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Md. wants to immunize millions for swine flu

August 14, 2009

BALTIMORE (AP) -- Millions of Marylanders would be immunized against swine flu for free or for a nominal fee under a plan being developed by state health officials, whose goal is to provide the vaccine to every resident who wants it.

The vaccination plan is unprecedented in scope but depends on a robust supply of the vaccine, which is expected to be ready by mid-October at the earliest.

When it becomes available, Maryland will begin distributing the vaccine to doctors, pharmacists, local health departments and other partners.

The first shots will be given to those deemed most vulnerable by the Centers for Disease Control and Prevention -- pregnant women, health care workers, children and people under 65 with chronic health problems, said Frances Phillips, Maryland's deputy secretary for public health.

Those priority groups account for more than 2.5 million of the state's 5.6 million residents, Phillips said.

"That's to be followed up very quickly thereafter with vaccinating the remaining 3 million Marylanders," Phillips said. "It's a massive, unprecedented vaccination campaign."

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Some people who receive shots will likely have to pay an administration fee of between $10 and $20, but no one will be denied a shot because they are unable to pay, Phillips said.

Vaccination against swine flu remains voluntary, as does vaccination against seasonal influenza.

State officials and other experts said it's too early to guess how many people will get shots this year because the severity of the virus and the amount of available vaccine are difficult to predict.

The state does not keep track of how many people receive flu shots each year because the vaccines are typically administered privately, officials said.

Nationwide, about 34 percent of U.S. residents were vaccinated against seasonal flu during the 2008-09 season, according to the CDC, despite its recommendations that 83 percent of the population be immunized.

"There's going to be a lot of unknowns about that vaccine in terms of the uptake," said Dr. John Bartlett, a professor at the Johns Hopkins School of Medicine. "If it turns out to be a serious flu with some deaths, I think people are going to want to get it and really bite and scratch to have it available."

Under that scenario, Bartlett is doubtful that the available domestic supply of the vaccine will allow Maryland to fulfill its goal of making it available to everyone.

Bartlett also noted that the flu season will be well under way before anyone becomes immunized. Vaccination against swine flu is likely to require two doses, three weeks apart, with immunity taking effect three weeks after the second dose, he said.

"The vaccine is going to be late," Bartlett said. "They can't make it any faster."

Another open question: how the state will pay for all those flu shots. The Department of Health and Mental Hygiene has received nearly $7 million in federal grants for swine flu preparation and will get more once it begins implementing its plans.

"The public sector can't do this alone. We can't vaccinate all Marylanders perhaps two times. We're relying on partners," Phillips said, including private insurance and Medicare. "We're hopeful we get the resources we need."

Part of the state's plan is to make the vaccine available at schools, prefarably in the form of a nasal spray, Phillips said. But it's unclear whether there will be enough doses of nasal-spray vaccine to immunize Maryland's 1 million school-age children.

The state is also trying to project what would happen if hospitals became inundated with swine flu patients. It is common during flu season for patients to be sent to hospitals other than the ones closest to their homes, but if swine flu hits hard, some patients may be hospitalized much farther away, Phillips said.

To prevent emergency rooms from being overrun, the state is planning a communication and education campaign about how to treat mild flu symptoms. Information will be available on Web sites, and the state may also set up call centers, Phillips said.

The World Health Organization has estimated that up to 2 billion people could be sickened during the swine flu pandemic, which is already known to be responsible for more than 1,400 deaths, including six in Maryland.

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