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

The vaccine reduces the risk of getting shingles by half and the risk of developing painful complications by two-thirds, according to Gary Euler, study co-author. Since the chance of contracting shingles increases with age and especially is high by age 80, when seniors are frail, he believes the value of the vaccine is incontestable.

Specifically, the vaccine protects against the herpes zoster virus, which causes chicken pox at first infection. The body never rids itself of the virus and it can show up again decades later as shingles. Symptoms include headache, fever and tingling or throbbing accompanied by jabs of stabbing pain called post-herpetic neuralgia (PHN), followed by a skin rash and blisters.

Up to 10 in every thousand seniors develop shingles every year. without the vaccination, 10 percent to 14 percent of them will suffer from neuralgia.

In the new study appearing online and in the February 2011 issue of the American Journal of Preventive Medicine, researchers found that estimated coverage levels were low among all seniors and lowest among minority groups. Surprisingly, 95 percent of younger seniors had missed at least one opportunity to be vaccinated, even though they had seen their physician at least once, been hospitalized or visited an emergency department that year. The people most likely to have received vaccinations were older, white, female seniors who were more highly educated and who had received a flu shot.

From the results of an earlier study, the researchers can see that uptake is growing, but at a snail’s pace. The study authors gave possible reasons: While most insurance and Medicare plans cover the cost of vaccination, other costs might be out-of-pocket and upfront. Physicians could be reluctant to recommend the vaccine because of this cost burden, especially if the patient has no insurance.

A downside exists for the physicians, too. Euler, an epidemiologist with the CDC’s National Center for Immunization and Respiratory Diseases, said that the vaccine must remain frozen until the last minute, which presents an added burden on two counts. first, there is a time lapse if the physician writes a prescription for the patient to buy the vaccine at a pharmacy and bring it back to the office to have it administered. second, if a physician writes a prescription for the patient to receive the vaccine at the pharmacy, patients often do not make that additional trip.

Despite these drawbacks, Euler strongly recommends that seniors receive vaccinations for shingles.

“most patients who know what PHN is like would absolutely agree,” Euler said. “And in terms of cost savings for medical attention and medicine on a population-wide basis, so would most economists.”

Antidepressants are prescribed by many doctors to treat the symptoms of non-seasonal depression, but there may be an antidepressant alternative that has mood-lifting benefits without the side effects – bright light therapy. bright light therapy has been successfully used to treat seasonal affective disorder, a type of depression triggered by the change in seasons, but it may be helpful for non-seasonal depression as well.

Exposure to bright Light: Does It Help Non-Seasonal Depression?

In a study published in the Archives of General Psychiatry, researchers gave 89 older adults bright light therapy or a placebo for three weeks. At the end of this three week study where the participants and researchers were blinded to which group received what treatment, the seniors who received the bright light treatment had fewer depressive symptoms and healthier sleep patterns. They also had higher levels of melatonin, a hormone produced by the brain that regulates the sleep-wake cycle. The results were as effective as antidepressant medications for relieving the symptoms of depression in this group of older adults.

How Does bright Light Treatment Help Depression?

It alters levels of the same neurotransmitters that antidepressant target. Exposure to bright light does this by stimulating the portion of the brain called the suprachiasmatic nucleus, the brain region that controls circadian rhythms. Circadian rhythms that are “off” can bring on symptoms of seasonal affective disorder, but non-seasonal depression may respond to bright light exposure too.

these older people who received bright light treatment had objective evidence of improvement in their sleep-wake cycle and stress levels. their levels of melatonin, a hormone that helps to regulate sleep was increased by the bright light exposure, and levels of cortisol, the stress hormone, in their saliva dropped. The beneficial effects of bright light therapy persisted even after thir treatments were stopped.

bright Light Treatment for Non-Seasonal Depression: The bottom Line?

Researchers emphasis that longer term studies are needed, but if the results can be replicated, bright light therapy could be a safer alternative to antidepressants for people who suffer from non-seasonal depression.

Medscape.com. “Bright Light Treatment May Improve Nonseasonal Depressive Symptoms”

   “there is great concern about seniors, with 52 percent not protected against the flu,” said Dr. Jane Zucker, assistant DOH commissioner for the Bureau of Immunization. “we are trying to get the word out and are distributing material to senior centers.”    In the borough, the lowest reporting areas for senior citizen flu vaccinations are locations in western Queens, including Corona, Jackson Heights and adjacent areas; and Jamaica, Hollis and Springfield Gardens. “we think in western Queens it may be due to the large immigrant population or an access issue,” Zucker said. “Some people just think they will never get the flu.”    But not contracting the virus in the past does not mean people are immune. “People are still at risk,” the doctor said, “and it’s miserable if you get it.”    The CDC estimates were released earlier this month, but reflect November statistics. Zucker believes the number vaccinated in new York City has increased, especially among children. But the DOH remains concerned that people are not taking the message seriously.    “It’s not too late to get vaccinated,” she said. “Flu activity is increasing in the city although it is not widespread yet.”    this year’s vaccine protects against three major strains of influenza, including the swine flu. The DOH reports that the virus and pneumonia are the third leading cause of death in the city, killing 2,192 residents in 2008, the latest reporting year.    Even more discouraging is the fact that fewer seniors are getting inoculated than in the past. In 2002, 63 percent of seniors got the vaccine and last year 53 percent.    “whatever your age, race or background, coming down with the flu can be miserable and lead to serious health complications and even death,” said Dr. Thomas Farley, the city health commissioner.    While yearly vaccinations are now recommended for everyone aged 6 months and older, the DOH says it’s particularly important for pregnant women, children under 5 years old, people 50 and over and those with chronic health conditions.    Any new Yorker 18 and older can get vaccinated this year at area pharmacy chains and many accept health insurance. So far, it’s estimated by the CDC that 10 percent of city adults have been vaccinated at drug stores. For others, free or low-cost doses are available through DOH clinics and Health and Hospital Corp. facilities such as Elmhurst and Queens hospital centers.    other city clinics and health centers are located in Corona, Jackson Heights, Ridgewood, Woodside, Jamaica and Springfield Gardens. For the closest location, call 311.    The peak flu season is now through March, and the vaccine takes about 10 days to become effective. Medical experts say it is safe and highly effective in preventing the illness.    Influenza is a viral infection that spreads easily from a cough or sneeze. The strain changes each year, thus the need for a yearly vaccination.    Antibiotics don’t work on viruses. For relief, use over-the-counter pain relievers or decongestants. there are three anti-viral medications available through prescription that treat symptoms, but only in the first 48 hours of the illness. they are primarily prescribed for high-risk patients because of their limited effectiveness. with treatment, symptoms that last three to five days are reduced to two to four days.    Flu symptoms include fever, weakness, body aches, headache and chills, which respond primarily to bed rest and pain medication. there is usually a sudden onset of the illness, which lasts longer than a cold, sometimes a week or more, and can be very debilitating.    because the virus spreads so easily, people are urged to take precautions. To stay healthy, the DOH recommends avoid touching you eyes, nose or mouth since that is how germs spread; eat healthy, drink lots of fluids and get plenty of sleep.    The DOH also advises people who get sick to stay home to protect others. To prevent the spread of flu, cover your cough or sneeze. Wash your hands often and carefully, especially after you cough or sneeze.