Flu Vaccine Complacency Concerns Linger

December 7, 2010
by Anthony Kimery
Homeland Security Today

We want and need to avoid complacency'

Dr. Anne Schuchat, director of the Centers for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Diseases, said during a media briefing Friday CDC  is “very encouraged by the number of people who have already received a flu vaccine." But she also stressed that “many others could benefit from being vaccinated and do still need to be protected.”

Schuchat said “we carried out a rapid survey by telephone of about 38,000 adults and 9,100 children around the country to give us an early snapshot of vaccine coverage results in the general population [through the second week of November], and at that time about 33 percent, or one out of three Americans, reported having already been vaccinated. Among those who had not yet been vaccinated, 15 percent said that they will definitely get vaccinated and 25 percent reported that they'll probably get vaccinated.”

The survey found, however, that immunization rates are lagging among minority groups, with vaccination rates for whites 10 percent higher than for blacks and Hispanics.

Schuchat said “it’s not too late to make a difference for more people who would benefit.”

Earlier, during a Jan. 7 media briefing , Schuchat had emphasized that “we have an uncertain future" and thus "we want and need to avoid complacency.”

"I'm always concerned about complacency," Paul Biedrzycki, director of disease control and environmental health for the Milwaukee Health Department, told the Journal Sentinel, adding, "flu is the one epidemic I can count on every year."

And although the majority of the specimens of influenza that have so far infected people nationwide contain the A/H3N2 and B strains, a minority contains the H1N1 pandemic flu virus.

Biedrzycki noted that "flu viruses by nature are unpredictable. This season is precarious because we don't know what strain will emerge and how severe it will be ... Could seasonal varieties be more severe? Absolutely."

The 2010-2011 flu season is the first for which CDC has issued a universal recommendation that everyone older than six months be vaccinated.

With all the uncertainty, Quebec, Canada's public health authorities for the first time identified the morbidly obese as a high-risk group that needs to be vaccinated and are eligible for a free shot.

The vaccine is designed to protect against the A/H3N2, B, and 2009 H1N1 pandemic strains that currently are in circulation.

“We are unsure what the second year of H1N1 and its inclusion in the vaccine will do to its incidence,” Abilene, Texas pediatrician Justin Smith told theReporter News. "This is why it is critical for everyone to receive their flu vaccine.”

Last January, New York Gov. David Paterson reiterated officials' concerns over complacency. He said in a statement that "complacency is the flu's best friend and our worst enemy. If people do not act now to get vaccinated, a third wave of this dangerous virus becomes more likely. There is plenty of H1N1 flu vaccine available from health care providers, county health departments, pharmacies and pharmacies-within-supermarkets, and I encourage all New Yorkers to take the opportunity to get vaccinated."

HSToday.us has repeatedly reported that public health authorities have long been concerned about what they call “creeping complacency” among the public toward getting vaccinated for influenza.

According to the CDC, among healthcare workers and pregnant women, about 56 percent of healthcare workers have been vaccinated, with seven percent of unvaccinated workers saying that they plan to get vaccinated. Last year, slightly more than half of healthcare workers were vaccinated against seasonal flu, with only about 37 percent getting immunized for the 2009 H1N1 vaccine.

Forty-five percent of the 1,400 pregnant women surveyed said they have already been vaccinated, with an additional four percent saying they intend to be vaccinated before their babies are due. Last year, about half of pregnant women received the seasonal flu vaccine.

Unlike last year, however, in some parts of the country vaccinations are down. In Oklahoma, for example, many fewer people than normal have gotten flu vaccinations, and it has state health officials concerned.

The Oklahoma State Department of Health reported last month that health departments across the state have administered slightly less than half of the flu vaccines they’ve received.

“Other states are saying the same thing. People are not getting vaccinated as early as they usually do,” Dorothy Cox, the Oklahoma State Department of Health’s vaccine management director, told The Oklahoman.

“It could be a big mess” nationwide if fewer persons get vaccinated than last year, she emphasized.

Indeed. One public opinion poll found that only 37 percent of respondents planned to get this season's flu vaccine.

As Tulsa Dr. Scott Cordray told The Oklahoman, some of his patients are concerned that the vaccine might not be very effective, he believes there’s another reason for fewer people getting vaccinated this year. “I think, definitely, they’re apathetic,” he said.

In Wisconsin, there's been a 40 pecent decline in vaccinations against the flu.

"Across the board, it's down," Lisa Taylor, coordinator of the Visiting Nurse Association of Wisconsin Shoo the Flu clinics, told the Journal Sentinel.

Joyce Lopez, the Oklahoma City-County Health Department immunization program administrator, said people are “a little skeptical after last year,” explaining that “the Novel A H1N1] pandemic didn’t seem to pan out quite as big as maybe they expected,” she said, leading the public to believe that vaccinations, especially against the H1N1 flu virus, to be unnecessary.

Most virologists and public health preparedness authorities though say the prevailing wisdom for why the H1N1 virus wasn’t more lethal is precisely because of the unprecedented global efforts to vaccinate as many people as possible worldwide. Action that is credited with having prevented the H1N1 pandemic flu virus from having been as lethal as could have been had the global vaccination effort not been undertaken.

But even with the concerted immunization efforts by the US government, the H1N1 flu pandemic still infected about 20 percent of Americans (approximately 60 million individuals), hospitalized close to 300 million, and killed about 12,000 (90 percent of whom were under 65, and at least 340 were children) – somewhat slightly less numbers for infection rates and deaths typically caused by seasonal flu strains. According to CDC, the actual number of deaths of children could have been as high as between 910 and 1,880.

And “more people were hospitalized from H1N1 than are typically hospitalized from the seasonal  flu,” stated the Trust for America's Health (TFAH) report,Fighting Flu Fatigue, that was released last month.

According to that report, vaccination rates have foundered in adults, minority groups, and even healthcare providers.

To increase vaccination rates, TFAH said a major flu vaccination campaign is still required to educate people about the need for an annual flu shot and to increase access to the vaccine, even in those who are uninsured or don't receive regular medical care.

“We don't want people to be complacent because disease activity has been low so far this year. Flu is coming. We do have early indications that flu activity is now increasing. The percentage of viruses testing positive for influenza nationally continue to increase … led by sharp increases that we're seeing in the southeast,” Schuchat said at CDC’s influenza briefing.

“This signal of the start of increased flu has been in the southeast led by Georgia," Schuchat said, noting that "Georgia is reporting high levels of influenza-like activity. On the maps that we have on our website, you can see Georgia is showing up as a ten out of ten on their scale. It's been called regional disease spread by the state epidemiologists of Georgia, and it's probably leading the country in terms of what we may be seeing later in the – in the later months.”

“The increase in Georgia is occurring in multiple sites around the state,” Schuchat continued, adding, “it's been seen primarily so far in school-aged children. They've seen an increase in the number of influenza viruses that they're detecting, and it's an increase in influenza B. Preliminary data show the majority of the B viruses from Georgia are related to the B virus that's in our vaccine. So we expect the vaccine to be a good match against this B strain already causing quite a bit of disease here in Georgia. Their detailed analyses of the viruses from Georgia are in progress. But everything we know so far suggests to us that the vaccine should be a good match for the circulating strain.”

Dr. Howard Koh, assistant secretary for health, Department of Health and Human Services (HHS), said at the CDC's briefing that “flu activity is now increasing across the country, and indeed the flu season is now well under way. If you've been thinking of getting vaccinated for influenza, now is a very good time to do so. With the holidays coming up, we are encouraging all Americans to be vaccinated and to protect themselves and their families, friends, and community from the flu. And we also want to stress that we want to build on the lessons learn from the H1N1 epidemic from last year.”

Koh said “last year at this time we were preparing for one of the largest mass vaccination campaigns in the nation's history … this year with the flu season now well under way, despite the fact that we no longer have a pandemic, we need to stress always that the flu is unpredictable, and the flu is potentially deadly, and so that all Americans need to take this threat seriously and promote prevention as much as possible.”

"Flu viruses are always changing,” and “that's why vaccines are updated every year to meet the need," Koh said. "This year's flu vaccine will protect not only against [the pandemic strain of] H1N1 but against other seasonal flu viruses as well. And we must always remember that even healthy people, young adults and children can become severely ill from the flu. That's why the CDC and Health and Human Services this year has promoted what's called the universal vaccination recommendation.”

Koh explained that this “is that all people with the exception of children under six months of age should be vaccinated against the flu. We need to send that message of the universal recommendation throughout every venue that we can. Not only with media, but health care providers, faith-based and community-based organizations, employers, and pharmacies that have done a great added push this year, and other stake holders to promote this message of prevention.”

The TFAH report stated that “the  H1N1 outbreak dramatically raised awareness about the threat that the flu poses, but now that a vaccine is widely available for H1N1 as part of the seasonal vaccine and concerns about the severity of the new strain of the virus have diminished, there is a real likelihood that the country will return to complacency in its attitude toward the flu."

"Nevertheless," the group's report pointed out, "there remains a significant risk that a more serious new “pandemic” strain of the flu could still emerge. If a new flu virus emerged that was as severe as the 1918 pandemic, it could lead to 90 million Americans becoming sick, 2.2 million deaths, and major economic losses.”

The report noted that “according to Carolyn B. Bridges, M.D., of CDC, ‘just because we’ve just had a pandemic does not mean we’ve de creased our chances of having another. We have to stay vigilant.’ For instance, as one potential concern, as of August 2010, there have been  500  total  cases  –  including  300 deaths – from the H5N1 ‘bird’ flu that public health officials and researchers around the globe have been tracking.”

Addressing the matter of complacency, molecular biologist Adam Ruben, who is working on a vaccine for malaria and author of, Surviving Your Stupid, Stupid Decision to Go to Grad School, wrote for NPR that “a year ago, the Harvard School of Public Health published a study that asked parents why they might choose not to get the H1N1 vaccine for their children. Some of the reasons stemmed from misconceptions - 24 percent feared the vaccine would cause the flu, even though the flu virus used to make the vaccine is verifiably dead and no dose of flu vaccine - out of billions given - is even capable of causing the flu.”

Ruben penned that “many parents wanted to distance their children from the preservative thimerosal, which some celebrities claim causes autism. And whom do you believe? On one hand, you've got numerous published, peer-reviewed studies showing no link between thimerosal and autism … But here's where the complacency comes in. Fifteen percent of parents elected not to vaccinate their child simply because the child dislikes needles."

But as CDC and public health authorities have begun to stress, children and those who are most at risk from both H1N1 and seasonal flu, they need to seriously be thinking about getting a flu shot - and soon!

"Just because we dodged the bullet of a potentially far more lethal pandemic from the pandemic H1N1 flu virus last flu season largely because of the widespread efforts by nations to vaccinate their citizens, it does not mean by any stretch that we can let out guard down - that we're out of the woods,"HSToday.us was told by a seasoned federal flu expert and public health preparedness planner who asked not to be identified because of the sensitivity of his position.

"The pandemic H1N1 flu virus could still reassort - mutate, if you will - into a much more deadly flu virus; we just don't know what it may do," the official said. "And then there's the still ever present threat of an H5N1 bird flu pandemic that, well, could cause untold numbers of deaths, hospitalizations and catastrophic crisis before we have a vaccine for it."

"A modern Spanish Flu-like scenario is still possible," the official noted, saying "we can't afford not to continue to make preparations for a serious, global pandemic, despite what the naysayers say."

As Schuchat said: the "flu is coming ... we don't want people to be complacent."

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