Tag Archives: flu

Blog break

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This blog is taking an extended break while I concentrate on other priorities. Blogging will resume (hopefully) at some yet-to-be-determined time in the future.

In the meantime, since influenza is in all the headlines right now, here’s a selection of past entries about flu and flu vaccine:

- We all know someone who’s been sick with the flu. But is it really influenza, or is something else? Read more here about Influenza’s identity crisis.

- Remember the H1N1 flu virus? Was it all Much ado about nothing, or was the public health community simply being prudent about a potentially serious disease threat?

- By now, many of us have heard that flu shots aren’t as effective as they could be, and it’s fueling a certain amount of skepticism over the value of annual flu shots. In defense of the flu vaccine explores some of the research on attitudes and beliefs about the flu vaccine.

- Does age have anything to do with how we view influenza? Read about what happened during the H1N1 outbreak when Generation X met the flu.

- Swine flu, avian flu, H1N1… Even when it’s a new type of influenza, the lessons are invariably the same.

- If you didn’t get a flu shot this past fall and plan to do so now, here’s a rundown of the vaccination options that may be available (ask your health provider which one is best for you).

- Finally, we could all do with a gentle reminder about the low-tech but effective practice of washing our hands.

Despite taking a break from blogging, I may not be able to resist posting new entries from time to time. Readers are invited to check for updates.

Generation X meets the flu

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How do you get a generation of healthy young adults to start paying attention to infectious diseases like influenza?

Perhaps they’re paying a little more attention than we realize. Researchers at the University of Michigan recently released a report on how American 30-somethings responded to the H1N1 flu pandemic of 2009-10 and concluded they “did reasonably well in their first encounter with a major epidemic.”

The report is based on survey data collected during the H1N1 outbreak from about 3,000 individuals aged 36-39. More than half of the respondents – 65 percent, to be exact – said they were at least moderately concerned, and nearly 60 percent said they were tracking the news about the novel flu virus either very closely or moderately closely.

Their interest didn’t necessarily translate into action. Only about one in five said they actually received the H1N1 flu vaccination. But the majority of the survey participants described themselves as being fairly well informed about the flu epidemic, with the highest level of interest reported by parents of young children.

Those surveyed also seemed pretty good at discerning reliable sources of information. They put physicians, the National Institutes of Health, their local pharmacist and county health nurses at the top of the credibility list. At the bottom of the heap? YouTube videos, drug company commercials and Wikipedia.

The survey findings are frankly more positive than I would have expected. In my younger adult days, I wasn’t particularly concerned about influenza and didn’t believe flu shots were necessary for people in my age group (although, to be fair, annual immunizations against influenza weren’t recommended back then for the under-65 crowd). I feel differently these days, perhaps because I’m older and because there’s more – and better – information available.

When it comes to infectious disease, why would the attitudes of young adults matter? There seems to be an increasing urgency among public health experts to address this demographic, and not only where influenza is involved.

Most older adults have some memory of disease outbreaks such as measles or whooping cough, writes Dr. David Detert in a recent entry at the Discover ACMC blog. “What we are faced with today is that a majority of our population hasn’t experienced those types of dire situations or has forgotten what it was like years ago before immunizations.”

As a result, many younger adults might underestimate the risk or severity of infectious diseases and may choose not to vaccinate because they perceive the benefit is so slight, he writes. And when that happens, herd immunity can diminish and set the stage for a resurgence of disease in a population that’s not well protected.

“You might hear people say, ‘It’s OK, we just don’t have outbreaks like that anymore,’” Dr. Detert writes. “What you have to remember is that our frame of reference now is during a time where we have had the benefit of being an immunized population; compare that to years ago, before vaccines were developed, and it’s a different story.”

It’s not always an easy message to sell. Young adults these days are bombarded with multiple messages, often conflicting and sometimes from sources that are biased or unreliable.

The University of Michigan study suggests, however, that younger adults do take an interest in health and disease and would likely be receptive to good information.

The H1N1 flu epidemic, which turned out to be relatively mild in the United States, wasn’t the first widespread disease outbreak and won’t be the last, points out Jon D. Miller, author of the Generation X Report, in an accompanying news release. “In the decades ahead, the young adults in Generation X will encounter numerous other crises – some biomedical, some environmental, and others yet to be imagined. They will have to acquire, organize and make sense of emerging scientific and technical information, and the experience of coping with the swine flu epidemic suggests how they will meet that challenge.”

Photo: Train commuters in Mexico City wear masks during the H1N1 influenza outbreak of 2009-10. Source: Wikimedia Commons

In defense of flu shots

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The assumption has long been that the influenza vaccine works well to prevent flu and that everyone who’s eligible to get vaccinated should do so. Thus it was rather a shock when a new study, published last month in a British medical journal, claimed the vaccine isn’t as effective as we think.

This negative-stained transmission electron micrograph depicts the ultrastructural details of an influenza virus particle, or virion. Photo by Cynthia Goldsmith, U.S. Centers for Disease Control and Prevention.

The study, led by a team from the Center for Infectious Disease Research and Policy at the University of Minnesota, analyzed about 30 previous studies carried out over the past four decades and concluded that the flu vaccine only protects about 59 percent of the population. And during some flu seasons it appeared to have little, if any, effect.

Does this mean we should write off flu shots as a waste of time and money? Not at all. Even 59 percent protection is “better than zero,” the study’s lead author, Michael Osterholm, told the StarTribune of Minneapolis.

If anything, the study underscores the need for development of better flu vaccines, Osterholm said.

Still, it’s not hard to see why many in the public health community have been concerned that some folks will interpret this study as yet another reason to skip being vaccinated.

Despite state and federal efforts to educate the public, there’s still a fair degree of skepticism about flu shots. A series of studies by the RAND Corporation this past year came up with some interesting findings about this:

- During the 2009-10 flu season, an estimated 39 percent of American adults received a flu shot. Among those specifically recommended for the vaccine because they met higher-risk criteria, 45 percent were vaccinated.

- Among those who opted not to get a flu shot, the leading reason was “I don’t need it,” followed by “didn’t get around to it,” general disbelief in flu shots, and worries about side effects or the possibility of getting sick from the vaccine.

The conventional wisdom has been that when people don’t get vaccinated, it’s usually because of a missed opportunity, such as a visit to the doctor’s office or urgent care center during which the flu vaccine could have been offered but wasn’t. The RAND researchers found, however, that even if the number of missed opportunities could be reduced, there would still be a percentage of individuals who say no to the vaccine.

They also found that adults who haven’t previously fit the recommendations for getting a flu shot are less likely to have ever been vaccinated against influenza, less likely to believe vaccines are safe and less likely to follow a doctor’s suggestion to receive a flu shot.

It’s not enough to simply make the vaccine available; the public health community also needs to actively promote it, the RAND researchers concluded:

Stepping up conventional strategies to encourage vaccination, including mail/telephone reminders and physician recommendations, and offering vaccines at more convenient locations, would help. Special efforts may be required to reach the healthy young adults who are now recommended for vaccination but do not visit providers often and may be difficult to reach through standard modes of public health messaging. These efforts could include using new media to deliver public service announcements and making vaccinations available at work. Finally, those most skeptical about vaccination may require one-on-one counseling with health care providers to help them understand that vaccination for flu carries very little risk compared with the risk that going unvaccinated poses to themselves and those around them.

Motivating people to take specific health-related steps is never easy, period. But this study suggests it’s especially important to pay attention to people’s beliefs and attitudes. For better or worse, beliefs and attitudes – even when they might be based on misinformation or incomplete information – do matter when it comes to getting an annual flu shot.

H1N1: Much ado about nothing?

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It has been eight months since the news broke of a new influenza virus sickening hundreds of people in Mexico. For several weeks this past spring, Americans were mesmerized, and a little fearful. The news media went into overdrive with its coverage of the virus we’ve come to know as the novel H1N1 flu virus or, more familiarly, swine flu.

Where are we today? Well, after lingering through the summer and peaking in October, H1N1 appears to be waning. Worries that the virus would become widespread and that it would swamp the health care system never really materialized. We now have a vaccine available to protect against it.

So was it all a big deal about nothing?

Fearmongers have overblown H1N1 into a crisis – a label it doesn’t really warrant, asserts Jeffrey Hall Dobken, a physician and bioethicist. Dobken’s thought-provoking column, which appeared last week in MedNews Today, is titled "About Crying Wolf":

What is the impact on children and families when every 15 minutes there is an "update" on the latest H1N1 news? The Health Department serves up statistics and guidelines to professionals with incredible frequency these days: hospitalization plus morbidity/mortality rates, availability of medication, utilization of medication, changes in vaccine availability and guidelines for use and/or delivery plus demographics as to who is to be vaccinated and who isn’t.

All this interspersed with items reporting U.S. vaccine production shortfalls, then vaccine distribution plans through commercial, big-chain pharmacies and supermarkets but not physician offices, or to special groups on Wall Street or at Guantanamo.

It is all bewildering enough to the professional. What must this be like for the patient, for the child told they are at greatest risk, or the pregnant woman, or the elderly who are advised that they "don’t need it"?

Dr. Dobken concludes with the suggestion: "Perhaps we can tone down the sky-is-falling just a little bit?"

Admittedly, the media hype about H1N1 has bordered at times on frenzy. Many of us in the media are aware of this, and we’ve struggled to balance the need to provide up-to-date information with the tendency toward overkill. It’s hard to know where to draw this line. If you stick to the basics, is it enough? Or should you be giving your audience more? It hasn’t helped that the situation has been extremely fluid, often changing from one day to the next. Even health providers have had a hard time keeping up.

The bigger question, though, is whether H1N1 itself has been exaggerated out of all proportion. From the start, there were doubters and critics of the U.S. reaction to the novel virus. Plenty of people wondered why this was any different from seasonal influenza.

I’m not convinced the critics are right. Even though H1N1 has turned out to be a relatively mild illness, there are still thousands of Americans who have become very sick. Young and otherwise healthy adults have ended up in intensive care, in some cases requiring a ventilator. In Minnesota, 50 people have died from H1N1 since May.

Nationally, it’s estimated more than 50 million Americans have had H1N1, with children and young adults hit the hardest. There have been more than 200,000 hospitalizations – "about the same number that there is in a usual flu season for the entire year," the U.S. Centers for Disease Control and Prevention pointed out in a recent media briefing. And there have been nearly 10,000 deaths – again, mainly among children and younger adults.

Perhaps because we’re accustomed to dealing with influenza every year, we tend to let down our guard and forget that flu can sometimes be fatal. It can be easy to overlook the cost of flu-related medical care and hospitalizations, and the toll that absenteeism takes in schools and in the workplace.

Public health officials can’t always win. If they urge everyone to be prepared and the threat subsequently fizzles out, they’ll be criticized for crying wolf. But if they downplay or brush aside a potential threat that turns out to be serious, watch the blamestorming erupt. The messages about hand washing, vaccinations, staying home when you’re sick, etc., are messages we should be heeding anyway, regardless of H1N1. There’s nothing wrong with reinforcing them, or with pushing the need to plan and be prepared. It’s simply the prudent thing to do.

Photo: Negative stain electron microscope image of the 2009 H1N1 virus. C.S. Goldsmith and A. Balish, Centers for Disease Control and Prevention.

Untangling the flu vaccine messages

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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

The responsibility thing

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I made a trip to Rice Memorial Hospital this morning to talk to someone for a story I’m working on. The minute I entered the lobby, a volunteer stopped me and asked if I was there to visit a patient. I wasn’t, so I declined the mask and hand sanitizer, but now I wonder if I shouldn’t at least have sanitized my hands just to be careful.

The growing spread of the H1N1 novel influenza virus seems to be demanding that all of us take more personal responsibility than ever before.

I mean, think about it. We’re supposed to wash our hands, and wash them often. We’re supposed to stay home if we’re sick. We’re being asked to cover our coughs and sneezes. We’re being asked to wear a mask if we’re visiting someone at the hospital. We’re being asked to think twice before going to the doctor or the emergency room unless we’re truly ill. We’re being urged to get flu shots.

These messages have always been out there and they’ve always been important for preventing the spread of flu and other germs, but they’ve gained even more urgency with the arrival of the H1N1 virus. When local health officials hosted a seminar last week for employers on dealing with influenza in the workplace, it was one of the first times I’d seen this level of effort to educate and engage the business community in limiting the spread of illness.

Face it, it’s not always easy to get the public on board – not just for influenza but for general health-related behaviors as well. People are busy. They multi-task and/or procrastinate or forget. Oftentimes they’re just not sufficiently clued in. Like exercise or eating fresh fruit, hand washing requires a mindfulness that can be hard for the average person to sustain, especially beyond a few weeks.

To their credit, local health providers have been proactive – aggressive, even – about educating the public, making sure there are opportunities to get flu vaccinations, and taking preventive steps such as asking sick people to wear masks. Is it helping? It’s hard, maybe even impossible, to know, but the fact that providers haven’t been overwhelmed (yet) with sick patients suggests they’ve been at least somewhat successful.

All the prevention messages in the world don’t do much good, however, if people don’t take some responsibility for heeding them. The next time I’m at Rice Hospital, I’m going to use the hand sanitizer. Just to be careful.

West Central Tribune photo by Anne Polta

Linkworthy 1.3

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A roundup of some interesting/thoughtful/informative reading I’ve encountered online lately:

If you haven’t already checked out the Kaiser Health News series "Are You Covered?", take the opportunity to do so. It covers the whole range of health coverage – the federal employee health plan, gold-plated plans, Medicare, Medicaid, the individual market and more. This excellent series, which is co-produced by NPR, also includes video and interviews with people about their experiences with their health coverage.

MinnPost has a couple of good reads published in just the past week. First, there’s an in-depth look at General Assistance Medical Care, Minnesota’s publicly funded health program for impoverished adults who don’t have children. The program was axed by Gov. Tim Pawlenty earlier this year during the state budget unallotment process. Its elimination doesn’t take effect until next year but, as MinnPost reports, time may be running out to find an alternative.

Pity the poor pig who came down with a case of swine flu at the Minnesota State Fair. What exactly is the story with inter-species transfer of the influenza virus? If humans, pigs and birds can share their influenza, why doesn’t my cat get sick too? MinnPost offers an interesting examination of the science behind this question.

For years, the mantra has been to screen, screen, screen for cancer. Increasingly, however, the evidence shows that the benefits of cancer screening have been overpromoted. Even the American Cancer Society, which has long championed the need for screening and early detection, is now starting to back off on this message. The New York Times explains what led to this change of heart and explores the difficulties of conveying it to the public.

It’s not uncommon to hear people boasting about how they "fired" their doctor. They shouldn’t get overly smug about it because doctors sometimes fire their patients too. No matter who initiates it, though, ending the relationship is hard to do, Dr. Rob Lamberts laments in "Breaking Up."

"The Exam Room – Three Views" is short but poignant. This vignette by a Minnesota physician was one of the honorable mention winners in Minnesota Medicine magazine’s annual creative writing contest and appears in the October issue online. No one in this fictional exam room is happy to be there, and I’m pretty sure they’re going to be even unhappier by the time the encounter is over.

Finally, from the sWell blog by Dr. Rahul Parikh, comes this story of "Regina Holliday and the Art of Health Care Reform." Regina Holliday is an art teacher and painter whose husband died of kidney cancer last year at the age of 39. Dr. Parikh writes:

The Hollidays’ experience is a case study in the ugliest, most festering problems of American health care. To share that horror story and to advocate for change, she began painting a portrait of a health care system that is fragmented and insensitive. It is a system where caregivers like Regina have to unfairly shoulder many bureaucratic burdens and one that needs to treat people better than the way it did her husband.

When we talk about health care reform, are we talking about changing the way patients and families actually experience health care? Or are we only talking about money and policy? Which of these is more important? Read the story to find out how Regina Holliday might answer this question.

A virus by any other name

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Some people call it H1N1. Others refer to it as swine flu. Still others call it novel influenza.

You’d think it would be a straightforward matter for scientists, public health experts and the general public to agree on a name for the new worldwide influenza virus that emerged earlier this year. But it hasn’t been straightforward or simple at all.

Reporters for the Associated Press dug into this issue awhile back and reached the conclusion that the virus everyone is talking about is indeed "pretty much all pig."

Six of the eight genetic segments of this virus strain are purely swine flu and the other two segments are bird and human, but have lived in swine for the past decade, says Dr. Raul Rabadan, a professor of computational biology at Columbia University.

A preliminary analysis shows that the closest genetic parents are swine flu strains from North America and Eurasia, Rabadan wrote in a scientific posting in a European surveillance network.

So does this mean it’s accurate to continue calling it swine flu, as the majority of the media and the public are doing? Not so fast, say U.S. health officials. One CDC scientist suggests the correct term is "swine-like." "It’s like viruses we have seen in pigs, it’s not something we know was in pigs," says Michael Shaw, associate director for laboratory science at the CDC. Another scientist doesn’t think swine flu is an accurate name either, although for a different reason: This new virus spreads quite readily from person to person, while traditional swine flu does not.

As far back as last spring, the World Health Organization said it would stop calling the virus swine flu, citing concerns that the name is misleading and that it implies, incorrectly, that pork is unsafe to eat. Unfortunately it hasn’t stopped some panic, especially overseas, that has resulted in painful economic ripples among the U.S. pork industry. And the virus is still often referred to as swine flu, although it’s also increasingly being called H1N1 or, more formally, 2009 H1N1. (The initials derive from the names of two of the proteins, hemagglutinin and neuraminidase, found in the outer coat of the influenza virus.)

What about the common practice of designating various influenza strains by the geographic area – Sydney, Hong Kong, etc. – in which they were first identified? In some of the earliest news conferences with the Minnesota Department of Health, state health officials called this "North American flu," since its first appearance seemed to be on the North American continent. I don’t hear this term very much any more, however, and in fact some of most recent information from the WHO suggests that no one really knows where this particular form of the flu virus may have originated.

At some point last May I started using the term "H1N1 novel influenza," or H1N1 for short, in keeping with the Minnesota Department of Health’s terminology. The word "novel" is important because other influenza viruses also contain H1N1 genetic markers - but not in the particular combination the swine flu/2009 H1N1/novel virus contains.

Is this the most accurate or descriptive term for the virus everyone is talking about? I’m not sure. But for now, it seems to be the best we have and it’s the term I’ll continue to use until a new or better one comes along.

West Central Tribune file photo

Influenza’s identity crisis

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I’ve talked to quite a few people lately who have "had the flu." But when a few of the details are pried loose, it turns out they’ve probably had something other than influenza.

In some cases, the symptoms have sounded more like a cold or a mild, unspecified respiratory virus. Or the illness has actually been a stomach virus, aka "stomach flu."

Pity the influenza virus. It has a long-standing identity crisis and is perhaps in need of a new and improved branding campaign.

If you consult a dictionary, you’ll find that influenza is an infection of the respiratory tract caused by one of the many varieties of orthomyxoviruses, the general family to which influenza viruses belong. The World Health Organization sums it up this way:

Influenza is a viral infection that affects mainly the nose, throat, bronchi and, occasionally, lungs. Infection usually lasts for about a week, and is characterized by sudden onset of high fever, aching muscles, headache and severe malaise, nonproductive cough, sore throat and rhinitis.

The virus is transmitted easily from person to person via droplets and small particles produced when infected people cough and sneeze. Influenza tends to spread rapidly in seasonal epidemics.

By the early 1800s, the virus was commonly referred to by its shortened name, flu. And somewhere along the way, it has morphed into a very broad term that people use to describe a whole host of ailments, vague or otherwise, accurately or otherwise.

It can get a little challenging for health care professionals to try to sort through a patient’s symptoms of "flu" that turn out to be "stomach flu," which isn’t influenza at all but a different and unrelated collection of viruses. (Just to make things confusing, the H1N1 novel flu virus is sometimes accompanied by vomiting and diarrhea – but it’s also characterized by respiratory symptoms that make it unlike so-called stomach flu.) Sometimes people are convinced they have the flu when what they actually have is some other type of respiratory virus. Sometimes what they have is an influenza-like illness that might or might not be a real, live case of influenza that can only be confirmed through testing.

The official definition from the Minnesota Department of Health of an influenza-like illness: a documented fever greater than 100 degrees F., accompanied by a cough and/or sore throat in the absence of any other cause. There’s no way to know for sure that it’s influenza, however, unless the patient is actually tested and the presence of the influenza virus is confirmed by a laboratory.

Various studies have examined whether it makes economic sense to test everyone who walks in the door of the doctor’s office with influenza-like symptoms. Although the jury is still out to some extent, the consensus seems to be that widespread testing, even among higher-risk patients, is of limited clinical use and is probably too expensive and labor-intensive to justify on a wider basis. The exceptions are sites that are part of the official state and national surveillance network for monitoring influenza (ACMC in Willmar is one of these). More often than not, then, the diagnosis of influenza hinges on an evaluation of the patient’s symptoms rather than on a lab test. For people who like a definitive answer to what ails them, it’s not entirely satisfactory – and it has probably contributed to some of the confusion over whether someone truly has the flu – but it’s the best that current technology can offer.

One final point: You feel achy, sniffly and feverish. Maybe it’s the onset of a cold, but how do you know it’s not something worse, namely influenza? The distinguishing factor, say the infectious disease experts, is the severity. Influenza symptoms usually develop rapidly and can knock you flat – "like getting hit by a Mack truck," as one health care worker described it the other day. But if your symptoms progress over a few days and don’t escalate into anything worse, chances are it’s a cold or some other relatively mild respiratory virus and you’ve dodged the flu bullet, at least this time.

Photo: Influenza virus particle. Photo source: U.S. Centers for Disease Control and Prevention.

Fearing the needle

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I have no real fear of needles. Being stuck with a needle for a vaccination or a blood sample doesn’t bother me in the slightest. Even a bone marrow biopsy didn’t freak me out, although I wasn’t thrilled about it and would rather not go through it again.

For lots of people, though, the prospect of anything to do with medical needles is fraught with a scariness that goes far beyond the normal apprehension or dislike of being stuck. There’s a name for it: trypanophobia. It’s surprisingly common, affecting an estimated 10 percent of the American population.

We often joke about needle phobia. But for the people who have it, it’s anything but funny. Receiving an injection sends them into a panic. At the sight of a needle they can react with a sudden drop in blood pressure, causing them to faint. In more extreme cases they’ll avoid doctors, dentists and other settings where they might encounter a needle. Sometimes this phobia will lead to a generalized fear of medical and dental providers and a refusal to undergo medical visits of any kind.

(While we’re on this topic, I have been annoyed for years with the news media’s insistence on images of people flinching or grimacing or, worse yet, crying over getting a shot. What is up with this? I don’t expect photos of people doing happy dances while being stabbed with a needle, but why are we reinforcing the fear that this is going to be painful and scary? Now that I’ve gone public with my gripe, maybe this practice will be re-examined.)

As you might guess, people with trypanophobia can be quite resistant to the idea of getting a flu shot. That’s why the introduction six years ago of FluMist, an inhaled form of the influenza vaccine, has frankly been a good thing. It makes vaccination less anxiety-inducing for these people, especially for children. Some researchers, in fact, believe needle phobia might be rooted in painful or frightening experiences with medical needles during childhood, although there’s also some evidence suggesting this phobia is at least partially genetic in origin. I personally know of someone who had a needle break off in his gluteus maximus while receiving a penicillin shot during childhood; the needle had to be extricated with a tweezers. There’s no way this kind of experience wouldn’t be upsetting to a child and remembered long into adulthood.

From the health care professional’s point of view, it can’t be enjoyable trying to jab a child who’s crying and struggling, or having a needle-phobic patient pass out. There’s also the ever-present possibility of needlestick injuries and the risks they pose to health care workers.

Researchers have been working for at least four decades to come up with vaccines that can be administered via a nasal spray versus the traditional shot in the arm. The influenza vaccine, which hit the market in 2003, is the first to be successfully developed. Inhaled versions of vaccines for botulism and for tuberculosis also are being studied, and various nasal-spray vaccines have been introduced in veterinary medicine as well.

The challenge, of course, is to produce an inhaled vaccine that’s at least as effective as the injectable kind. There’s little point in taking the sting out of vaccination if the trade-off is going to be a vaccine that doesn’t perform as well.

Studies among children who received FluMist have found that it is as good or better than traditional vaccine at protecting youngsters from influenza. It seems to work best among children in the 2- to 5-year-old age group.

The jury is still out over whether FluMist works equally well among adults. Most studies to date have produced inconsistent results, with the latest findings suggesting the injected version of the influenza vaccine is more effective for this age group.

To be sure, FluMist has its drawbacks. Because it’s formulated with a weakened live virus, it can’t be used on everyone. So far, it has only been approved for healthy people ages 2-49. Whether this will ever be expanded to those 50 and older is an open question; not enough people older than 49 have been included in studies to determine the safety and effectiveness of using FluMist among middle-aged and older adults.

I’m not aware of any studies examining how people with trypanophobia feel about the option of receiving an inhaled vaccine. It would be interesting to know whether the availability of FluMist is encouraging these people to get vaccinated against the flu, perhaps for the first time in their lives.

Needles, alas, seem to be ubiquitous in medical care. They’ve been refined into a multitude of sizes and functions. They’re used for everything from basic blood draws to advanced surgical procedures. There’s no denying they sometimes hurt, and you don’t have to have a needle phobia to dislike them or to want to avoid them. Although the use of needles will continue to be inevitable for many medical procedures, it would be a kinder and gentler world if we could use them less often.

West Central Tribune photo by Gary Miller