The flu watch: Delays and concerns

While many health care providers are waiting for additional shipments of both seasonal flu and H1N1 flu vaccines, Dorchester has yet to experience large numbers of influenza-like cases this fall.

Still, if the flu season mirrors the spring incidence rate, the number of cases could rise significantly. As a result officials at most health care facilities in Dorchester are advising residents to get both vaccines when they are available.

From April through July, the months when H1N1 first appeared, the incidence of hospitalization due to the H1N1 flu was higher among African Americans and Hispanics in Boston. Of the 72 people hospitalized with severe complications, 35 percent were African American, 28 percent were Hispanics, 15 percent were white and 5 percent represented other groups, according to the Boston Public Health Commission.

African American and Hispanic neighborhoods suffer disproportionately from chronic illnesses such as diabetes and asthma compared to white areas, which makes them more vulnerable to complications from the flu, the commission noted in a report. Also, urban crowding may contribute to the disproportionate spread of the virus.

Dorchester health officials said that they are seeing lower numbers of cases so far this fall and it’s difficult to predict what will happen in the coming months.

At the same time, delivery of both seasonal flu and H1N1 vaccines has been stalled.

The same pharmaceutical companies are producing both vaccines and experiencing production and distribution pressure, wrote Mass. Department of Health Commissioner John Auerbach in his Oct. 22 blog. “Neither the seasonal nor the H1N1 vaccines are as widely available as we would like,” he wrote.

Although Carney Hospital has some seasonal flu vaccine available for its in-patients, the hospital recently had to cancel large-scale clinics because of delays in production for both vaccines. “We still have a limited supply of seasonal flu vaccine for patients, no H1N1 at the moment, and no clear idea when it’s going to appear,” said Dr. Philip Carling, service chief of infectious disease at Carney Hospital.

Last week, President Obama declared the H1N1 flu a national emergency. The president’s action, however, does not change the availability of the vaccine, said Carling, “but it puts people’s awareness up a little higher.”

The Department of Public Health reported last week that it has already distributed 300,000 doses of H1N1 vaccine statewide. “We estimate that we are expecting about 3.5 million doses of H1N1 that will come throughout the flu season,” said spokeswoman Jennifer Manley. “It’s all coming in small allotments. We anticipated more at this point, but it’s not there. It is a production delay.”

The state had indicated to local boards of health to plan for large-scale clinics in mid-November, she said, “but now it’s not going to be happening before December.”

Of the 885,000 seasonal flu vaccines ordered, as of Oct. 22, the state had received and distributed 631,530 doses. The state distributes about 30 percent of the total flu vaccines dispensed each year and the remaining 70 percent is made available through private-pay sources. The rest of the state’s order is expected to come in over the next few weeks and the balance should come in by the end of November.

“Seasonal flu begins around the beginning of December and peaks in January and February,” Manley said. “H1N1 is the only type of influenza in the city right now.”

Carney Hospital, which held 22 seasonal flu clinics in 2008 and distributed 2,177 doses last year, will likely hold another two dozen or more clinics this year when supplies become available. To date, the hospital has seen few admissions of patients with the H1N1, Dr. Carling said. People should get both vaccines when they can, he added. “I certainly don’t see a reason why not. I’m a believer in the flu vaccine. The data is good.”

Having the seasonal flu vaccine each year can have an added benefit. “Data have also shown that normal healthy adults have less days missed from work from the flu and due to respiratory infections of any type,” Dr. Carling said. “It seems to offer a cross-protectiveness to other viruses. It’s been seen over time in the data.”

Seasonal flu vaccines are recommended for children ages 6 months to 19; pregnant women; people 50 years or older; people of any age with chronic medical conditions like asthma; health care workers; caregivers of those at high risk of the flu; and those who live in nursing homes, according to the DPH.

The H1N1 vaccine is being made available to such high risk group first, the DPH noted on its website.

Even healthy adults should get the H1N1 vaccine when it becomes available to them, Dr. Carling said. “We don’t know how this is going to evolve over the next year or so,” he said. “It’s so easy to take the shot. The rate of any complications is so low compared to the risk of influenza itself.”

Some believe that those who were born before 1950 may have already been exposed to H1N1 in previous flu seasons. “The probability is that it would not offer a tremendously good immunity.” Dr. Carling contends. “It’s certainly possible that the illness will be less severe if you had been exposed before. But you still should get the vaccine.”

Dr. Robert Hoch, chief medical officer for Harbor Health Services, agreed. “It’s very hard to count on immunity. It’s hard to know for each individual if they have immunity that is protective or not. The safest thing to do it just to get the vaccine.”

Like other health centers, Harbor Health, which operates the Neponset Health Center and Geiger Gibson Health Center, is working with limited supplies.

The Codman Square Health Center is probably seeing about 20 cases of flu each week, said Cecilia Joseph, RN, the center’s director of compliance and training. “But we haven’t had anyone acutely ill or that would have to go to a hospital,” she said. The center has distributed more than 2,000 doses of seasonal flu vaccine and nearly 200 doses of H1N1.

The Uphams Corner Health Center has already distributed about 200 H1N1 and more than 500 seasonal flu vaccines, said Ed Grimes, executive director, adding that “as the vaccine comes in we contact patients at risk.”

Not all health care providers believe that both vaccines are necessary for all people. Dr. Douglass Bibuld, medical director at the Mattapan Community Health Center, recommends the H1N1 vaccine for people with underlying conditions like asthma, diabetes, respiratory disease or other complications.

“I would also recommend it for children with asthma, or diabetes or other illnesses that could put them at risk,” he said. “ And for pregnant women. And for young children [in general].  It makes sense for young kids, especially those in day care. But they should also be vaccinated against the seasonal flu. It looks like the seasonal flu is more dangerous than H1N1, especially with younger children.”
But he is not convinced that otherwise healthy adults need the H1N1 vaccine. “It seems to be over-hyped. Reports of the H1N1 flu is that it is not as severe as the seasonal flu. Like any virus, flu exists on a spectrum from mild to severe. This particular strain does not appear to be very severe.”

He also pointed to cities which had a high incidence rate in the spring and have not seen high rates this fall. “Once we have seen community wide exposure, the incidence is not as high,” he said. “The areas who didn’t have it in the spring are getting it now. Once you have some exposure, immunity builds up and that slows it down considerably. I think what we’ve seen so far is probably the worst of it.”

For those seeking either or both vaccines, local health officials say stay in touch with doctors, health centers, and the newspapers for announcements. Also, public clinics are listed on websites sponsored by the city.

What to Look For

Symptoms of the flu include a high fever of more than 100 degrees, cough, and sore throat. Some patients also report malaise, tiredness, headache and vomiting. Patients should see a doctor if the fever does not go away quickly with Tylenol or if they have difficulty breathing, she said. For those waiting for the vaccine who are concerned about prevention, all of the health providers encourage people to practice good hand-washing, cough into a sleeve or elbow, and stay home if they do get sick.