First doses of H1N1 vaccine to be nasal spray

New drug not recommended for pregnant women and heart patients

But nearly all those 3.4 million doses will be of the FluMist nasal spray type, which is not recommended for pregnant women, people over 50 or those with asthma, heart disease or several other problems, officials from the Centres for Disease Control and Prevention warned. Nonetheless, it will still be possible to vaccinate people in other high-risk groups: health care workers, people caring for infants and healthy young people.

The nasal spray contains a weakened live virus, while injections contain killed and fragmented virus. The spray gives a stronger immune reaction but carries a small risk that the virus will multiply too quickly in people with compromised immunity. The normal side effects of FluMist include fever, headache, muscle aches, runny nose, vomiting and wheezing. These side effects, of course, mimic the flu, leading to the rumour that flu vaccines cause the illness. But health agencies say the side effects cannot expand into a life-threatening infection.

Spurt in cases

Swine flu cases are rapidly increasing across the country, the officials said. There is now “widespread” flu activity in 21 states, up from 11 a week ago, and virtually all the samples tested are the new swine flu.

Officials said they expected some confusion as a result of getting nasal spray out first. But they said they had decided it was better to move vaccine along as fast as possible rather than waiting until more injectable batches were ready, which could be in as little as a week or two later.

“The balance here is finding the sweet spot,” said Dr. Jay C. Butler, chief of the agency’s swine flu vaccine task force. “Do we hold it to build up stocks, or do we get small amounts out?”

Further confusion is expected because many Americans still do not understand the difference between the swine flu vaccine and the seasonal vaccine, of which 54 million doses have already been distributed.

Also, because the pork lobby has loudly objected to the term “swine flu,” all federal health officials are required to refer to it as pandemic H1N1 or 2009 H1N1. But seasonal flu shots also contain an H1N1 component; this means two H1N1 viruses could soon be circulating, each addressed by a different vaccine.

Flu vaccine will soon be streaming in batches from five manufacturers by overnight express to 90,000 distribution sites, some as small as a single doctor’s office and some as large as pharmacy warehouses. These sites will have to funnel their orders through state health departments, and from them to the CDC, which will coordinate the orders before passing them to the five companies.