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Flu vaccine should be plentiful this year

By Roger Mezger
NEWHOUSE NEWS SERVICE
September 23, 2002

Body and Soul

A deadly virus is out there, just waiting to get us.

Not West Nile virus, the exotic new microbe on the block that gave us and the mosquitoes something to buzz about this summer.

The stalker is that old standby, the influenza virus.

In an average year, flu puts 114,000 Americans in the hospital and kills 20,000 of them. By contrast, this year's West Nile outbreak – the largest since birds brought the disease to the United States in 1999 and mosquitoes began spreading it – has sent 1,700 people to the hospital so far and killed 84.

"The threat from influenza is much greater than from West Nile," said Dr. Jennifer Hanrahan, a Cleveland infectious-diseases specialist.

Flu spreads easily by sneeze, by cough, by touch. The slim chance of getting West Nile from a mosquito, on the other hand, makes lottery's odds look reasonable.

Yet some of the same people who spent August and September worrying about dead birds and mosquito bites won't bother getting flu shots in October or November.

And this year, there's simply no excuse.

Production problems limited the flu vaccine supply or delayed shipments the last two years. This year, things are different.

The federal Centers for Disease Control and Prevention estimates that 94 million vaccine doses will be available, about 7 million more than last year. Some have already shipped, and the CDC says 75 million should be in providers' hands by the end of October.

A new flu vaccine option for babies and toddlers will hit the market in limited quantities in November. The Food and Drug Administration this month gave the drug company Aventis the OK to make a flu vaccine that does not use the preservative thimerosal, which contains mercury.

Some believe thimerosal in pediatric vaccines is responsible for an increasing number of children under 3 being diagnosed with autism. Last fall, an Institute of Medicine study found insufficient evidence to prove or disprove a link between thimerosal and the psychiatric disorder. But the CDC has been pushing vaccine manufacturers to stop using the preservative.

Policy change
Another twist this flu season is that flu-shot providers who end up with more vaccine than they can use may resell it to providers in their area who have too little. That change in FDA policy should ease any local supply problems.

Something that has not changed is that the vaccine price has gone up again, from a top price of about $5.50 a dose last fall to $6.50 or $6.75 a dose now. At the same time, the amount that Medicare reimburses providers for giving the shot has declined, from $9.13 last year to $8.01 this season.

That will pinch family doctors and others who place small vaccine orders and pay the highest price. Bulk buyers receive discounts.

The CDC says groups at greatest risk of developing flu-related complications should be vaccinated first, in October and November.

They are people 65 and older; the chronically ill and people who live in the same household with them; nursing-home residents; health-care workers; children under 9 who are getting a flu shot for the first time, because they will need a booster a month later; children and teens on long-term aspirin therapy; healthy children 6 months to 23 months; and women who will be at least three months pregnant before flu season ends April 1.

In addition, the agency recommends a shot for healthy people ages 50 to 64. They can get vaccinated from mid-November through December, along with others who want the shot.

But many won't take the CDC's advice. Only about two-thirds of senior citizens bother to get flu shots. Yet the death rate for those who do is as much as 50 percent lower than for those who do not, according to a study published last month.

High fever, sudden headache, a dry cough, fatigue and general achiness make the flu unpleasant. But when serious complications set in, flu kills.

Primary influenza pneumonia, a complication seen in the elderly, is almost always fatal, said Hanrahan. Flu also can lead to encephalitis, the same swelling of the brain that West Nile virus sometimes causes.

Heart patients who get the flu risk a heart attack or congestive heart failure. Flu can cause inflammation of the liver or pancreas, too.

Hanrahan thinks misconceptions about the flu shot keep some people from getting it. Although some fear that the vaccine will make them ill, "that's not possible," she said, because the vaccine does not contain a live virus.

Others do not believe the vaccine works, perhaps because they got a shot once and still took ill. Getting the shot early in the season will allow immunity to build before flu starts circulating, Hanrahan said.

Outbreaks can occur as early as December, usually peaking around February.

And don't forget: There are lots of other influenzalike viruses out there that the vaccine does not protect against. The average adult gets up to three of them a year.