Rural areas at risk for flu

Summerville --- The start of flu season has been a cause for celebration in Chattooga County for years.

"Each year, we have people lining up for the first two or three days of flu season to get their shots," said Chattooga Health Department nurse manager Mitzi Smith. "They were always happy, some were seeing people they hadn't seen since last flu season, and it was a very positive atmosphere."

There was no flu shot celebration in Summerville this fall. Nor in any of the other North Georgia counties.

As bad as the shortage of flu vaccines is in the metropolitan areas of the state, the northern rural areas are suffering even more. Most of the rural counties in the northern half of the state ordered vaccine supplies from Chiron Corp. of England, which marketed its vaccine slightly cheaper than that made by Aventis Pasteur, the other major manufacturer of flu shots. The 46 million doses manufactured by Chiron were impounded because of contamination, cutting roughly in half the supplies headed for the United States.

In Georgia, the 29 northernmost counties, which run from the Alabama line across to the South Carolina line, ordered 81,900 shots. They received 11,340, or less than 14 percent of enough to cover the need. Several North Georgia counties received no flu vaccine at all.

Health department officials in the northern counties said people are calling by the hundreds begging for the shots or to be put on a waiting list for when more shots arrive.

There is no list. As far as anyone can tell, no more doses are on the way.

"We started [a list]," said Malindy Ely, the Polk County nurse manager for the county health office in Cedartown, "but it got overwhelming. We had five legal pad pages filled up before lunch the first day. We simply don't have the manpower to maintain a list."

Ely said that while approximately 300 people usually call or come through her offices weekly, she had more than 150 calls or visits in three hours when word came down that there was no more flu vaccine.

Smith said her office had taken more than 500 names when she realized the futility of it. "We called all of the people back and told them there would be no flu shots available."

"We've asked the counties in our division not to put people on a list," said Gayle Brannon, the director of Public Health Nursing and Clinical Services in the Northwest Georgia Division of the state Department of Public Health, which encompasses 10 counties. "If you maintain a list, it gives them false hope." South Georgia's status

In South Georgia, things were somewhat better because more counties and hospitals ordered from Aventis. For example, Roger Naylor, a spokesman for the Southeastern Division in Waycross, said his division received all of the 26,000 doses ordered. "We obviously ordered only from Aventis," he said. "We started giving the shots Oct. 1, and now we're out."

The South Division in Valdosta initially got none of its 7,500-shot order, but has since received 5,000 through redistribution. "We gave 801 shots yesterday at a clinic in two hours and 32 minutes," said Jennifer Steedley in the Valdosta office.

But there were problems nonetheless. Carla Belcher, CEO of Community Health Care Systems based in Wrightsville, operates three clinics. She ordered 700 shots from Chiron, but only got 40 shots for children through a Medicaid vaccine program. "We're making a list hoping we get more down the road," she said. "People are frustrated they can't get a flu shot. It makes you see how fragile the health care system is. We already had a physician who had the flu. He had it for a week and developed pneumonia after that."

In North Georgia, the major worries included nursing home patients and people with ongoing medical conditions.

"Nursing homes are my personal priority," Ely said. "They're a captive audience and can't control their environment. The chronically ill are used to getting their shots from us. We're part of their routine."

"We have no shots for our nursing homes," Smith of Chattooga County said. "We need to get shots for the nursing home attendants, too. I just hope we get enough to take care of them." No consistency

Fred Watson, president of the Georgia Nursing Home Association, said that most nursing homes in the state don't have flu vaccine. "We've been told that nursing homes are on the high-priority list,'' he said. "We're hopeful we're going to get it.''

Hospitals aren't faring much better, said Jimmy Lewis, CEO of HomeTown Health, an association of rural hospitals in Georgia. He said that there's no consistency in vaccine distribution.

"It's a function of who was tied to Aventis in buying vaccine and who was tied to Chiron,'' Lewis said.

Margaret Bean, program manager for the Northwest Division of the health department in Rome, shakes her head. "I've been in health care for 32 years, and I've never seen anything like this."

Rural health officials across the country are struggling with the same problems that North Georgia faces. At a meeting in Atlanta last week of a group that advises the Centers for Disease Control and Prevention on vaccination policy, the head of a small health district in southwestern Virginia related reports from colleagues nationwide.

"We are dealing with whether or not our nursing home patients are a higher priority than patients in the community with chronic disease," said Dr. Jody Hershey, who is also former president of the National Association of City and County Health Officials. Patchwork system

If nothing else, the flu vaccine shortage has pointed out that sweeping changes need to be made in the procedure for ordering vaccine in Georgia.

The Georgia Department of Public Health is organized into 19 divisions across the state. Each county places its own order for vaccines, sometimes through the district office, but usually independent of other counties. There is no central ordering and very little communication between counties.

"That's the frustrating thing," said Logan Boss, spokesperson for the Northwest Division. "Each division orders independently. I can't tell you who has ordered what outside our district."

To further complicate matters, several county health departments sent out news releases announcing flu vaccine clinics before they became aware of the shortage and had to explain to numerous potential customers that they had no serum.

Boss says his 10-county division is not accepting new appointments or walk-ins for flu shots. "We need to communicate to the public that the county health departments are not hoarding flu shots," said Boss. "We are working with the CDC, the Georgia Department of Public Health and the private sector to see that whatever flu shots which may become available go only to people identified as being at high risk." --- Staff writers Andy Miller and M.A.J. McKenna contributed to this article.

Copyright 2004 The Atlanta Journal-Constitution