As flu cases begin to appear in Kansas, a former Centers for Disease Control and Prevention epidemiologist urged providers to continue distributing the flu vaccine while also preparing antiviral medications for high-risk patients.
William Atkinson, a doctor who spent 25 years at the CDC and is now associate director for immunization at the Immunization Action Coalition, said there's still time to inoculate more of the population before the flu season peaks.
“Don’t stop just because Thanksgiving has passed,” Atkinson told an audience of about 40 at a Thursday meeting of the Mother & Child Health Coalition in Kansas City, Mo. “Keep going as long as you’ve got it.”
People six months and older are recommended to get a flu shot in the United States, where Atkinson said flu still kills more children than all other vaccine-preventable diseases.
About 100 children died of flu last year, Atkinson said, and that number may be low because it represents only the confirmed cases.
The illness has an even higher fatality rate in people 65 and older, who make up the bulk of the thousands of flu deaths each year.
Need for antiviral use
Atkinson emphasized that a recent CDC alert about possible compromised effectiveness of this year's flu vaccine was not intended to discourage its use but rather to inform providers about the urgency of dispensing antiviral medications to high-risk patients with flu-like symptoms.
The CDC alert warned that early cases of the flu this year have predominantly been of the influenza A (H3N2) type, which the annual vaccine has traditionally been less effective in preventing. But Atkinson said there are many types of flu that the shot will still be effective against and, because influenza seasons are unpredictable, it's impossible to know yet just how comprehensive the shot will be this year.
“The vaccine is still effective and will work most of the time,” Atkinson said. “It may work almost all the time.”
The CDC alert advises that patients with flu-like symptoms who are at high risk of complications should be administered antiviral drugs such as Tamiflu or Relenza before laboratory tests have confirmed influenza. Such drugs shorten the duration of influenza and can prevent complications, especially when administered within 48 hours of first symptoms.
Those at risk of complications include patients who are older or have underlying health conditions.
“Those are the people you need to pull the trigger on your antiviral drugs sooner rather than later,” Atkinson said. “That was basically the message.”
The message is timely, Atkinson said, because flu season has begun in many states.
The CDC’s weekly surveillance map showed “local” outbreaks of flu in Kansas and Missouri as of Nov. 22, and on Thursday the Sedgwick County Health Department confirmed the first cases of flu in that area this season.
Misty Kruger, a spokeswoman for the Shawnee County Health Agency, said in an email that she could not confirm the presence of the illness in the county but flu cases have occurred in the northeast Kansas region.
Kruger said the health agency still has flu vaccine and encourages residents to get vaccinated “wherever flu shots are available within the community.” The agency also reminds people to wash their hands frequently, cover their mouth when they cough and stay home when ill to avoid spreading influenza.
‘High dose’ for seniors
Atkinson said some versions of the flu vaccine have been shown to be more effective for different demographics.
He said he now recommends a “high dose” version for seniors, including his parents.
“There now is data that is clear, that this vaccine when given to people 65 and older, the high dose vaccine compared to the regular vaccine, it works better,” Atkinson said. “It reduces influenza disease and complications in people 65 and older.”
Atkinson also said the “data are quite convincing” that a live vaccine administered by nasal spray is more effective in children, though studies have yet to show any added benefit for adults.
“Nobody understands exactly why, but clearly it’s better in children,” Atkinson said.
The nasal spray, or flu mist, is approved for ages 2 through 49. Atkinson advised that providers should administer it to patients age 2 through 8 if they can, but give the traditional injection if that's all they have on hand.
“If you don’t have flu mist — you ran out, didn’t order enough, whatever reason — don’t let them go,” Atkinson said. “Don’t let them out of your sight before you get a dose of influenza vaccine into them. Don’t send them away and say, ‘Come back next week,’ because odds are they won’t. Get them while you’ve got them there.”
