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A second wave of the flu could break out soon, and could be more severe than last year's outbreak.

The Washington Post August 10, 2009

The United States and other northern countries are bracing for a second wave of swine flu infections that could sicken millions of people and contribute to the hospitalization and deaths of thousands, including many children and young adults.

While flu viruses are notoriously capricious, making any firm predictions impossible, a second wave could hit the Northern Hemisphere within weeks and lead to major disruptions in schools, workplaces and hospitals, according to U.S. and international health officials.

"The virus is still around and ready to explode," said William Schaffner, a Vanderbilt University School of Medicine influenza expert who advises federal health officials. "We're potentially looking at a very big mess."

Since emerging last spring in Mexico, the virus, known as H1N1, has spread to at least 168 countries, causing more than 162,000 confirmed cases and playing a role in at least 1,154 deaths, including 436 in the United States.

President Obama arrived in Mexico on Sunday for a two-day summit that will include discussions on swine flu, along with Mexico's drug wars, border security, immigration reform and economic recovery.

"Everyone recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die," said John Brennan, the U.S. deputy national security adviser for counterterrorism and homeland security. "The strategy and the effort on the part of the governments is to make sure we collaborate to minimize the impact."

As the first flu pandemic in 41 years spread through the Southern Hemisphere's winter over the last few months, scientists have been closely monitoring the virus for clues to how much of a threat it might pose this fall. So far, no signs have emerged that the microbe has mutated into a more dangerous form. Most people who get infected seem to experience relatively mild illness.

Still, the virus has caused major outbreaks involving a disproportionate number of younger people in Australia, New Zealand, Argentina and other countries, prompting schools to close, causing theaters to shut down, and straining some emergency rooms and intensive care units, sometimes forcing doctors to postpone other care, such as elective surgeries.

Swine flu has also begun to spread in South Africa, where at least two deaths have been reported and the national laboratory was overwhelmed last week with samples that needed testing. In India, a 14-year-old girl became the first person to die from the disease in that densely populated nation.

In Britain, meanwhile, where anxiety was running high because of high-profile cases including Harry Potter films actor Rupert Grint, health officials were trying to determine the cause of a sharp increase in reported cases in recent weeks.

"This is something that we could see here soon," said Arnold Monto, a University of Michigan infectious disease expert who advises the World Health Organization, the U.S. Centers for Disease Control and Prevention and other federal health agencies. He noted that some emergency rooms were overwhelmed by last spring's outbreak in New York City. "We have to be worried about our ability to handle a surge of severe cases."

Concern about a second wave has prompted a flurry of activity by federal, state and local officials, including intensifying flu virus monitoring and making plans to distribute vaccine and antiviral drugs and other treatments if necessary.

"There's a lot of moving parts to this," said Joseph Bresee, who heads the CDC's influenza epidemiology and prevention branch. "Hopefully we won't have a panic, but instead we'll have the appropriate level of concern and response."

The Obama administration has been updating recommendations for when to close schools, what parents should do if their children get sick, how doctors should care for patients and how businesses should...