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Vaccine could head off severe flu season: variant, virulent strain.

Early influenza infections, many of them caused by a more virulent strain not included in this year's vaccine, have federal officials calling for increased rates of vaccination to forestall what could be a severe flu season.

The variant strain, A/Fujian (H3N2), is associated with more serious disease, higher hospitalization rates, and higher mortality than the A/Panama (H3N2) strain from which it originated, said Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, Atlanta. This year's flu vaccine protects against A/Panama/2007/99 (H3N2), A/New Caledonia/20/99 (H1N1), and B / Hong Kong / 330 / 2001-like virus strains.

By the beginning of November, influenza was already widespread in Texas, and there were regional hot spots in Colorado; 21 other states were reporting sporadic activity. Of the antigenically characterized viruses tested since Sept. 28, 84% were the Fujian variant strain, Dr. Gerberding said during a teleconference.

"This earlier onset is perhaps a signal of more widespread infection, and with this particular strain we are worried about greater consequences in the population this year," she said. "It would make all the difference in the world if we could get the immediate vaccination response we need. We could nip this situation in the bud."

Although the current vaccine does not contain the Fujian variant, animal studies and past experience with variant strains suggest that cross-immunity will occur, but at a lower rate. According to the CDC's weekly influenza summary update, it is expected that the current vaccine will offer some cross-protective immunity against the Fujian virus and reduce the severity of disease.

Dr. Gerberding stressed that the CDC is not predicting a pandemic, and that conscientious preparation could very well result in a more moderate flu season.

"Right now, this is just an earlier onset of the flu season and we are working hard to get out in front of it. But we don't have a crystal ball."

Any patient who asks for an influenza vaccination should receive one, she said, but the vaccine is most important for those at increased risk for serious complications, including:

* Adults aged 50 years or older.

* Children aged 6-24 months.

* Residents of nursing homes or other long-term care facilities.

* Adults and children aged 6 months or older who have chronic heart or lung conditions (including asthma), metabolic diseases (including diabetes), chronic kidney disease, or a weakened immune system (including immune system problems caused by medicine or by infection with HIV).

* Children and teenagers on long-term aspirin therapy who could develop Reye's syndrome after the flu.

* Women who will be more than 3 months pregnant during flu season.

* Doctors, nurses, and other employees in hospitals and doctors' offices, including emergency response workers.

* Employees of nursing homes and long-term care facilities who have contact with patients.

* People who provide home care to those in any high-risk group.

* Household members (including children) of those in any high-risk group.

Anyone who previously developed Guillain-Barre syndrome within 6 weeks of getting a flu shot should not receive another. The vaccine is also contraindicated in anyone with an allergy to eggs.

Dr. Gerberding stressed the importance of the vaccine for health care workers. Immunization not only helps prevent personal illness in this group, but also lessens the likelihood of them spreading it to their families and communities.

"We know from past experience that immunization rates in health care workers are not optimal," she said. "Less than 50% receive the vaccine. It's not just a good idea, it's a responsibility for them to provide that extra protection for themselves and their families and patients."

Since immunity takes about 2 weeks to develop, "Right now is the best time to get a flu shot," Dr. Gerberding said. "We encourage people to get the shot all through the flu season, but the sooner, the better."

There have been no reports of severe acute respiratory syndrome (SARS) here or anywhere else in the world. Unless that changes, physicians should assume that influenza viruses are the cause of any flulike illnesses they treat.
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Title Annotation:Infectious Diseases
Author:Sullivan, Michele G.
Publication:Internal Medicine News
Date:Dec 15, 2003
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