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Experts Brace for Rougher Flu Season

Fear is complacency over vaccine after two straight mild years

TUESDAY, Sept. 23, 2003 (HealthDayNews) -- It's impossible to know for sure, but some early indications suggest that this flu season might be worse than the last two.

"I haven't heard anything official, but there have been rumors that there will be more infections and more illness than last year," said Dr. John Belko, chief of pediatric infectious disease at Long Island College Hospital in New York City. Still, Belko adds, it doesn't appear that it's "going to be that bad."

One factor is the mere law of averages.

"It's always very difficult to predict with influenza year to year how severe the season will be, or which viruses will be circulating with a high degree of certainty," said Dr. Kristin Nichol of the National Coalition for Adult Immunization and the Minnesota VA Medical Center in Minneapolis. "We do know that influenza will be here this year. More likely than not, we will have an epidemic and it may be a more severe outbreak than we've experienced just when one averages the outbreaks over the past 10 years or so."

Another indication is that more virulent forms of the virus have been circulating in other parts of the world. The Australian state of Victoria, for instance, just had its biggest outbreak of influenza in five years.

"We are closely monitoring early influenza isolates in the U.S. for possible indication that these troublesome viruses may predominate in the coming influenza season in the U.S.," Nancy Cox, chief of the federal Centers for Disease Control and Prevention's influenza branch, said at a news conference Tuesday.

In general, U.S. death rates from influenza are on the rise, from an average of about 20,000 deaths per year to an updated annual average of about 36,000.

An aging population no doubt plays a part in this increase. Recent influenza seasons have also been longer and, in the 1990s, more severe.

More troubling and more telling, perhaps, is the fact that vaccination rates have declined. The estimated vaccination coverage among adults aged 18 to 64 with high-risk conditions was 29 percent in the 2000-01 season, while the Healthy People 2000 and 2010 campaign's objective was 60 percent. Only about 9 percent to 25 percent of children with moderate-to-severe asthma receive an influenza vaccine annually, in spite of a long-standing recommendations for this group, Cox said.

Experts attribute these sorry statistics to a general attitude of complacency. Relatively mild flu seasons in the past two years may have contributed to a false sense of security. Also, people who have mild forms of the flu may not be able to distinguish it from other upper respiratory illnesses. Even individuals who have severe complications, such as pneumonia or stroke, may not initially recognize this as a consequence of the flu.

"Influenza is almost like an iceberg, where we recognize just the tip above the surface of the water," Nichol said.

"It's a common illness and it's usually mild, so it doesn't seem frightening because most people don't appreciate this tip-of-the-iceberg effect," added Dr. Julie Gerberding, director of the CDC. "Many people don't realize that while it may not be a health hazard to me because I'm a healthy person, it may be a hazard to the person next to me. People underestimate the extent to which they can put others at risk."

The influenza vaccine, which is in plentiful supply this year, can prevent illness in 70 percent to 90 percent of healthy individuals. It can also prevent up to 50 to 60 percent of influenza-related hospitalizations and up to 80 percent of influenza-related deaths in seniors.

This year, health officials are making a dramatic plea to health-care workers, in particular, to get vaccinated to protect the people they care for.

"Only 38 percent of health-care professionals are getting vaccinated for the flu. That's an alarmingly low number," Dr. Donald Palmisano, president of the American Medical Association, said at the news conference. "Flu bad. Vaccine good. Get it now."

Added Nichol: "Few if any other interventions available for care of adults in this country can have such a large and immediate benefit on death rates. The payoff can be huge, but only if people are vaccinated. Last year, tens of millions of elderly and high-risk people did not receive influenza vaccine and yet tens of millions of doses of flu vaccine we never used went to waste. What a shame."

This year, health officials are also urging at-risk people to get immunized against pneumococcal disease, which kills about 6,000 people each year.

More information

For more on the flu, visit the CDC or the National Foundation for Infectious Diseases.

SOURCES: Julie L. Gerberding, M.D., director, U.S. Centers for Disease Control and Prevention; Nancy Cox, Ph.D., chief, Influenza Branch, Centers for Disease Control and Prevention; Kristin Nichol, M.D., National Coalition for Adult Immunization and chief of medicine, Minnesota VA Medical Center, Minneapolis; Donald Palmisano, M.D., president, American Medical Association; John Belko, M.D., chief of pediatric infectious disease, Long Island College Hospital, New York City; Sept. 23, 2003, press conference, Washington, D.C.
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