While the Health and Human Services Department works out plans for immunizing millions of Americans against the H1N1 flu virus, Defense officials are working on a parallel track to protect service members and mitigate the flu's effect on military operations.
"We'll be getting vaccine the same time the highest priority groups are receiving their vaccine," said Army Lt. Col. (Dr.) Wayne Hachey, director of preventive medicine and surveillance in the Office of the Assistant Secretary of Defense for Health Affairs.
That likely will be in October. In the meantime, military officials are working to contain the virus by isolating infected troops and using antiviral drugs whenever H1N1 is detected. All the services screen personnel before they deploy overseas and when they arrive at their destination. Earlier this summer, several dozen infected troops en route to Iraq were held in isolation in Kuwait until they were no longer contagious, Hachey said.
The nature of respiratory infection is such that small outbreaks are expected, he said. During one week in July, more than 100 cases of H1N1 were reported at the Air Force Academy in Colorado Springs, but by rigorously following public health guidelines, officials quickly contained the virus. Patients were isolated for several days and closely monitored; individuals who had been in contact with them also were watched for signs of infection.
"After the first week [officials there] stopped it cold," Hachey said. "That's one clear advantage the DoD has -- noncompliance [with public health directives] is not an option."
The Defense Department is purchasing its own supply of vaccine through HHS to meet military operational requirements. Department officials have ordered 2.7 million doses, which they expect will enable them to vaccinate 1.35 million people. Health officials estimate individuals will require two doses of vaccine to be protected, although that assumption could change if the virus evolves in unexpected ways or becomes more virulent, Hachey said.
While all military personnel on active duty or reservists activated for service will be vaccinated, troops and some key civilians determined most vulnerable will receive the vaccine first, including those deployed on missions overseas, recruits in training, sailors and Marines aboard ships that are at sea, and health workers.
"Any place where we take people and cluster them pretty tightly and put them under stressful conditions, those are the people we want to protect first" because they are subject to the highest rates of transmission, he said.
Military dependents will receive H1N1 vaccine under a separate distribution program managed by HHS through supplies provided to states based on population data. Access to vaccine among military family members living on bases will be the same as it is in civilian communities, with priority given to health care workers and the most vulnerable groups, including pregnant women and children.
Health officials expect vaccine will become available in October; however, if experts at the Centers for Disease Control and Prevention decide that it should include an adjuvant -- a compound that increases the vaccine's efficacy -- it could be November or December before the vaccine becomes available, Hachey said.
"The current assumption is the vaccine will not be adjuvanted, in which case we should receive it probably in mid-October," he said. "If the virus mutates so much so that it's no longer a good match for the vaccine we may have to use an adjuvant, but the data do not [suggest that] will be the case."
Defense has been preparing for pandemic influenza for several years now. For the last four years it has maintained significant stockpiles of gowns, gloves, masks, needles and syringes, and has on hand 8 million antiviral treatment courses, Hachey said.