Get Your Flu Shot Before the Flu Gets You

Whether there is an epidemic of influenza — affectionately known as “the flu” — or not, all Americans should learn how to prevent an encounter with this potentially devastating bug.

To say we should all have been vaccinated already seems like pointless harping, sort of an I-told-you-so approach. It’s certainly true that a better-planned approach to vaccination would have forestalled this outbreak (and it is not too late to get your flu shot). But one issue remains clear: Only a small fraction of those who should be vaccinated will be.

A recent study, conducted by Ipro, a quality-assurance monitoring group, found that only 30 percent of New York City Medicare patients had been immunized in 1998, an astoundingly low number, considering the shot is fully covered by Medicare. In other words, it is free. This means that both private-care and government health providers are not doing an effective job of vaccinating those who need to be vaccinated. If these same numbers held for children’s immunizations, it would not be tolerated. Why should it be so for the frail and elderly?

How can this pattern be remedied? As Dr. John Quinley, clinical coordinator of Ipro, points out, “Family doctors should explain the benefits [of being vaccinated] to those who come in for unrelated care. … Strategies that have made childhood vaccinations such a success could be adapted for adults. Public and private senior centers could be used to inoculate the elderly.”

Some people even believe that getting a flu shot can give them the flu, thus they avoid getting one. Public health authorities, as well as community healthcare providers, should aggressively counter such misinformation. Only then will the next flu epidemic be mitigated.

But no one in public health circles recommends that everyone get immunized. Certainly, all those over 65 should do so, as well as anyone with a chronic disease that makes them more susceptible to infection, including those with heart, kidney or (especially) lung problems.

In some countries, all healthcare workers are offered influenza vaccination as part of a plan to reduce the toll of flu-related death among the elderly in hospitals and nursing homes. A study in this week’s The Lancet demonstrated that such vaccination significantly reduced all-cause mortality among the residents of those institutions whose staff was offered the vaccine.

This approach has the potential to make a serious impact on flu-related deaths, because the large majority of such cases are in the elderly. Influenza’s yearly death toll is at least 20,000, and pneumonia adds another 45,000. Pneumonia often follows the flu in those with weakened immune systems.

While there are cheap drugs available to reduce the duration and intensity of illness, they must be taken within 48 hours of the onset of symptoms and must be prescribed by a physician. And the newer drugs are expensive. These drugs may play a role in preventing institutional epidemics someday. For now, the message remains the same: Get your flu shot before the flu gets you.

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