventilator or dies.  Unfortunately, herd immunity comes at a cost, where the current social attitude is to effectively use the children of our community as a canary in a coal mine- one of them has to go down to convince the not-insignificant subset of vaccine refusers to vaccine and contribute to protective herd immunity.

But we get ahead of ourselves.  The key questions to ask now are the following:

1. What are the policy triggers to execute release into production of the seed strains already sent to the vaccine manufacturers?
2. What is the current time delta for vaccine production?  Two months?  Four months?  Six?
3. How quickly is HHS able to distribute the produced vaccine nationwide?

CDC should be commended for pushing laboratory testing capacity out to the states.  It is clear this has helped to boost the gain on signature recognition.  Based on the experience with the 2009 H1N1 influenza pandemic, the first wave of impact observed weeks before many communities saw distribution of vaccine.  In the case of A/H3N2v, we have been provided more warning time.  It will now be interesting to see if we as a nation are able to proactively execute on that increased warning opportunity.