Even with modern vaccination efforts, the flu infects about 5%-20% of Americans each year. And while most of us just suffer through it and feel better in a week or so, the flu kills an estimated 36,000 Americans each year, and sends about 200,000 to the hospital. Influenza viruses can also cause pandemics, such as in 1918, in which at least 20 million people worldwide were killed.
Prevention is the key to minimizing flu-related morbidity and mortality, so recent vaccine shortages have caused a large amount of concernespecially for individuals with compromised immune systems. Another problem is that, even when a vaccine is not in short supply, many persons who could benefit (primarily the elderly and young children) simply dont get the vaccine as they should.
But while vaccination remains the best method of control, there are other methods of treatment and prevention. Certainly you can make efforts to keep your immune system strong and reduce your risk of exposure to the viruses. Furthermore, certain antiviral drugs can help you shorten the duration and severity of the flu if and when it does strike. These medications are sometimes prescribed to prevent new infections, as well.
The Vaccine Shortage The flu is caused by two types of viruses, influenza A and influenza B, each of which has several different strains. Influenza A is both more common and severe than influenza B. The viruses mutate a bit between each flu season, and dominant strains vary from year-to-year. In turn, scientists have to adapt the flu vaccine yearly so that it targets those strains they expect to be most widespread. Health officials also have to predict consumer demand for the vaccine in a given year. The production process is thus inevitably laden with guesswork and other difficulties. In years when the vaccine successfully matches the appropriate flu strains, a protection rate of 70%-90% can be expected.Manufacturing errors, such as the 2004 contamination fiasco in Great Britain, can also affect production. On October 5, 2004, the US Centers for Disease Control and Prevention (CDC) was notified by Chiron Corporation that none of its influenza vaccine supply would be available to the US due to inability to assure freedom from contamination. As a result, about half of the anticipated 100 million doses for the 2004-2005 influenza season were suddenly unobtainable. In a rush to beat the seasons peak, starting in late December, health officials scrambled to secure more vaccine. In the end, they obtained extra doses from competing vaccine manufacturers, resulting in a total of approximately 60 million available doses.
To make optimal use of this limited supply, the CDC developed new guidelines for vaccine distribution, prioritizing the following subgroups of the population at high-risk for complications such as bronchitis , pneumonia , and other, more serious infections. Other high-risk groups include: Children ages 6-23 monthsAdults ages 65 years and olderAll individuals with underlying chronic medical conditionsAll women who will be pregnant during flu seasonResidents of nursing homes and long-term care facilitiesChildren ages six months to 18 years on chronic aspirin therapyHealthcare workers involved in direct patient careCaregivers of children less than six months old As for the majority of Americans in 2004-2005, flu shots were made more difficult, though not always impossible to come by. Fortunately, most experts predict that in 2006 and beyond there should be far less of a problem with vaccine shortages because manufacturing facilities in the US have been greatly augmented. Additional Defenses So if you dont belong to one of the CDCs priority groups, and, indeed, you do not receive a flu shot , what else can you do to protect yourself from the flu? First, remember that only the injectable form of the flu vaccine has been in short supply. Nasally-applied vaccine (no needles needed) has consistently been available, is effective, and can be used in individuals between the ages of 5-49.
Reduce Your Risk of InfectionThe CDC recommends taking the following steps to keep yourself, and others, from getting sick:Avoid close contact with anyone who is sickStay home when you are sickCover your mouth and nose when coughing or sneezingClean your hands oftenhands are the number one vehicle for spreading germsAvoid touching your eyes, nose, or mouthsince its almost impossible to keep your hands clean at all times!Its also a good ideaas alwaysto get enough sleep, eat nutritious meals, drink plenty of water, engage in regular exercise, and find ways to manage stress in your life. This will keep your immune system strong throughout the cold and flu season. Give Antiviral Medications a ShotBesides the vaccine, antiviral medications have recently been used to both prevent and treat the flu. They are often used as a secondary preventive measure in high-risk individuals who have also been vaccinated. Antiviral drugs work by inhibiting the spread of the virus within the upper respiratory tract. Specifically, the following four prescription drugs are approved by the Food and Drug Administration and commercially available in the US: Amantadine (Symmetrel)--an oral medication for the prevention and treatment of influenza ARimantadine (Flumadine)--an oral medication similar to Amantadine but with fewer side effects, also for the prevention and treatment of influenza AOseltamivir (Tamiflu)--a newer, oral medication for the prevention and treatment of influenza A and BZanamavir (Relenza)--a newer, inhaled drug, similar to Oseltamivir, for the treatment only of influenza A and BAs prevention , these drugs are about 70%-90% effective for most adults. But while they are about as effective as the vaccine, they need to be taken consistently throughout the flu season, which greatly increases their risks and expenses compared to the vaccine. As treatment , they can reduce symptoms of the flu and shorten its duration by an average of 1-2 days or soif taken within two days of becoming sick. (The sooner they are administered, the more effective they are.) They can also make you less contagious to others.
It is uncertain, however, whether antivirals can treat the most severe, life-threatening cases of flu in high-risk individuals. Furthermore, possible side effects range from nausea to anxiety , depending on the drug. Additionally, they are not necessarily recommended for all individuals or all age groups. Relenza, for example, is not recommended for people with asthma or chronic lung disease, or for children under age seven. Like any prescription drug, youll need to discuss your personal medical history with your provider before deciding if an antiviral drug is right for you. All antivirals must be prescribed by a doctor and taken for five days. Flu Control in the FutureWhile it is unlikely that another vaccine shortage will occur in the near future, its important to keep in mind that even when theres enough to go around, no vaccine is foolproof. Developers are not always successful. For example, one recent flu vaccine apparently protected only about 38% of those with a high-risk condition and 52% of individuals without a high-risk condition. In these cases, antivirals are often employed as an adjunct therapy, and have been found to be cost-effective as suchin both younger adults and senior citizensin studies published in the Annals of Internal Medicine in 2002 and 2003.
One big advantage of antivirals over vaccines is that they can be effective against a number of strains of influenza, rather than just the three incorporated into each years vaccine. Some flu strains, however, can quickly become resistant to Amantadine and Rimantadine. Still, if an unpredicted strain of flu (one that was not targeted by the vaccine) struck, an abundant supply of antivirals would be essential to saving thousands of lives. And since many specialists speculate that the coming of another influenza season of pandemic proportions is only a matter of time, sustaining adequate supplies of antiviral drugs may be well-warranted. RESOURCES: American Lung Associationhttp://www.lungusa.org National Center for Infectious Diseaseshttp://www.niaid.nih.gov/default.htm Centers for Disease Controlhttp://www.cdc.gov/flu References: Cost-effective management of flu in adults older than 65 years of age (summaries for patients). Ann Intern Med . 2003;139:I-27. Influenza (flu) index (various pages). US Centers for Disease Control website. Available at: http://www.cdc.gov/flu/ . Accessed November 15, 2004. Influenza vaccination or antiviral treatment for healthy working adults (summaries for patients). Ann Intern Med . 2002;137:I-22.
Mitka M. Health officials brace for flu season. JAMA . 2004; 292:1670-1671. Stephenson J. Progress treating, preventing influenza. JAMA .1998; 280:1729-1730. Stiver G. The treatment of influenza with antiviral drugs (Review). Journal of the Canadian Medical Association website. Available at: http://cmaj.ca.cgi/content/full/168/1/49 . Accessed November 19, 2004. US flu season slow so far, official says. November 7, 2004. Reuters UK website. Available at: http://www.reuters.co.uk/newsArticle.jhtml?type=healthNews&storyID=6736636§ion=news . Accessed November 16, 2004. Last reviewed August 2006 by Lawrence Frisch, MD, MPH Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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