An easy means of prevention :
A flu shot
By: Jane E. Brody
New York Times, October 23, 2001
While millions of Americans fret over the threat of
anthrax spread by terrorists, they may ignore another infectious disease
that will soon descend on the country and probably claim tens of thousands
of lives. That disease is influenza. And while an anthrax vaccine is not
available to the general public, a flu vaccine is, and it can prevent a
vast majority of cases of influenza and the death and disability they can
cause.
In a typical year, 10 percent to 20 percent of
Americans come down with influenza, 200,000 people are hospitalized and
more than 20,000 die from flu-related complications. Most of this can be
prevented by a shot that costs $10 to $15.
So whether or not you are anxious about anthrax, you
would be wise to follow the most current flu prevention guidelines. These
guidelines are issued each year by the Centers for Disease Control and
Prevention to assure that those most at risk of suffering severe and
potentially fatal consequences of the flu are protected first, before the
rest of the population depletes supplies of vaccine.
Vaccine availability varies from year to year because
it must be made anew each summer and fall to protect against the viral
strains likely to cause the greatest problems in the coming winter. For
example, this season's vaccine will protect against three viral strains:
A/Moscow, A/New Caledonia and B/Sichuan; the Moscow and Sichuan strains
were not in last year's vaccine. And while there was an extended delay in
vaccine production last fall, a delay is not expected this year. Still,
there is a limit to how much vaccine can be available at any one time.
Now is the time for those at highest risk to get
their flu shots. If past years are any indication, at best only 60 percent
of Americans most likely to become hospitalized or to die as a result of
the flu will get the shot.
And with so much attention now focused on anthrax,
chances are flu vaccine percentages will take a big hit this season,
resulting in a greater toll than usual on the health of Americans and the
economic well-being of a nation already under financial stress.
Whom to Immunize and When
The newest guidelines from the disease control
centers establish an immunization timetable that calls for people with the
greatest risk of serious complications from the flu to be protected first
— now, in October. Those who should get the vaccine without delay
include the following:
Everyone over
65. As people age, their ability to fight off infections wanes and they
become more susceptible to complications like pneumonia, which can be
life-threatening. Even if an older person's immune system fails to respond
strongly enough to the vaccine to prevent the flu, the vaccine can reduce
the severity of the illness and lower the risk of serious complications.
Anyone with a
chronic medical condition: heart or lung disease, including asthma;
diabetes; kidney disease; liver disease; chronic anemia; or chronic
malignant conditions like leukemia and lymphoma, as well as people with
AIDS and those who are H.I.V. positive.
People receiving
treatments that suppress the body's ability to ward off infections: those
taking high levels of corticosteroids for conditions like rheumatoid
arthritis and ulcerative colitis; those undergoing treatments like
chemotherapy or radiation treatments for cancer; and organ transplant
recipients who take drugs to prevent rejection.
Children and
teenagers who must take aspirin for long periods, since they may develop a
serious illness called Reye's syndrome if they come down with a viral
illness like influenza.
All women who
will be in the second or third trimester of pregnancy (months four through
nine) during the flu season, which in North America starts in November and
usually lasts through March.
All health care
personnel who minister to high-risk people, whether in a hospital, nursing
home, outpatient clinic or home, since if caretakers contract the flu they
could readily transmit it to someone likely to become seriously ill.
Next in line for flu shots, to be administered in
November, are those at lesser risk of complications or of causing illness
in others at higher risk.
Healthy people
between 50 and 65. Last year, the C.D.C. added middle-aged healthy people
to the list of those at higher than usual risk of flu complications after
studies showed that hospitalizations and deaths associated with the flu
start rising considerably at age 50.
Household
members who live with people 65 and older or with anyone with a chronic
medical condition (see the list above), since they could increase the risk
to those more vulnerable to flu complications.
Anyone else,
including children, who would like to avoid getting the flu.
Many people were long under the impression that flu
vaccine was only suitable for older people, when it has always been true
that anyone of any age can benefit from it. In fact, the younger you are,
the more effective the vaccine is likely to be.
Further, a study over several years in Japan showed
that immunizing children against the flu protected older people because
children were the primary vectors of the disease. Lacking immunity to flu
viruses, children are most likely to acquire the virus, spread it among
themselves and transmit it to others.
Vaccine Concerns
Some people should not get the flu vaccine. Anyone
with an allergy to eggs (the vaccine virus is grown in chick embryos, and
traces of egg may remain in the finished vaccine) and anyone who has had
an allergic reaction or who developed Guillain- Barré syndrome (a
condition causing paralysis of involuntary muscles) after a previous flu
shot should not get the vaccine. Also, people who are sick and have fevers
should wait until they recover before getting the vaccine. On the other
hand, having a minor illness like a cold or a seasonal allergy is not a
reason to delay a flu shot.
Typical side effects of a flu shot are soreness at
the injection site and sometimes a low fever and achiness. There are
people who avoid the vaccine because they say that previous immunizations
gave them the flu. This is not possible, since the vaccine is prepared
with killed virus that cannot multiply in the body.
But people totally lacking immunity to one or more of
the viral strains in the vaccine may experience a reaction lasting two or
three days that resembles a mild case of the flu. Unlike an actual case of
influenza, this vaccine reaction, though it may be temporarily
debilitating, is not dangerous, and infectious disease specialists say it
should not deter someone at high risk of flu complications from being
immunized.
Others hesitate to get the vaccine because they don't
like shots. Unfortunately, although tests of a nasal spray vaccine called
FluMist have shown it to be highly effective, the company that makes it,
Aviron of Mountain View, Calif., is not yet ready to market it because the
Food and Drug Administration is not yet convinced of its safety.
For people who cannot or will not get the flu
vaccine, there are several prescription drugs available that can either
help to prevent the flu or reduce the severity of an attack.
Two preventives that can also reduce symptoms of Type
A influenza are amantadine (Symmetrel and generic versions) and
rimantadine (Flumadine). Two drugs that can reduce symptoms of both Type A
and Type B influenza are zanamivir (Relenza) and oseltamivir (Tamiflu).
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