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Promoting
Flu Shots for All
By
David Tuller, the
"We've had three relatively mild flu seasons, and I think people have short memories and may forget how ill they can get from influenza," said Dr. Carolyn Bridges, a medical epidemiologist and flu specialist at the Centers for Disease Control and Prevention. But this will also be the first post-SARS flu season, and health authorities have been debating how people's fears about the new disease will affect the vaccination push. They also worry that simultaneous outbreaks of influenza and SARS, should it return this winter, could overwhelm the health care system. Some say that SARS, or severe acute respiratory syndrome, has raised public awareness of respiratory illnesses in general and could spur demand for the influenza vaccine. Flu vaccination rates, even among groups most at risk for serious influenza episodes, routinely fall well below 50 percent. "People are reading and seeing a lot more than usual about respiratory diseases, and we hope that will lead to increased interest in individuals' stepping forward and getting immunized," said Dr. John Agwunobi, secretary of the Florida Department of Health. Many also believe that a successful vaccination campaign, by reducing the overall number of people flocking to doctors' offices and emergency rooms this winter, may make it easier to distinguish true cases of SARS, which has early symptoms that can mimic those of the flu. "The initial presentation of influenza and other winter
respiratory viruses, including SARS, can be for all intents and purposes
identical," said Dr. William Schaffner, a professor of preventive
medicine at the Vanderbilt University School of Medicine in "Even absent any known cases of SARS, you still have to consider with some degree of seriousness whether any patient who comes in with a cough, malaise and fever might have it," Dr. Schaffner said. "And the more influenza out there, the more background noise there is." Certainly, the potential dangers of influenza itself, with or without the threat of a return of SARS, offer plenty of reason to get the vaccine. According to the C.D.C., influenza and complications arising from it,
like pneumonia and heart failure, kill an average of 36,000 people a year
in the The agency recommends vaccination most strongly for demographic groups with the highest risk for developing serious illness, among them people at least 6 months old who suffers from asthma, diabetes, heart disease and some other chronic disorders; women more than three months pregnant; and everyone 50 and older. Although the risk of complications rises considerably after 65, the disease control agency expanded its age-related recommendation a few years ago after studies indicated that even people from 50 to 64 experienced more serious bouts of influenza. Vaccinations are also urged for health care workers; all children 6 months to 23 months; and family members and other household contacts of people at risk for complications. Beyond that, the agency hopes that even healthy older children and adults under 50 will receive the vaccine this year. Several factors should help make vaccines more accessible to a broader population than in the past. Although supply shortages hampered vaccination campaigns in 2000 and 2001, disease control agency officials say those problems have been solved. These days, pharmacies as well as doctors' offices routinely offer flu vaccines, and a nasally inhaled vaccine called FluMist has been approved for use by healthy adults. Discussions about how or whether to incorporate talk of SARS when providing information about the flu season have percolated through public health circles for months. In early September, the World Health Organization urged health officials to promote flu vaccination as a way of easing the potential difficulty of diagnosing possible SARS cases and the health care burden that could result from concurrent epidemics. But the C.D.C. has declined to cite a possible return of SARS as a way to persuade people to seek flu vaccination. Many health experts worry that linking the two may confuse the public, encouraging the misconception that the flu vaccine somehow prevents SARS. "The C.D.C. needs to be very clear and consistent in its messages that the flu vaccine is about the flu, and separate that entirely from SARS," said Gerard Brogan, a nurse and spokesman for the California Nurses Association. Others express concern that those who are vaccinated and still become ill may wrongly assume — in a panic — that they have SARS. In a recent issue of Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control, the agency addressed that concern by stressing that the flu vaccine is not 100 percent effective even against influenza and does not confer any protection against the various non-flu pathogens that can also cause respiratory illnesses. "Therefore, receipt of influenza vaccination in a person who subsequently experiences a febrile respiratory illness does not eliminate influenza as a possible cause nor necessarily increase the likelihood that the illness is SARS," the report says. But Dr. Susan Fernyak, director of community health epidemiology and disease control at the San Francisco Department of Public Health, said many people were going to conflate the flu and SARS no matter how health authorities presented their message. "It's naпve to say, `Let's put the flu vaccine on the right and SARS on the left and keep them separate in everyone's minds' because that doesn't necessarily reflect the reality of the questions you hear from patients," she said. "SARS is front and center for people, and a lot are going to go through those thought processes regardless of what public health people say." Part of the public confusion over the benefits of the flu vaccine, said James Bentley, a vice president at the American Hospital Association, a trade group, stems inevitably from a detail in the description of SARS offered by public health agencies and the press. "People with SARS are said to have `severe flulike symptoms,' " he said. "You can't say that without people concluding that SARS has something to do with the flu." Copyright
© 2002 Global Action on Aging |
Health
officials across the country, concerned that the public has become
complacent about the potentially serious complications of influenza, have
mounted an aggressive campaign to persuade as many people as possible to
be vaccinated this fall.