INDIANA PARLEY

Fort Wayne Appears Alone in US in Urging Restriction for Flu Shots

Could it be that Fort Wayne-Allen County Board of Health officials are depressing the numbers of people who should be getting flu shots? The Journal-Gazette and the News-Sentinel both carried stories on Tuesday reporting that the Board of Health on Monday recommended that medical providers should restrict flu shots for highest-risk patients.

Yet the national news was all flowing in the opposite direction. Norman Adelman, chief medical officer of the National Lung Association was quoted in the Washington Post Tuesday that there was plenty of vaccine. USA TODAY carried a story Tuesday headlined "Seasonal flu shots now available for all." The story cited Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, for its story. USA TODAY's lead was:

Starting this week, flu vaccine is available to anyone who wants it, health officials said Monday. Until now, the vaccine has been prioritized for people at highest risk of serious flu complications, including the ill and elderly.

Dr. Gerberding was not the only one of the nation's health officials speaking out Monday to encourage vaccination for all. She was joined in a joint press conference by Secretary of Health and Human Services Mike Leavitt, Acting Director of the Food and Drug Administration Andrew von Eschenbach, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

The Washington Times, in a United Press International report, carried this further explanation:

U.S. government officials expanded their recommendations for annual influenza vaccinations Monday while trying to dispel public confusion over the vaccine's ability to fight avian flu.
The heads of the four top public-health agencies said annual flu vaccinations -- which last year became the subject of rationing caused by vaccine shortages -- are now available for all age groups. For the past month they have been attempting to discourage vaccinating anyone except senior citizens, infants, adults with chronic diseases and others at high risk of flu complications because of continuing uncertainties about supply.

Leavitt said that

[s]till, some patients have not been able to obtain recommended shots, because companies have fallen behind in delivering ordered doses to smaller doctors' offices and clinics.
Leavitt called the reports "anecdotal" but said they could encourage patients to be persistent in seeking flu shots.

Earlier today, I was at the office of a health care provider. I overheard the receptionist take a telephone call from a patient. Although I only heard one side of the call it was clear that the patient was asking whether vaccine was being restricted. The receptionist urged the patient to come to the office; that there were plenty of doses. This was confirmed when I talked to one of the medical professionals in the office.

Leavitt is urging persistence; Fort Wayne-Allen County officials are urging a wait. A Google news search indicated that Fort Wayne was the only city in the country where restraint was continuing to be the recommendation. Will patients who could be getting protection at this time be too discouraged to get the vaccine before full flu season hits? Will there be enough herd immunity if flu strikes this area hard?

Comments: Fort Wayne Observed cited this post by Indiana Parley on its website. Two readers of FWOB posted comments that deserve some additional in-depth documentation and response.

First Comment- The first person to comment wrote that:

This is a great use of blogs - to ask these sorts of questions. Theoretically the "regular" media could ask them, of course, but they don't often seem to.

And on the specific topic at hand - there have been studies done that the best use of vaccine is on 2-5 year olds (rug rats, in technical public health parlance). This makes sense since it's the snotty noses that spread flu among everyone else. So why doesn't the Board of Health focus resources on that age group? I'm sure there is a reason - I'm not accusing, but it does seem like something they should think about. # posted by Anonymous : 10/26/2005 8:00 AM

Indiana Parley response- Great comment. Here is link to one study courtesy of the National Center for Biotechnology Information. The NCBI is part of the National Library of Medicine operated by the National Institutes of Health.

Highest attack rates for influenza occur in children. Immunization of schoolchildren with inactivated influenza vaccine in Michigan and Japan was associated with decreased morbidity and mortality, respectively, in older community contacts.

Second Comment- The second person wrote:

Snotty noses don't spread flu. The flu doesn't cause snotty noses. It's an ailment of the lungs. In shortages, vaccine goes to those most likely to die of flu, which includes the elderly.
Nevertheless, that's a good question, about why the vaccine is restricted here and nowhere else. # posted by Anonymous : 10/26/2005 8:46 AM

Indiana Parley response-Given the studies cited above which do show that vaccinating the young is a powerful way to get herd immunity in order to effectively limit transmission to those at-high-risk such as the elderly and chronicaly ill this comment may have already had an adequate response. However, it is important to correct the mistaken notion that "snotty noses" can't transmit the flu virus. The following is from the Dr.Greene.com website.

Classically, the flu begins abruptly, with a fever in the 102 to 106 degree range, a flushed face, body aches, and marked lack of energy. Some people have other systemic symptoms such as dizziness or vomiting. The fever usually lasts for a day or two, but can last five days.

Somewhere between day 2 and day 4 of the illness, the "whole body" symptoms begin to subside, and respiratory symptoms begin to increase. The virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, and/or pneumonia.

The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore (red) throat and a headache. Nasal discharge and sneezing are not uncommon.

...Is it contagious?
The flu is very contagious. It can be spread by airborne, droplet, or contact transmission and by fomites.

How long does it last?
Inhaling droplets from coughs or sneezes is the most common way to catch the flu. Symptoms appear 1 to 7 days later (usually 2 to 3 days). Symptoms (except the cough) usually disappear within 4 to 7 days. Sometimes there is a second wave of fever at this time. The cough and tiredness usually lasts for weeks after the rest of the illness is over.