Getting First Jab
Flu vaccination urged for children aged six to 23 months and other high-risk groups
By Michelle Ciriacruz
Things might be changing a little. Still, the flu gets probably just a shrug and a fatalistic comment from most people on the street that would be asked about it.
They would say, it is just a lengthier version of the cold, and as inevitable as the advent of the rainy season.
If flu were to bring a shiver separate from the symptoms experienced by someone already suffering from it, the thought of an influenza pandemic will probably do the trick.
Influenza pandemics have stalked our history since the time of Hippocrates with devastating regularity. With each major shift in its genetic material, the flu virus spreads and kills like a wildfire does to the millions of blades of grass in its path.
All the world wars combined cannot equal its skill for death. As proven in 1918, when it killed 20 to 40 million people across the world.
Years apart, yet influenza's virulence during pandemics is legend-in 1957, we had the Asian flu; in 1968, the Hong Kong flu; in 1977, the Russian flu.
We are long overdue for another influenza pandemic, in fact.
In 1997, the H5N1 virus outbreak in Hong Kong forced the mass slaughter of poultry to control the spread of the virus. This action probably averted the next pandemic. Still, the virus infected 18 persons and caused the death of six of them. It reappeared in 2001. Again, hundreds of thousands of chickens were slaughtered.
New strains usually emerge from Asia, where animals like poultry and swine live in close proximity with their human caretakers. This makes it easier for the flu virus to cross the species barrier.
Worse than a Pandemic
While the National Influenza Centers around the globe (110 in 83 countries) are doing a good job at epidemiological and virological surveillance, they cannot predict when and where the next pandemic is going to erupt. The threat of a flu strain becoming virulent enough to cause global deaths and sickness cannot be removed.
All very frightening, but according to epidemiologist and flu expert Dr. Frederick Ruben, the interval between pandemics is more devastating as any of the pandemics we had in the past century, in terms of health, mortality, and morbidity.
Dr. Ruben, former advisor of the CDC and now director of scientific and medical affairs and public policy of Aventis Pasteur, was in Manila early October to report on the WHO recommendations and latest updates on flu prevention and control. He was the main speaker in an experts' forum organized by Aventis Pasteur.
"The cumulative effect of influenza between pandemics is greater than the effect of a pandemic. So basically, influenza is something we have to pay attention to every year, not just when a pandemic grows around," he points out.
Just this year, Madagascar suffered through a bad flu season-beginning early June and lasting until late August. More than 22,000 were infected and 671 died. The epidemic was very hard on the children-the main victims, as they were already suffering from poor nutrition, and when the disease took them, had no access to medical care (Asia Intelligence Wire).
Worldwide, the flu strikes one in every 10 persons annually. Yearly, around 500 million people all over the world are infected with the disease.
Even with its extensive flu awareness, prevention, and control program, the United States loses about 20,000 lives to the flu and its complications every year, even if that year's flu season were comparatively mild.
The Philippines, already so vulnerable to so many tropical infectious diseases, also has to contend with influenza outbreaks yearly. The difference is, with us, the flu strikes year round.
We do have peak seasons-June to September (rainy season) and December to February (cold season), but anyone can catch the flu whatever time of the year it is.
Latest data from the Department of Health (DoH) put influenza up on the list among the leading causes of illness in the last five years, in fourth place with a rate of 659 cases for every 100,000 population.
Although the Philippines is involved in the global influenza surveillance network, our contribution, so far, lies only in a laboratory-based surveillance and identification of circulating pathogens within a very select area and target population. This, the Research Institute for Tropical Medicine handles.
Truth is, if a pandemic were to emerge this very moment, it would come upon us with us ill prepared. A government-financed vaccination against the flu is not forthcoming any time soon, admits Dr. Luningning Villa, program manager for the Emerging Infectious Diseases at the National Center for Disease Prevention and Control.
Presently, what we have is the different medical societies and health-related organizations concerned with vaccination individually encouraging vaccination among members, and to some extent, the public.
Recently, there is effort at marshalling all these resources into an advisory committee that will help the DoH's Pandemic Preparedness Plan, which it initiated last June as part of the Program for Surveillance, Prevention, and Control of Emerging Infections.
Basically, the plan aims to come up with a center-based surveillance system for influenza, one that is also based strictly on the disease's case definition.
Incidentally, it also aims to detect increases in the incidence of flu-like illnesses, which says Dr. Villa, could be brought about by bioterrorism. "We are trying to develop this not only for influenza but also for us to have a better means of detecting a possible deliberate use of biological agents."
The Pandemic Preparedness Plan also identifies groups that should be prioritized for immunization. It recognizes the importance of vaccinating those at high risk like the elderly, however, in case of a pandemic, priority will be shifted to those involved in giving key services, like military men and firefighters.
Dr. Villa also hopes to conceptualize a vaccination program, supported by health insurance or a reimbursement scheme.
The World Health Organization (WHO) recommends vaccination as an effective preventive measure against flu, especially for those who are at high risk for the disease and its complications.
Dr. Ruben cited Japan's experience to illustrate how critical vaccination is in decreasing the morbidity and mortality among high-risk populations.
Japan used to have a policy, initiated in the 1970s, to vaccinate schoolchildren. This vaccination program lasted for about 20 years and then was discontinued in 1997 due to alleged adverse effects from the vaccines.
This proved unfortunate, because as a review was made of Japan's excess mortality attributed to influenza and pneumonia during this period, it turned out that, "in the years that they had this school immunization policy, the mortality of the Japanese elderly dropped down four-fold... When they discontinued the school program, the mortality rate in the elderly went right back to where it was," Dr. Ruben notes.
"It is estimated that it was probably saving several hundred thousand lives a year in the elderly population when they were vaccinating the schoolchildren," he also points out.
This case also illustrates the role children play in the spread of influenza. Dr. Ruben confirms that "children are spreaders of influenza" and by vaccinating them, the spread of the disease can be prevented.
The latest WHO recommendations acknowledge that children are among the high risk groups that should be prioritized for vaccination. A review of data reveals that all children under age two have the same degree of complications as the elderly. But children as not as prone to death as the elderly; they are prone to hospitalization, pneumonia, ear aches, Dr. Ruben clarifies.
The risk to infants under six months is also almost the same for children under two years. Since flu vaccines are not yet licensed for use in infants, the Advisory Committee on Immunization Practices of the US Centers for Disease Prevention and Control (CDC) instead encourages caretakers to make sure they don't miss out on their annual flu shot.
But there is no formal recommendation-because supply of flu vaccines is not enough, Dr. Ruben explains. "The worse thing is to build up expectations and then not have something to use on what [people are] expecting to get."
High-risk people also now include everyone over age 50. Dr. Ruben says it is a lot easier to target people with an age-based recommendation. He explains that although many people over age 50 have high-risk conditions like COPD (chronic obstructive pulmonary disease) or a heart problem, they tend to deny that they have it. "But nobody [can] deny that they're 50 years or older," he points out.
In countries where there is a flu season, vaccinations are timed in anticipation of it. In the tropics, where flu can strike regardless of the time of the year, Dr. Ruben advises doctors conduct vaccination as soon as the new vaccine becomes available, and to make this practice consistent.
This will make it easier from an organizational standpoint, he explains. "If you give it year round, then you can't remember who got it when," he comments.
Influenza is described as an unvarying disease caused by a varying virus. The virus mutates but its toll on health, lives, and manpower is consistently devastating. One wonders why it takes so long for people to perceive its true threat.
Pandemics could happen sometime in the future. Right now, however, is a tragedy occurring every year, in the millions of lives affected by the disease yearly.
It doesn't take a genius to figure out that if we are already used to dealing with the yearly threat of flu, then our readiness to deal with a pandemic would be greater than if we were to totally disregard flu as an inconsequential health nuisance.
|
