FLU SEASON MAY BE EARLY, FIERCE.

Byline: Usha Lee McFarling Knight Ridder Newspapers

After some serious flu outbreaks in the summer, infectious disease experts are gearing up for what could be a ferocious and long flu season.

And too few people are getting the flu shots that could save their lives in the yearly epidemics that sweep the nation, said experts who gathered last week for an international conference on vaccines.

Even fewer are getting a second shot, pneumococcal vaccine, which effectively prevents the pneumonia, bronchitis, middle ear infections and sinusitis that often follow a bout of flu. The vaccine, needed only once in a lifetime, has been available since 1977 and can be taken at the same time as the flu shot.

``Never has any vaccine been so widely ignored by so many people for so long a time,'' said Dr. David S. Fedson, an immunization expert from Pasteur Merieux in Lyon, France.

Influenza hits tens of millions of Americans each year and kills an estimated 20,000, mostly among the elderly. Pneumococcal disease claims an estimated 40,000 lives in the United States each year, also mainly among the elderly. And with an aging population and increased antibiotic resistance among bacteria, vaccines are more important than ever, experts said.

``Despite the fact that we're delivering more and more vaccine, we're seeing severe mortality,'' said W. Paul Glezen, director of the preventive medicine section of the Baylor College of Medicine in Houston. ``The excess deaths are only the tip of the iceberg.''

The upcoming flu season is of particular concern because of several remarkable outbreaks that occurred during the past year, said Dr. Keiji Fukuda, who directs a section of the Influenza Branch of the Centers for Disease Control and Prevention.

In one outbreak, a new, highly lethal virus in Hong Kong spread from chickens to people at the end of 1997. Because it did not spread from person to person, this virus was contained, but Fukuda said other similar viruses could be more contagious. ``We don't know why this virus jumped from birds to humans,'' he said. ``It's possible for that to happen again.''

A flu outbreak in July, spread in part on cruise ships, led to dozens of cases of pneumonia in Alaska's Yukon. A July flu outbreak in Florida caused nearly a dozen patients to be hospitalized, he said.

Summer flu outbreaks are relatively uncommon and can signal an early or severe flu season. The two outbreaks were caused by the A/Sydney virus, which wrought havoc in Los Angeles last winter and caused such crowding in hospitals that some shut down and others were forced to postpone elective surgery.

Because flu and its spread are so unpredictable, Fukuda said he can only guess how this year's flu season will turn out. A/Sydney is included this year in the vaccine, he noted.

The number of Americans who get flu vaccine is increasing, partly because Medicare pays for more of the cost and because of convenient programs. In Atlanta last week, free drive-through flu shots for motorists drew lines of cars.

Both flu and pneumococcal vaccinations are recommended for everyone 65 and older and for those with chronic diseases, including HIV, who can be hit harder by respiratory illness. In addition, the flu shot is advised for healthy adults who simply want to lessen their chances of getting the flu.

But many people aren't getting the message. Men and women 65 to 74 are less likely than those 75 and older to get flu and pneumococcal vaccinations. Older minority adults are less likely than others to be vaccinated, said James Singleton, a vaccine expert with the CDC.

Singleton said epidemiologists have no explanation for why minorities underutilize vaccines. Even minorities with high incomes, high education levels and good access to health care are not being vaccinated at the same rates as whites.

``People continue to suffer and die from a disease we know how to prevent,'' said Singleton, adding that studies on how to improve vaccination rates in different populations will soon be under way.

In addition to preventing deaths, the vaccines stem the costs of hospitalization and absenteeism brought on by flu and pneumonia. Flu costs the nation an estimated $12 billion each year. ``Nothing that we do in health care is as cost-effective as using these two vaccines in older people,'' said Fedson.

Despite some early reports of a shortage of flu vaccine, Fukuda said he expects enough vaccine to be available by the end of November. Production problems have delayed vaccine from one of the nation's four flu vaccine manufacturers, but other manufacturers have taken up the slack.