Untangling the flu vaccine messages

Every year there’s some new angle on the influenza vaccine.

One year, I remember, it was discovered that the vaccine produced by one of the manufacturers wasn’t strong enough to offer full protection against the flu. Thousands of high-risk patients had to be called back in to receive a second booster dose.

Some years there have been vaccine shortages. Other years there have been delays in manufacturing and distribution.

The target audience for the vaccine has continually expanded. At first, flu shots were for the elderly. Then annual vaccination began to be urged for anyone with a chronic health condition – diabetes, for instance, or asthma or lung disease – who might be at risk of severe illness from flu or flu-related complications.

Within the last few years we’ve seen a bigger push to vaccinate children, after studies found this helps reduce the spread of flu viruses and increases what’s known as herd immunity. There also has been a push to vaccinate health care workers, partly to keep them healthy but also to lower the possibility of germs being transferred from patient to doctor or nurse and thence to the next patient they see.

If anyone is handing out prizes, though, the current influenza season takes the award for being the most complicated in recent memory. Not only do we have seasonal influenza to contend with, we also have the H1N1 novel virus. The arrival of the novel influenza virus this past April has meant we’ve been seeing flu cases through the summer and into the fall – months when flu is usually absent.

One of the biggest reversals: It’s children, not older adults, who are being hit hardest by the H1N1 virus. During the first six months of the pandemic, there were 98,000 hospitalizations and nearly 3,900 deaths. One-third of the hospitalizations were among children and teens 18 and under. Deaths also have been occurring at the highest rate among people younger than 65, the complete opposite of what we’re accustomed to seeing.

Now add in separate vaccines for seasonal flu and for H1N1, delays in manufacturing, and priority lists for who should receive the vaccine, and watch the complexity intensify.

Those who work in public health say it has been very challenging this year to craft their messages and to ensure these messages are accurate and that they’re reaching the right audience. (I’ll add here that it has been challenging for the news media as well.)

When we talk about flu vaccine, are we talking about the seasonal vaccine or the H1N1 vaccine? We’ve had to be specific because these are two different things.

When we’re describing the priority groups to receive the H1N1 vaccine, do we mean children, teens and young adults through age 24 or up to age 24? Even people who work with this every day tell me they’ve had to frequently stop and double-check to make sure the message is coming across clearly.

One thing we’ve all learned is you can’t assume anything. A new question cropped up just this past week: If a local medical clinic is offering the H1N1 vaccine, can anyone come in for a shot or is this only for established patients? I figured people pretty much knew this service is for established patients but clearly we need to say so directly.

It’s easy to take the whole process for granted. What most people don’t see is the work that happens behind the scenes – the planning, the coordination, the partnerships to help ensure local medical providers and public health are all on the same page. Without this coordination, there can be confusing and inconsistent messages to the public. Flu vaccine might not reach the people who need it the most.

The seasonal flu and H1N1 sagas are still far from over. There’ll likely be more confusion and questions as the weeks progress. But the process has been relatively orderly, and none of it has happened by accident. So the next time you talk to one of your local health care professionals, take the time to say thank you.

West Central Tribune file photo by Bill Zimmer

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