I received my annual flu shot back in October, and I have to say, I felt pretty good about myself. though doctors constantly tell us to get vaccinated, most Americans don’t bother — a survey by the Centers for Disease Control and Prevention (CDC) in November indicated that just 36% of all Americans age 6 months and older will get the flu vaccine. That’s too bad — a simple flu shot can save the average person days of unhappy illness (and lost time at work or school) if they get exposed to the flu this winter. and for the very young, the very old and the immunocompromised, a flu vaccination might make the difference between life and becoming one of the 30,000 some Americans who die from influenza-related causes each year.

There’s just one problem: influenza is unpredictable. Flu viruses are notoriously promiscuous, which isn’t a judgment of their morals, but their genes. Flu viruses mutate constantly, sometimes on their own as they replicate inside an infected cell, and sometimes through recombination — directly swapping genes with other flu viruses. We need a new vaccination every year because the flu strains we might be exposed to over the winter differ from season to season. The flu shot itself is actually a trivalent vaccine, meaning that it protects against the three separate flu strains that experts believe are most likely to be circulating around the Northern Hemisphere this winter. if all goes well, you’re unlikely to be exposed to a flu strain that’s not covered by the vaccine.

Unless, of course, something unexpected occurs. and that may indeed be happening this winter.

Since the middle of August, the CDC has received 12 reports of human infections with a new flu virus — a swine influenza a strain called H3N2. so far the cases come from five states — Indiana, Iowa, Maine, Pennsylvania and West Virginia — and all but one of the affected individuals were below the age of 18. while the virus itself seems to have originated in pigs and initially jumped directly from swine to human beings, half of the cases had no documented contact with pigs, which means there’s at least minimal person-to-person transmission. Because there’s already a common seasonal flu called H3N2, health officials are calling the new strain H3N2v — meaning v for “variant.”

Twelve cases may not seem like much, especially since only three required hospitalization and no one so far has died. but in an article for Scientific American earlier this month, ace flu reporter Helen Branswell explained why the possible emergence of a new flu strain worries health officials — even as they fear overly alarming the public:

The cases leave public health authorities in the U.S. and elsewhere wondering if a new swine-origin flu virus is circulating at low levels among humans — and what needs to be done if that is indeed happening. (Read “Flu Factories” in the January 2011 Scientific American (preview) to learn why health authorities fear the next pandemic virus may emerge as a result of industrial farming  practices.)

Given the mercurial nature of flu viruses — which can easily mutate into lethal pathogens — ignoring the new virus is not an option, even though to date there have been no deaths and most of the infections have produced only mild symptoms. but the widespread perception that the 2009 swine flu pandemic was much ado about nothing means health authorities risk further damage to their already battered credibility if they sound an alarm and this virus turns out to be a dud. and they know it.

In fact, what unfolds with H3N2v could be similar to what happened in 1977, when H1N1 flu viruses suddenly re-emerged — possibly through a lab accident — after a 20-year absence. The new H1N1 infected mostly younger people who had never been exposed to a similar flu strain before, while older people proved more resistant.

Ordinary flu vaccine has always worked out for Carolyn Hendrickson, so the 77-year-old was perplexed on a recent Monday when her clinic gave her a high-dose version without asking first.

Confusion turned to anger that night as she lay in bed at home in Brooklyn Park. Her muscles ached, her head pounded and her stomach churned.

“I’ve had the flu shot before and never had a problem,” she said. “Why was this different?”

Hendrickson had learned the hard way that a new influenza vaccine, Fluzone High-Dose, is available. the vaccine is loaded with four times the usual virus-fighting antigen, so public health experts believe it will better protect seniors whose immune systems have weakened with age.

but it also causes a slightly higher rate of side effects, mostly short-term aches and flu-like symptoms.

Hendrickson was back to full strength the following Friday. but in hindsight, she wonders if she would have taken the high-dose version if her clinic had offered her a choice.

Fluzone High-Dose was first offered midway through last flu season. Manufacturer Sanofi Pasteur estimates that 10 percent of seniors who were vaccinated last season received the high-dose version.

Studies have shown that the larger dose stimulates the immune system to respond more aggressively against influenza. but research hasn’t yet proven that the vaccine is more effective for seniors. Answers to that question are expected in 2014 or 2015, according to the U.S. Centers for Disease Control and Prevention. the federal agency has taken no position yet on whether seniors should opt for this type of vaccine.

for now, it is “between the provider and patient” to decide when to use Fluzone High-Dose – assuming a clinic has any in stock, said Kristen Ehres¬mann, who directs immunization programs for the Minnesota Department of Health. Hendrickson complained to her as well. Ehresmann replied that it wasn’t unethical or illegal for her clinic to provide the high-dose version without offering a choice.

“Some clinics may have decided to offer high-dose flu vaccine to their senior population,” she said. “That would be reasonable. when physicians prescribe a medication, they don’t necessarily say, ‘There are six antidepressants on the market; which one would you like to take?’ the providers use their judgment and prescribe a medication. the same could be said for flu vaccine.”

the need for better vaccines is evident from the fact that influenza contributes to 3,000 to 49,000 U.S. deaths each year, according to the CDC. Most victims are 65 or older.

further proof came this fall from the University of Minnesota’s Dr. Michael Osterholm and colleagues. A national expert on infectious diseases, Osterholm reviewed existing studies and concluded that the standard flu vaccine was only 59 percent effective in healthy adults younger than 65. That is lower than the 70 to 90 percent estimates offered in the past by public health officials.

there is little reliable data on the effectiveness of traditional flu vaccine in seniors, and nothing on Fluzone High-Dose. Osterholm still recommends it to seniors.

“Would I take it? yes,” he said. “At the same time, we have to be honest with the public about what we know and don’t know.”

Sanofi Pasteur has produced more of the vaccine this year than last and expects more interest. Whether individual clinics have the high-dose version depends on whether their distributors order vaccine from Sanofi Pasteur or other makers.

Hendrickson admitted some responsibility for taking the high-dose vaccine. She received paperwork at her Fairview clinic in New Brighton about Fluzone, but didn’t read it before receiving the shot. She believes a discussion should have taken place.

“They ought to give patients the opportunity to say whether or not they want the high dose,” she said.

Allyson Schlichte of Fairview Pharmacy Services said Fairview “generally recommends” that seniors get the high-dose vaccine and that they discuss the option with their providers.

(c)2011 the Star Tribune (Minneapolis) Distributed by MCT Information Services

Louisiana?s flu activity has spiked in recent weeks and continues to be widespread. according to the state?s most recent influenza surveillance data, flu symptoms accounted for more than 20 percent of the state?s doctor visits last week, up from 12 percent the previous week.the state?s seasonal flu activity is most prevalent in North and Central Louisiana and in the Baton Rouge Metropolitan area.Because of the increases, the Louisiana Department of Health and Hospitals is strongly encouraging all residents who haven?t already done so to protect themselves and their families by getting a seasonal flu vaccination.Each year, the flu kills more than 36,000 Americans.?It?s not too late to vaccinate,? said Dr. Frank Welch, director of the state?s immunization program. ?The flu shot only takes a few days to be effective, and people are usually protected completely within 7-to-10 days of getting the flu vaccine. Vaccines are the best preventive measure we have to help fight the spread of this illness, and we encourage everyone to get their seasonal flu shot to help protect not only themselves, but their families and friends as well.?This year, the CDC recommends everyone older than 6 months get the flu vaccine. This year?s flu vaccine will protect against both the seasonal flu and the H1N1 virus. Medical studies show getting the flu vaccine has proven to be very safe and effective in preventing people from catching the flu. While everyone should get a flu vaccine, vaccination is especially critical for certain groups of people who are at a higher risk of developing flu-related complications. Those groups include: ? Children younger than 5, especially children younger than 2 years old ? Adults 65 and older ? Pregnant women ? American Indians and Alaskan Natives, who appeared to be at higher risk of flu complications last flu season ? People who have a weakened immune system or chronic medical conditions such as asthma, diabetes or heart and lung disease”Vaccination is also important for health care workers, and other people who live with or care for high-risk individuals to keep from spreading flu to people who may be especially susceptible to the virus’ effects. This includes anyone who works with babies younger than 6 months of age, who are not eligible for the vaccine themselves,” said Dr. Welch. “This year’s vaccine is plentiful and available at many places, including health care providers, pharmacies, some employers and Louisiana?s parish health units.” in addition to getting the vaccine, DHH encourages the public to take other preventive actions to stop the spread of the flu: ? Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. ? Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer. ? Avoid touching your eyes, nose and mouth. Germs spread this way. ? Try to avoid close contact with sick people. ? If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) ? While sick, limit your contact with others as much as possible to keep from infecting them. for more information on flu activity by region in Louisiana and to find out how you can avoid being ill, visit fighttheflula.com.

i heard the flu vaccine can actually cause problems if you already have the flu, is that true?

No, do not get the flu shot. the flu shot exposes you to small amounts of infection so that your body learns to fight them with the appropriate immune response. If you already have the flu, it is too late. Buy tissues, tea, sudafed and tough it out.