McSweegan

Flu

In the ‘Grippe’ of the Flu For flu specialists, this is the winter of their discontent. The influenza virus arrived earlier than expected. It arrived violently, killing children in the western U.S. News of the deaths sent people rushing to their doctors for the vaccine, thereby causing a temporary shortage. The shortage may not have mattered much; this year’s flu strain was an unexpected variant that the vaccine did not seem to protect against. Influenza viruses appear each winter and kill between 36,000 and 50,000 Americans. The numbers may actually be higher, but there is no requirement to report flu-related deaths in many states, Maryland included. This annual loss of life goes largely unreported, except in an odd little publication called Morbidity and Mortality Weekly Reports. That we heard so much about this year’s flu epidemic was because of the deaths of 93 children since October. The young are susceptible. They have immature immune systems, and they may never have been exposed to previous flu viruses or been vaccinated. Seventy-three percent of the children who died this winter were not vaccinated. It should also be pointed out that more than a third of the dead had underlying chronic medical conditions—making them more vulnerable— and more than a quarter of the children died, not directly from flu, but from complicating bacterial pneumonias. The three-year-old Baltimore boy who died in December had pneumonia. The elderly, of course, continue to bare the brunt of influenza’s annual sweep across the planet. Advanced age, chronic aliments, and immune-suppressing therapies make them highly vulnerable to infections. The rest of us, those between kindergarten and retirement, are at least partly protected by a variety of antibodies from prior flu seasons and vaccinations. The Centers for Disease Control and Prevention (CDC) in Atlanta completed a very

1

McSweegan

Flu

preliminary study of the effectiveness of this year’s flu vaccine. Based on a questionnaire sent to 3,100 health workers in the Denver area, the CDC tentatively, and reluctantly, concluded that the vaccine protected between zero and fourteen percent of the surveyed people. That’s not good news. Why did this year’s vaccine seem to fail? First, it’s important to understand that flu vaccines are not stockpiled commodities waiting to be pulled out of the frig at a moment’s notice. Different flu viruses appear each year and each year a different vaccine has to be made to match them. The influenza virus is unstable —as it replicates it changes its appearance to varying degrees in order to keep our immunological memories from recognizing it. In effect, it puts on a hat and dark glasses in the hope of sneaking by our defenses. Spotting the new disguise requires a complex national and international effort. Once new strains are recognized, it becomes a race to manufacture and distribute the vaccine before the flu season starts. This annual effort is part hard-core science and part crystal ball-gazing. This year the crystal ball was clouded by the appearance an unexpected flu strain called A/Fujian/411/2002 (H3N2). Given the annual uncertainty about the effectiveness of a flu vaccine, should you even bother getting one? Yes. The vaccines usually are effective in reducing the severity and the number of flu cases. If the vaccine is not especially effective one season, the antibodies it generates in your bloodstream may be effective against next season’s viruses. Then there’s the “herd effect.” The more people who are vaccinated, the less likely viruses will spread to other vulnerable and unvaccinated people. Vaccinated children, for example, are less likely to bring something home from school or give something to grandma. So getting vaccinated is both a selfish and an altruistic act.

2

McSweegan

Flu

For all the news about the severity of this year’s flu and vaccine shortage, a more important story may have occurred on the far side of the world. In Viet Nam, a different flu virus emerged from birds and killed five people. Health officials reacted by killing poultry and fowl to keep the virus from spreading to more people. We have little immunity to bird flu so it tends to be highly lethal when someone catches it. Small outbreaks occurred in 1997 and 1999 in Hong Kong, and in 2003 in the Netherlands. The great fear is that one of these bird viruses will mutate and start spreading rapidly from person to person. One flu expert said, “What is going on in Vietnam is of very great concern. If [it] gets out of control it will make SARS look quite trivial…” An experimental bird flu vaccine is being developed...just in case.

Words: 750

Edward McSweegan has a Ph.D. in microbiology. He works on and writes about infectious disease issues. He can be contacted at emcsweegan@verizon.net.

3