Flu Shot, Yes! But Don’t Stop There

With less fanfare and fear than last year, flu season has arrived, and public health officials wasted no time in urging health providers to go on the offensive: “Begin offering influenza vaccine to people of all ages as soon as it becomes available” was the key recommendation.

With the specter of the H1N1 pandemic fresh in everyone’s mind, the fight against the flu has expanded. The Centers for Disease Control’s annual guidelines contain important additions this year, most notably a recommendation of ‘universal’ vaccination for everyone six months of age and older, and this year’s vaccine protects against the H1N1 flu, precluding the need for a separate shot.

Also new are updated dosing recommendations for children under 9 and the addition of American Indians/Alaska Natives and the morbidly obese to the list of those at increased risk for flu-related complications, bringing the number of groups in that category to eight. Visit www.flu.gov or www.mass.gov/dph/flu for the latest information on the 2010-2011 flu season.

The medical community spends huge amounts of time and energy urging people to get flu shots, and rightfully so. The flu contributes to thousands of deaths annually, especially in the elderly population, and, depending on the severity of the outbreak, can put enormous stress on our health care system, especially emergency departments. So it makes sense to prepare and make flu vaccination a sound part of preventive medicine.

But vaccinations should go far beyond annual flu shots. In its most recent Health Care Trends Report, the American Medical Association warns that “The lack of public awareness regarding the importance of immunization, together with continuing suspicion by some of the vaccines for children, poses a significant public health risk for patients and their families.” Some of the indifference may stem from fears of side effects, but many people simply forget or ignore the value of prevention.

The estimated numbers of annual deaths occurring from vaccine-preventable diseases are stunning. The U.S. Department of Health and Human Services figures that more than 50,000 Americans die from diseases such as flu, pneumonia, and hepatitis B; the World Health Organization believes preventable diseases claim more than 2 million children.

The growing resurgence of preventable diseases should make us all pay attention to the importance of immunization, and plenty of examples exist. California has experienced its biggest whooping cough outbreak in nearly five decades, with more than 4,000 cases as of mid-September, a seven-fold increase over 2009. The disease has claimed at least nine infants, and public health officials there attribute the outbreak to low immunization rates. Vermont is also now reporting a rise in whooping cough cases.

Outbreaks of measles, a contagious disease with some 10 million cases and 164,000 deaths worldwide annually, have been reported in South Africa and the Philippines. An outbreak in California earlier this year was unwittingly caused by a 7-year-old unvaccinated boy who brought back the virus with him from a trip to Europe.

A mumps outbreak infected more than 1,000 people in New York and New Jersey, caused by a young boy who likewise returned from overseas with the disease. And while polio has all but disappeared in this country, recent outbreaks have occurred in Tajikistan and Russia. Those nations may seem far away, but distance no longer offers the protection it once did. The CDC cautions that “The United States can remain free of polio only by maintaining high levels of population immunity and reducing or eliminating the risk for poliovirus importation.”

The lesson: experience shows us that an outbreak of disease can be a single plane ride away.

While childhood diseases get the most attention for immunization, infectious diseases know no age limits, and immunization should be a regular part of medical care for all age groups. The CDC at www.cdc.gov has recommended schedules for children birth to 6 years, adolescents 7 to 18, and adults over 18, and the National Network for Immunization Information at www.immunizationinfo.org contains information on specific vaccines and the diseases they prevent.

So when you get your flu shot this year, check to see if you’re up to date on other immunizations. Vaccines are one of the greatest achievements in medicine and public health. We should use them for our ultimate benefit. –

Alice Coombs, M.D., is president of the Massachusetts Medical Society and a critical care specialist at South Shore Hospital in Weymouth.