- The Washington Times - Tuesday, October 16, 2001

Get ready, the bug is coming.Several strains of the familiar virus known as influenza will arrive this year as surely as autumn follows summer.Fortunately, the U.S. Centers for Disease Control and Prevention has a handle on this nasty communicable disease and long ago initiated a vaccination program in cooperation with local health departments around the country. In addition to providing guidelines on who is at highest risk and should receive the vaccine first, the federal agency in many cases works with approved manufacturers to ensure that supplies of the vaccine reach their destination.
Typically, the flu season in the United States runs from November until April, with the peak period between late December and early March. That means the best time for persons at high risk to get vaccinated is in October and November. It takes up to two weeks for the vaccine antibody to become effective although, as public health professionals warn, being vaccinated is not a guarantee that influenza won't develop. Generally, vaccination provides protection against some of the disease's most dangerous side effects, such as pneumonia. The vaccine, they say, is not a cure.
The person who neglects to get a shot and comes down with the flu can be treated with a daily dose of anti-viral medicines and expect to spend a lot of time in bed resting, warns Jan Tenerowicz, the nurse in charge of Arlington County's communicable disease program.
To reduce the chances of becoming sick, "again, the most important thing is hand-washing, one of the best defenses against transmitting colds and viruses," she advises in time-tried nursely fashion.
Curtis Allen of the CDC National Immunization Program's press office, says the program is in a better position than last year to meet the challenge.
"The delay in vaccine supply this year is not as severe as last year. We're ahead of the curve," Mr. Allen says.
"Last year the delay was caused by the difficulty of growing the viruses. They were slow, and there were manufacturing problems. By the first of December, we expect to have a full complement of the vaccine available," he explains by telephone from the agency's headquarters in Atlanta.
Mr. Allen says there were four vaccine manufacturers, but one decided to get out of the business, leaving three others, which have had to increase their capacity.
"CDC expects to have 50 percent of the vaccine available by the end of October, 31 percent [more] by the end of November, and the rest by the end of December, for a total 79.6 million doses this year," he says.

Such words are meant to reassure a public left hanging last year when reports of a delivery slowdown caused a minor sense of panic. This year, Washington area health officials say, most of the calls coming into their offices to date have reflected worry over the possibility of the deadly anthrax turning up locally. Some of the symptoms including high fever and fatigue may be the same in early stages, they say, but most people who fall victim to the flu virus recover completely in one to two weeks.
Anthrax, as it has been reliably covered in most news media, these same health officials say, is caused by a bacterium, bacillus anthracis, and need not be fatal if it can be treated quickly with antibiotics. Influenza is caused by a virus, which is not treatable by antibiotics. It is a serious threat mainly to the elderly people older than 65 and to those with chronic pre-existing health problems. CDC says the flu is associated with more than 20,000 deaths and more than 100,000 hospitalizations in the country each year. Deaths occur mainly among the frail elderly.
The so-called "Spanish flu" in 1918-19 caused the highest-known influenza-related death toll in the United States to date: 500,000. The 1957-58 "Asian flu" was responsible for 70,000 deaths, and the "Hong Kong flu" in 1968-69 for 34,000 deaths.
Over the past 19 years, flu season has peaked most often in February (seven years out of the 19), January (five years), December (four years) and March (three years), Mr. Allen says. He also urges anyone 65 or older to get a flu shot regardless of the state of his or her health because "even if they are healthy, the age factor will kick in eventually, which can lead to complications."
Much still is unknown about influenza viruses, CDC admits on its comprehensive Web site, so federal health officials also recommend that people between the ages of 50 and 64 get the vaccine annually. (A yearly dose is necessary because the vaccine is only effective for that length of time.) The reason is that more than a quarter of the age group have at least one high-risk condition.
The effectiveness of the vaccine varies in each individual, but it has been shown to be effective in as many as 90 percent of healthy young adults using it and in preventing the most debilitating effects of the disease for anyone of any age.
The vaccine licensed in the United States is made from killed influenza viruses (which cannot cause infection, the CDC emphasizes) that may produce minor symptoms of fever and body aches after the inoculation in people who never before have been exposed to the virus. These symptoms seldom last more than two days.
While public health officials agree with the CDC's guidelines on who among the population is most at risk and should get the doses first, availability of the vaccine and its cost to the consumer varies throughout the region.
"We have the vaccines now," says Dr. Michael Richardson, acting senior deputy director of primary care prevention and planning in the District's Department of Health. "This year is different from last in that we have some vaccine early. We expect we will get enough, but there still is less than we optimally like. We are going to discourage people who come in simply because they want it and want to avail themselves of what is free. We need to cover the most vulnerable and needy."

Montgomery County expects to receive 10 percent of its order by Oct. 29 direct from manufacturers recommended by CDC.
"I want to be very clear: The first vaccine will be for high-risk people," says Sandra Cox, nurse-administrator with the county's immunization program. "The first categories are people 65 years or older or anyone with a chronic health condition. Health care workers and caregivers such as hospital employees are in the third and fourth categories. The last category are those younger who want to minimize their risk.
"Some people say they never had the vaccine and never get flu, but you never know when you might get it. I've had some people say that and then come back the next year begging for [the vaccine]. A lot depends on where your immune system is, where you [live or work] and how exposed you are. We also recommend the vaccine for women in the last three months of pregnancy, but we ask at the clinics for those women to have a note from their doctor."
The bottom line, she adds, is "how well people take care of themselves."
The county will publish notices when the vaccine is in hand, sending word through library bulletin boards and other public buildings. The cost is $10, Ms. Cox says, "but if a person [arrives] without money or Medicare, we still give them the shot."
In addition to six or seven clinic locations, she says, other health care entities and several area supermarkets contract separately to provide the service.
"People will say they want to go to a supermarket and ask if it is the employees who administer the vaccine. That isn't the case. The health care contractor brings in nurses."

Mrs. Tenerowicz, communicable disease bureau chief for Arlington County, says the county expects to get the first vaccine supply from the Virginia Department of Health next week and adds that the vaccine "is widely available in the community generally, but we make special efforts for people who can't get out, such as the homebound elderly." A $12 fee is set by the state, she adds.
Fairfax County residents can obtain the vaccine for $10 at five Health Department clinics, says Michelle Bachus, the county's communicable disease program coordinator.
"We'll have 10 percent of the vaccine by the end of the month, 40 percent by November and the rest in December. There won't be any shortage," she reports, adding: "We're not seeing any flu yet, and folks have a lot more else on their minds."

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