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U.S. Sends Mixed Message on Flu Shots and Anthrax

Recommendations from HHS at odds with one another

FRIDAY, Oct. 26, 2001 (HealthDayNews) -- Leading doctors are trying to unscramble the mixed message the same U.S. government agency is sending about whether Americans should get flu shots to expedite the diagnosis of anthrax.

The Centers for Disease Control and Prevention insists that people needn't rush to get a flu shot so as to reduce any flu-like symptoms that may be mistaken for anthrax. But the man in charge of the CDC, Health and Human Services Secretary Tommy Thompson, is saying the opposite.

Thompson has said he wants vaccine makers to speed up production of flu shots since early symptoms of the inhaled -- and deadliest -- form of anthrax can resemble those of influenza. Preventing flu infection could therefore presumably allow doctors to eliminate it as a diagnosis and more quickly treat the person for the bacteria, he says.

On Friday, Thompson summoned vaccine makers to Washington, D.C., for a public slap on the wrist for failing to produce ample doses in a timely manner for the second year running. "I am going to have a stern discussion with them,'' the Associated Press quotes him as saying.

But the CDC has so far shown more patience with the vaccine makers. The agency on Friday reiterated its stance that only the most vulnerable people, such as the elderly and chronically ill, get vaccinated so early in the flu season in order to ease the effects of the delay in getting enough vaccine. Flu kills about 20,000 people each year in this country. While the vaccine is an important line of defense against the virus, it prevents only between 70 percent and 90 percent of infections, the CDC says. Moreover, other viruses can cause flu-like symptoms.

Thompson's statements and actions aside, the CDC hasn't budged. "We are in communication with the Secretary's office, but as of right now, our official recommendations have not changed," says Rhonda Smith, a CDC spokeswoman. The Department of Health and Human Services is the CDC's parent agency.

The line from the country's leading medical groups is consistent and clear: Healthy Americans should not get flu shots in an attempt to rule out the flu and allow doctors to look for anthrax instead.

Dr. Barbara Yawn, a Minnesota practitioner and chairwoman of the commission on clinical policies and research for the American Academy of Family Physicians, calls the suggestion "absurd."

"We have very clearly said you do not give low-risk people an influenza shot, or anybody else, for that matter" for that purpose, Yawn says. "That doesn't make any sense at all. There are many other conditions besides influenza that have all of the signs and symptoms of anthrax," which initially can include aches, fever and general malaise, one of which is the common cold.

How Thompson hit on the idea to promote flu shots to help quell the anthrax scare -- a disease which, to date, has claimed three lives -- isn't clear, and HHS would not respond to repeated requests for comment.

The mixed messages aren't limited to the government, though. Earlier this month, ABC News medical editor Dr. Timothy Johnson suggested on television that patients get immunized against influenza as insurance against missing anthrax symptoms.

The American Medical Association strongly disagrees. In a letter to ABC's "Good Morning America," the group says, "Dr. Johnson's statement may cause a rush of healthy persons to seek flu vaccine in October. This would reduce the amount of vaccine available to the high-risk individuals; these persons are most likely to suffer potentially fatal complications if they contract influenza.

"The real risk of death or severe illness to the unvaccinated high-risk population from influenza is far greater than the potential need to differentiate symptoms of the flu from the flu-like symptoms that accompany an unlikely inhalation anthrax exposure," the letter continues.

"I think there has been some confusion," says Dr. Timothy Flaherty, chairman of the AMA's board of trustees. One problem, Flaherty says, is that health officials generally describe inhaled anthrax as having "flu-like" symptoms.

Although doctors should understand the importance of prioritizing access to flu shots, Flaherty's worried that people will flock to out-of-doctor's-office settings to get vaccinated. But as long as high-risk people aren't deprived of inoculations, going to other venues is not necessarily a problem, and may even lead to increased vaccine coverage this year, he adds.

Johnson, who is a physician, could not be reached for comment Friday.

The CDC has said it expects the nation's three flu shot makers to produce 79 million doses of vaccine this year. An estimated 56 percent of doses were scheduled to be shipped by the end of this month, officials say, with the rest coming in November and December when virus activity typically peaks.

In July, before vaccine availability was clear, disease officials had recommended that the most vulnerable people -- nursing home residents, people over 65, pregnant women, and people of any age with lung or heart problems or weakened immune systems -- get vaccinated as early as September.

Thompson's pressure appears to have influenced at least one vaccine maker. Len Lavenda, a spokesman for Aventis-Pasteur, of Swiftwater, Pa., which met with Thompson today, has agreed to speed up the announcement of an additional 5 million doses of its flu vaccine that should be ready for shipping next month. Lavenda says the company had originally planned to announce the extra stock -- which he says was the result of a boom production year -- in "a few weeks," but changed the schedule after the meeting.

Still, Lavenda says Aventis won't enter the volleying over the flu-anthrax question. "In terms of the medical aspects, we really need to defer to the CDC and the AMA," he says.

Aventis is raising the price of its vaccine this year to $5 a dose, up about 80 percent from 2000. The hike is due in part to increased capital expenses to make up for the exit from the market of another flu shot maker. Aventis is also spending more on shipping, Lavenda says.

Another flu shot maker, Wyeth Lederle Vaccines, a unit of American Home Products Corporation, did not return calls for comment.

What To Do

For more on the flu vaccine situation, check out the Centers for Disease Control and Prevention or the CDC's National Immunization Program.

For more on bioterrorism and what officials are trying to do to stop it, try the National Memorial Institute for the Prevention of Terrorism or the Centers for Disease Control and Prevention.

SOURCES: Interviews with Timothy Flaherty, M.D., chairman, board of trustees, American Medical Association, Chicago; Barbara Yawn, M.D., FAAFP, chairwoman, chairwoman, commission on clinical policies and research for the American Academy of Family Physicians, director of research, Olmsted Medical Center, Rochester, Minn.; Len Lavenda, spokesman, Aventis-Pasteur, Swiftwater, Pa.; and Rhonda Smith, spokeswoman, Centers for Disease Control and Prevention, Atlanta; Associated Press; American Medical Association, CDC Web sites
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