Cases of swine flu declined significantly in Pennsylvania last week, and there were hints that the spread of disease might be slowing in New Jersey. But some cities elsewhere have experienced two peaks - first for children, then for adults - and health officials cautioned against complacency.
"We still have a higher incidence of disease now than in any season since we started electronic tracking of flu cases in 2003," said Stacy Kriedeman, press secretary for the Pennsylvania Department of Health. "Influenza is one of the most unpredictable viruses out there, so we don't know what this virus will do in the coming weeks."
Pennsylvania yesterday reported drops in every measure of flu last week: visits to emergency rooms and physicians' offices for flulike illness, suspected cases reported by a sampling of colleges and nursing homes, and the percentage of specimens testing positive at a sampling of laboratories in every county in Southeastern Pennsylvania. Several measures declined for the second week in a row.
Similar findings were reported by the Philadelphia Department of Public Health, although the SEPTA strike might have affected the data as, for example, some parents delayed taking their mildly ill children to emergency rooms.
In New Jersey, where swine flu hit a week or two later, the Department of Health and Senior Services recorded more recent and less robust declines on some measures (lab positives and school absenteeism) and small increases on others (physician visits for flulike illness), suggesting - tentatively - that the spread of disease might be approaching a peak.
There was continued demand for limited amounts of swine flu vaccine.
The Burlington County Health Department scheduled two clinics for this afternoon: noon to 4 at Burlington Center Mall in Westampton (limited to people who got pink rain checks when last Friday's overcrowded clinic ran out), and 2 to 4 at the Moorestown Mall (pregnant women and county residents ages 18 to 24).
Interest in vaccine at Philadelphia's 28 walk-in clinics for members of all priority groups, many of them open daily, varied from place to place. Lines formed before opening at some, said Caroline Johnson, director of the city health department's Division of Disease Control. The clinics have been instructed to hold back when necessary to ensure vaccine is available every day, she said, so "it is probably best to come early."
The city completed a first round of vaccine clinics - children younger than 10 require a second dose - at every public school last week, will finish the parochial schools today and the charters next week, and expects to complete the remaining private schools by Thanksgiving.
Still, Johnson and others doubted that the number of people vaccinated so far was large enough to have any impact on the spread of disease around the city, although it might have helped individual schools with high immunization rates.
She urged everyone who is at risk of complications from the flu to continue looking for vaccine.
After the first wave of swine flu ended in early summer, the infection reappeared a couple of months later in the South. Much of that region has now experienced two peaks of disease, separated by a brief trough, during this second wave.
"Epidemiologically I guess it makes sense," Neil Fishman, an infectious disease physician at the Hospital of the University of Pennsylvania, said last night. "Kids were the center of infection, and then spread it to adults, and then adults spread it to adults."
Fishman said he had observed the same pattern in the University City medical community in the spring. The first wave of swine flu showed up at Children's Hospital of Philadelphia, where it reached a peak and began to decline.
Adult disease started to peak next door at HUP two weeks later. "Which is sort of what I've been waiting for," he said.
Second peaks seem to be lower, Fishman said, perhaps because adults are not as vulnerable as children.
Third waves - pandemics historically have come in waves, with the next predicted in winter - also tend to be less severe.
But public health officials said they are nothing to sneeze at.
Details on public flu vaccine clinics are posted at http://go.philly.com/flu
Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.
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