Flu clin­ics re­tool to of­fer more in­jec­tions to chil­dren

Nasal spray vac­cine found in­ef­fec­tive, set­ting off a scram­ble to set up shots

Baltimore Sun - - FRONT PAGE - By Mered­ith Cohn

Fall has ar­rived — and with it the flu sea­son and those per­sis­tent re­minders from school, work and else­where to get vac­ci­nated.

But pro­tect­ing chil­dren from the flu this year will be a bit more painful. The FluMist nasal spray ver­sion of the vac­cine pop­u­lar with nee­dle-averse kids, and their par­ents, is no longer avail­able.

A task force ad­vis­ing the U.S. Cen­ters for Dis­ease Con­trol and Pre­ven­tion rec­om­mend­edear­lier this year that peo­ple not use it af­ter stud­ies found it in­ef­fec­tive. Schools, health de­part­ments, drug­stores and doc­tors’ of­fices are now stock­ing up on the in­jectable flu vac­cine. School flu clin­ics are be­ing re­tooled for the more time-con­sum­ing, angst-pro­duc­ing shots. And wor­ried par­ents may­bring their chil­dren to doc­tors’ of­fices so they can be there for them.

Paige Matthews cried a bit when she got pricked by the nee­dle this week at MedS­tar Union Memo­rial Hos­pi­tal but soon for­got about the flu shot, said Sharon Robin­son, her grand­mother.

“It’s very im­por­tant to get a flu shot so you won’t get the flu,” said Robin­son, who brought Paige in and lives with the girl and her mother in North­east Bal­ti­more. “Now that she’s in school, the kids are al­ways sick. They’re al­ways touch­ing and shar­ing.”

While in­fluenza vac­ci­na­tion isn’t re­quired by schools in Mary­land, pub­lic health of­fi­cials and doc­tors still ex­pect students, who are good at spread­ing the flu

“I don’t want to see peo­ple’s kids in the hos­pi­tal with se­vere in­fluenza.”

bug, to get vac­ci­nated against the nasty virus that sick­ens mil­lions across the coun­try ev­ery year from early Oc­to­ber to late May.

Chil­dren are par­tic­u­larly vul­ner­a­ble be­cause of their fre­quent and close in­ter­ac­tions at school, said Dr. Howard Haft, the state’s deputy sec­re­tary for pub­lic health ser­vices.

“It is im­por­tant for par­ents to make sure they get their chil­dren vac­ci­nated against the flu, a virus that can be trans­mit­ted through the air and by ca­sual con­tact and that still can prove fa­tal,” he said. Although the no-muss, no-fuss nasal spray typ­i­cally made up just 8 per­cent of the na­tion’s to­tal vac­cine stocks, about a third of chil­dren older than 2 were get­ting it, ac­cord­ing to the CDC. Nonethe­less, Dr. Tom Frieden, direc­tor of the CDC, said there should be an am­ple sup­ply of in­jectable vac­cine since about 93 mil­lion doses al­ready have been shipped, with a to­tal of 168 mil­lion ex­pected.

Last sea­son, only 46.6 per­cent of the U.S. pop­u­la­tion got in­oc­u­lated, the CDC found. Frieden urged ev­ery­one to get vac­ci­nated by the end of Oc­to­ber, es­pe­cially chil­dren and se­niors, who have the high­est rates of flu com­pli­ca­tions.

Be­cause there is no nasal spray, two county school sys­tems — Anne Arun­del and Har­ford — ei­ther won’t of­fer in-school flu clin­ics this school year or could sig­nif­i­cantly scale them back.

In Anne Arun­del, the county health depart­ment is work­ing with schools to de­ter­mine how best to of­fer free vac­ci­na­tions to students. It’s con­sid­er­ing evening and week­end clin­ics for pub­lic- or pri­vateschool students at com­mu­nity health cen­ters and some schools. The Har­ford County Health Depart­ment, mean­while, is rec­om­mend­ing that par­ents take their chil­dren to their doc­tor’s of­fice or go to one of a few county clin­ics for students that will be held on evenings and week­ends.

The shots take longer to ad­min­is­ter than the nasal spray, eat­ing into the school day and staff time, and some par­ents might not want their chil­dren to face a nee­dle with­out them, said Tif­fany Tate, ex­ec­u­tive direc­tor of the Mary­land Part­ner­ship for Pre­ven­tion, a non­profit that works on school im­mu­niza­tion pro­grams.

About 100,000 students in Mary­land — a quar­ter of those in ele­men­tary school — nor­mally are vac­ci­nated with the nasal spray in school clin­ics ev­ery fall. State health depart­ment of­fi­cials said Wed­nes­day that 19 Mary­land lo­cal­i­ties re­sponded to a depart­ment sur­vey that found 68 per­cent planned to hold school-based clin­ics.

Tate said she didn’t ex­pect par­ents to aban­don the vac­cine this year be­cause there is no nasal spray.

“Par­ents are ed­u­cated about this and know the vac­cine is im­por­tant,” Tate said. Soren Jensen, 9 months, is ex­am­ined by Dr. Laura Brook­shire this week af­ter get­ting his first flu vac­ci­na­tion shot at MedS­tar Med­i­cal Group at North Parkville. “They un­der­stand that an in­jec­tion may be a lit­tle less com­fort­able, but they are com­mit­ted.”

Abi­gail Bozarth, a spokes­woman for As­traZeneca, par­ent com­pany of the Gaithersburg-based FluMist maker MedIm­mune, said the com­pany con­tin­ues to in­ves­ti­gate prob­lems with the nasal spray, with the goal of re­turn­ing with a new spray vac­cine for­mu­la­tion next year.

Mean­while, other lo­cal­i­ties do plan to of­fer in­jec­tions to students in school clin­ics. Howard County will of­fer shots to all ele­men­tary and mid­dle-school students start­ing Oct. 18; Bal­ti­more County ex­pects to of­fer clin­ics at schools with large num­bers of students from low-in­come fam­i­lies, pos­si­bly be­gin­ning in late Oc­to­ber; Car­roll County plans to give in­jectable vac­cines to ele­men­tary and mid­dle school students in Oc­to­ber, Novem­ber, and De­cem­ber; and Bal­ti­more City also ex­pects to of­fer clin­ics in schools, ac­cord­ing to Tate.

Schools that plan in-house clin­ics an­tic­i­pate send­ing no­tices home soon with dates and con­sent forms.

Veron­ica Jensen of Parkville al­ready took her 11-year-old and 6-month-old boys to their doc­tor at MedS­tar Med­i­cal Group at North Parkville for flu shots.

She didn’t much care which ver­sion of the vac­cine her older son, Valen­tine, re­ceived. Baby Soren wasn’t old enough for FluMist even if it had been avail­able; it was

Dr. Aaron Mil­stone, Johns Hop­kins Hos­pi­tal

rec­om­mended only for chil­dren 2 and older.

“My fam­ily has a his­tory of ill­ness, res­pi­ra­tory ill­ness, and once when I got the flu I ended up in the hos­pi­tal,” Jensen said just be­fore a med­i­cal as­sis­tant, Teresa Schroyer, gave Soren his shot, which the smil­ing baby didn’t seem to no­tice. “I don’t want them to go through that. And I don’t want other kids to get sick be­cause my kids aren’t vac­ci­nated.”

Jensen said she was wor­ried other par­ents would skip flu vac­ci­na­tion be­cause there was no nasal spray or be­cause school clin­ics were can­celed.

Ev­ery­one in Heidi Whit­ing’s fam­ily will be vac­ci­nated this year, in­clud­ing her 14-year-old daugh­ter, Aniyah Clark, who got a shot Wed­nes­day from the fam­ily doc­tor in West­min­ster. Whit­ing works in the in­ten­sive care unit at MedS­tar Union Memo­rial Hos­pi­tal and sees pneu­mo­nia cases ev­ery year, some of them the re­sult of com­pli­ca­tions from the flu.

She prefers the in­jec­tion to the FluMist, which was made from a weak­ened live virus and could not be used by some pa­tients, in­clud­ing those with weak­ened im­mune sys­tems or asthma.

“Flu can be very se­ri­ous,” Whit­ing said. “Vac­ci­na­tion is good to help stop spread of com­mu­ni­ca­ble dis­ease. It’s keep­ing us healthy.”

The CDC rec­om­mends ev­ery­one 6 months and older be vac­ci­nated, though flu vac­cines aren’t uni­ver­sally ef­fec­tive even when they are well matched to cir­cu­lat­ing strains. Two sea­sons ago the vac­cine and strains weren’t well matched. The dom­i­nant strain in the United States mu­tated a bit af­ter it was in­cluded in the vac­cine, giv­ing the vac­cine far less punch. Sev­eral years ago a new strain, H1N1, popped up and re­quired man­u­fac­tur­ers to make a new vac­cine af­ter the sea­son started.

A man­u­fac­tur­ing prob­lem last year with FluMist led to de­lays and can­cel­la­tions of in-school clin­ics and a scram­ble among par­ents to get the nasal spray for their chil­dren in re­tail set­tings.

CDC of­fi­cials say it’s too early in the sea­son to know if this year’s vac­ci­na­tion for­mu­la­tions of three or four flu strains will match those cir­cu­lat­ing, but they and doc­tors say that vac­cines are the best pro­tec­tion against in­fec­tion. An an­nual dose can lessen symp­toms, even if it doesn’t pre­vent sick­ness.

Dr. Aaron Mil­stone, a pe­di­atric in­fec­tious-dis­ease physi­cian at Johns Hop­kins Hos­pi­tal, said there have not yet been lo­cally trans­mit­ted cases of flu at the hos­pi­tal. But he said Hop­kins treated hun­dreds of peo­ple, in­clud­ing young, healthy peo­ple, for com­pli­ca­tions from the flu last year, and some died.

About 20,000 chil­dren un­der age 5 are hos­pi­tal­ized with flu-re­lated com­pli­ca­tions ev­ery year, said Dr. Pa­tri­cia Whit­leyWil­liams, di­vi­sion chief and pro­fes­sor of pe­di­atrics at the Robert Wood John­son Med­i­cal School at Rut­gers Uni­ver­sity. About 90 per­cent were not vac­ci­nated.

“I ask par­ents why they would put their child at risk” by not vac­ci­nat­ing them, said Whit­ley-Wil­liams, who also spoke at the CDC press event. “Cer­tainly no car­ing par­ent would get into car and not belt their kids in. ... This pro­tects your oth­er­wise healthy child.”

Mil­stone hopes the lack of FluMist won’t de­ter par­ents from vac­ci­nat­ing their kids. Chil­dren han­dle flu shots and all kinds of other shots well, he said.

Other pre­cau­tions are im­por­tant, Mil­stone said, such as fre­quent hand-wash­ing and sneez­ing into your el­bow. But vac­ci­na­tion “needs to be a pri­or­ity,” he said.

“The vac­cine is im­por­tant and it does save lives,” he said. “I don’t want to see peo­ple’s kids in the hos­pi­tal with se­vere in­fluenza.”

AL­GE­RINA PERNA/BAL­TI­MORE SUN

Paige Matthews gets a flu shot this week from Kar­malla John­son, med­i­cal as­sis­tant at MedS­tar Union Memo­rial Hos­pi­tal. Hold­ing Paige is her grand­mother, Sharon Robin­son, who lives with Paige and her mother and said Paige soon for­got about the shot.

KEN­NETH K. LAM/BAL­TI­MORE SUN

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