January 2004
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A Matter of Health
The wily flu bug
Public health experts learned this year how to energize the public to get their flu vaccine. Start the epidemic early and keep it going.
In a recent issue of The New England Journal of Medicine, John Treanor, MD, of the University of Rochester (NY) Medical Center, makes that clear as he discusses the difficulties public health officials face when they try to predict the kinds of flu that are most likely to hit the world in the next year.
Even though the vaccine was not specifically tailored to provide complete protection against the flu bug circulating this year, enough people sought its protection that there were sporadic shortages around the country. Demand outstripped supply, despite assurances earlier that there would be enough.
Such sensitization of the public is a good thing because it brings home the message that influenza is not anything to sneeze at. Annually, it is associated with 51,000 excess deaths in any given year. Those who die are usually the oldest and youngest among us, as are those it sends to the hospital. This year, children 6 to 23 months of age were among those for whom the vaccine was strongly recommended.
Perhaps the most difficult part of getting people protected against the flu is that the virus changes annually, and that means getting a new vaccine each year. The influenza virus has two proteins on its surface – hemagglutinin (H) and neuraminidase (N). The structure of these proteins can change subtly from one virus to the next, eluding the protective effects of vaccine with surprising facility. This happens almost every year, meaning that most of us remain susceptible to the flu’s onslaught, year after year.
When a specific type of influenza protein denoted as H3 changes significantly, the annual epidemic begins early and hits hard. Often, the new form of virus is not identified early enough to include in the current vaccine. Vaccine preparation must often begin a year before the flu epidemic. Including in the vaccine a similar type of virus, even if it is not a complete match, can help reduce the virulence of the flu that people contract.
Many who have contracted the flu this year have been disappointed that they were ill, even though they had the vaccine. However, for most, the illness was much shorter and milder than for those who contracted it without any protection.
Annual flu vaccinations are probably a fact of life for most who can
get them. And they are a good idea.
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The wily flu bug |