This year’s influenza season is more confusing than usual, with the regular “seasonal” variety arriving along with the emerging H1N1 “swine flu” that appeared last spring.
City government, hospitals, and other health care providers have been scrambling to deal with the one-two punch here in New Haven. Their plans are still evolving.
There are vaccines for both the seasonal and new H1N1 flu viruses. Health officials want to inoculate those highest at risk — a complicated challenge, since the seasonal flu is most dangerous to the elderly, while H1N1 hits children the hardest.
The new H1N1 is of concern because it is a novel combination of swine, avian and human flu. So people have not even a hint of residual immunity.
And while federal health officials somewhat optimistically ordered and expected delivery of 114 to 115 million doses of seasonal flu, the six worldwide manufacturers delivered only about 90 million.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that 32 million doses of H1N1 vaccine are available so far.
What to do?
Following are some commonly asked questions and answers about what to expect in coming weeks.
So, who’s responsible for ordering the vaccine? For shipping it? Where is it all stockpiled? Why are both seasonal and H1N1 so difficult to find? And is the government or private industry responsible for this year’s flummox?
Calm down. To answer your questions: No one in particular is responsible for ordering. A private distributor distributes. There is no stockpile. Right now demand exceeds supply. And again, no one specific person is responsible for the current shortage. If you insist on placing blame, check out our current national health care system.
Meanwhile, adults can probably get a seasonal (not H1N1 swine flu) shot at a New Haven health department clinic at 54 Meadow St., on Tuesday from 9 a.m. to noon. Or try Walgreens.
What is the city’s plan for seasonal flu?
There isn’t one.
Get a seasonal flu shot from your doctor or primary care provider, suggested William Quinn, director of the New Haven health department. The elderly, and people with chronic illnesses of compromised immune systems, are advised to get the seasonal vaccine, which contains two type A and one type B deactivated viruses. Some community health centers may also have supplies of the seasonal vaccine.
Infants, children and pregnant women are at the greatest risk for H1N1, the swine flu you’ve heard so much about.
Well, what about H1N1?
There is no set plan for the H1N1 vaccine, either, other than to vaccinate firefighters, police officers, and emergency technical technicians. There are major state and federal plans to cope with a repeat of the 1918 “Spanish” flu, which killed millions. People were dropping in the streets. Thank goodness, we’re nowhere near that. You would not like that plan. It’s a bit Draconian.
So how do I get my child an H1N1 shot?
Again, start with your own doctor. New Has received about 13,000 doses, but it had to vaccinate the fire department, and police department. Quinn said he wants to make sure that infants, pregnant women, and daycare providers receive the vaccine first. “We still don’t have enough,” he said.
Clinics requiring pre-registration will be given starting next week, he said. Check the New Haven health department website. If you don’t have an Internet connection or computer, ask to borrow a friend’s; or call 946‑7878. Do not show up at the clinic without registering first, Quinn said.
Vaccines may also be distributed to public school students at a regional school, if and when the vaccine becomes available, he said.
If can’t get either vaccine right now, I’m screwed, right?
Possibly, but not necessarily. It takes two weeks for the vaccine to work its immunological magic, and flu can linger well into April or May, said Dr. Louise Dembry, hospital epidemiologist at Yale-New Haven Hospital and an infectious diseases specialist.
So even if you can’t score a shot right away, get one when there are more around, she said.
On the other hand, an average of 36,000 people die from flu every year in the U.S., usually from complications such as pneumonia, meningitis, encephalitis and other unpleasant problems.
To avoid influenza, cough into your sleeve, stay home if you have flu-like symptoms, wash your hands frequently and steer clear of anyone who may appear to have flu. If you are ill stay home. Wait for one day without a fever before returning.
If cities don’t have plans, what’s the state plan, for crying out loud? Isn’t someone planning something, somewhere?
Not really, no. There is no state plan, said William Gerrish, spokesman for the state Department of Public Health. “A vast majority of vaccine goes into the private sector. The state has no involvement. Local health departments can buy small amounts from the Department of Public Health,” he said.
Well, how much did New Haven order, and based on what?
Most private care doctors ordered the vaccine themselves, based on past experience.
New Haven ordered 3,000 doses of seasonal flu and 13,000 doses of H1N1, Quinn said. Most of New Haven’s seasonal flu is used up. It went to first responders, people who work with elderly patients, and other high-risk people. Walgreens acquired several tons of vaccine, according to the CDC. Check your local Walgreens store for availability. They still have a little left.
“Dribs and drabs,” in technical public health jargon, are arriving daily, so supply should fluctuate. Novartis had to stop what it was doing to develop and test the new H1N1 vaccine. This process would have gone faster, but H1N1 does not grow in eggs as rapidly as researchers anticipated. This has to do with vaccine production.
The seasonal vaccine can cost anywhere from $5 to $30.
The CDC price ranges from about $7 to $20, including federal tax. The state attorney general is investigating the possibility that prices are being gouged somewhere in the chain.
Given that it seems like we’re all being left to tend for ourselves, should I drag myself to the emergency room?
Not unless your fever persists, your cough gets worse, or some other serious symptoms arise, Dembry said. Go to the ER with flu-like symptoms and you may enjoy the free television for a few hours before being told to drink liquids, take Tylenol, cough and sneeze into your elbow, and stay away from healthy people. To avoid flu, wash your hands frequently, do not hang around sick people, and avoid infecting yourself by touching your eyes, nose or mouth.
But if I get the flu, I can just take some Tamiflu, correct?
Only if you really need it, which is to say, you have a chronic health condition, or are immunologically compromised. Tamiflu and Relenza, two anti-viral drugs, work onlly if given within 48 hours of the first symptoms, Dembry said. They might eliminate one day of sickness, but otherwise healthy people do not need these drugs, she said.
Good grief. Is the vaccination plan for H1N1 any better?
Sort of. The federal government is allocating H1N1 vaccines to states based on population. The government may also use a secret formula; it’s not clear. Connecticut amassed a list of providers and asked them how much H1N1 vaccine they will require. The provider tells the distributor, who sends the vaccine directly to the provider.
The CDC provides weekly H1N1 vaccine availability reports. The H1N1 is free. All you should pay for is the administration of the shot.
Great. So we’re all set for the H1N1 vaccine, right?
Well, here’s the deal. Connecticut asked the CDC for 500,000 doses, and has received 297,000. More than 1,600 providers want to administer the vaccine, which is free.
Doing the injection is not free. Gerrish, of the state health department, said the 297,000 doses are “on the ground” and in the process of distribution. “The projection was 500,000 doses by mid-October. It hasn’t worked out that way,” he said.
Remember, dribs and drabs.